What Insurance Do You Get With Social Security Disability?

Few subjects dominate the government policy discussion as much as the availability of affordable health insurance. It is a central concern for virtually every American, whether they are working and healthy or disabled due to an injury or illness. When someone becomes disabled and files for Social Security Disability Insurance (SSDI or SSD), or Supplemental Security Income (SSI), they need to know what type of health insurance they will have access to as a disability benefits recipient.

The answer depends on which of the federal Social Security disability programs is involved. The Social Security Administration (SSA) oversees two programs designed to provide some financial support to people in these situations: Social Security Disability Insurance (SSD or SSDI) and Supplemental Security Income (SSI).

While both programs use the same standard to determine what qualifies as a disability, the two programs differ significantly in every other aspect. One of the central differences is what insurance coverage is provided with disability benefits and when that insurance coverage begins.

When you need to be sure you are getting accurate and complete information about disability benefits, contact a disability law firm with experience. Our disability law team know all the complexities of the various disability programs. We want our clients to understand exactly what benefits are available to them when they suffer a disabling injury or illness. Benefit payment amounts, eligibility requirements, and health insurance coverage are tremendously important subjects when you suffer a disability.

Two Federal Disability Programs – Very Different Health Insurance Coverage

The Social Security Disability (SSD) program and the Supplemental Security Income (SSI) are often confused with one another by those unfamiliar with the programs. But they are actually very different programs.

The SSD program pays monthly benefits only to people who qualify because they worked a sufficient number of years and contributed payroll taxes before becoming too disabled to work. The SSI program, on the other hand, is a needs-based program that provides financial benefits to disabled people with low income and minimal resources, regardless of whether they ever worked or paid taxes.

There are three major differences between the SSDI and SSI programs:

• SSI: lower income eligibility limit, lower monthly benefit payments, immediate Medicaid coverage
• SSDI: higher income eligibility limit, benefits proportionate to income, 2 year waiting period for Medicare coverage.

SSI benefit recipients get immediate Medicaid Insurance coverage.

However, those who receive SSD benefits get Medicare Insurance coverage only after two years from the date their benefit payments began.

Remember, though, there is a five-month waiting period between the disability onset date and the beginning of benefit payments. That means the actual Medicare waiting period works out to 29 months.

The Two-Year Medicare Waiting Period for Social Security Disability

The Social Security Disability Insurance (SSDI or SSD) program’s two-year waiting period before Medicare coverage begins is a source of great controversy. Many advocates condemn the long waiting period as unnecessary and inconsistent with the purpose of a program that is named “Social Security Disability Insurance.”

Why Is There a Two-Year Wait for Medicare?

The reason cited to justify the long 24-month waiting period before an SSD benefits recipient gets Medicare coverage has several prongs:

• 2-year Medicare waiting period ensures only truly long-term disabilities are covered,
• any proposed shorter Medicare waiting period would deplete Medicare’s funds too quickly,
• alternate sources of health insurance coverage are available to most SSD recipients during the waiting period.

Are these valid arguments justifying a 2-year wait for Medicare?

• Is the arbitrary selection of 2 years to qualify for Medicare on SSD logical? Social Security eligibility rules provide that all SSD applicants whose disability last for 12 months qualify for monthly payment benefits. If a person only needs to be disabled for 12 months to be eligible for SSDI or SSI benefits, it seems unfairly illogical to then require 2 years before the claimant obtains Medicare?
• Medicare is paid from money in two trust funds; one is financed by payroll taxes of employees and employers, by income taxes on Social Security benefits, by returns on the fund’s investments, and by Medicare Part A premiums. The second trust fund is financed by Congress, by Medicare Part B and D premiums, and by return on investments. Given these funding sources, Medicare may be more self-sustaining than some argue. Would the additional Medicare cost to cover SSD beneficiaries who have no other coverage and who have been disabled for a year or more truly bankrupt the trust funds?
• Many SSD recipients might have alternate sources of healthcare insurance, especially since many disabilities arose from work-related injuries and illnesses, enabling them to receive worker’s compensation. But non-work-related medical costs are not covered, nor are family members healthcare expenses.
• While waiting for Medicare coverage, some SSDI recipients may be required to complete intervention programs, such as the IDIP program, which can have additional costs and time commitments.

Key’s to Dealing with the Long Medicare Waiting Period

Any SSD claimant who must wait for the full 24 months for Medicare (plus the 5-month benefit waiting period) may have options. Many states administer their own healthcare assistance programs and have expanded Medicaid eligibility to cover more people.

The best and most experienced disability lawyers know that they can shorten the real waiting time for Medicare coverage by fighting to establish your earliest possible “disability onset date,” the date recognized by SSD as when your disability began.

For more information about SSDI’s healthcare insurance coverage, contact our office today.