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Does Being Approved for SSD Also Come with Medical Benefits and When Do Those Benefits Start?

Given our country’s system of private health insurance, health insurance is a particular concern for many of those who have a medical condition that qualifies for Social Security Disability (“SSD”). Most individuals who have health insurance in the United States either obtain it through an employer or a spouse’s employer or purchase coverage either through an exchange or directly from an insurer. However, if someone is disabled and cannot work, then he or she is likely not in a position to have health insurance given that most people in the United States receive coverage through a health insurance plan offered by the person’s employer or else may not be able to afford coverage either directly from the insurer or through an exchange. Given the complexity of many of the illnesses that lead an individual to apply for SSD benefits in the first place, having insurance to help defray the costs of any healthcare associated with that disability and in particular how to pay for the often substantial medical needs that accompany such medical conditions is often a real concern for many SSD recipients.

However, being approved for SSD also comes with eligibility for Medicare, which is one of the major benefits of applying for and being approved for SSD for some applicants. Nevertheless, for virtually every medical condition, the receipt of Medicare by an SSD recipient is subject to a 24 month waiting period, meaning that it only becomes effective on the first day of the 25th month after an SSD applicant disability is determined to have become disabled and eligible for SSD benefits.

Medicare and the Receipt of SSD Benefits

The Medicare eligibility that accompanies the receipt of SSD benefits can often be just as important, if not more important, to an SSD recipient than monthly disability payments that come with being approved for SSD. There is a 24 month waiting period for most recipients before Medicare eligibility kicks in, but there are several narrow exceptions to this rule. If you are approved for SSD benefits for ALS, also known as Lou Gehrig’s disease, then you are automatically enrolled in Medicare your first month after being approved. For the vast majority of SSD recipients, the 24 month waiting period is determined not from when your application for benefits is approved, but from your disability onset date, which is five months from the date that SSD determines you first met the definition of disabled for SSD purposes. (There is a five-month waiting period to become eligible for benefits based on a disability, thus if you met the criteria on Day 1, your first day that you become eligible for SSD benefits would be five months after Day 1.) Thus, if your disability onset date is determined to have occurred sometime before you first are approved for benefits, this means that it may be less than 24 months from when your application is first approved until you are eligible for Medicare.

This is automatic, so it is not something that the SSD recipient has to mark his or her calendar in order to track this date and then fill out several forms in order to actually receive the Medicare medical benefits to which he or she is entitled. Several months prior to an SSD recipient becoming eligible for Medicare, he or she will receive a letter explaining when the person will become eligible for Medicare coverage and how much will be directly deducted from the recipient’s monthly SSD payments to pay the premium associated with Medicare. (Obtaining Medicare coverage through SSD is not free and comes with premiums, co-pays and deductibles in most cases).

Talk to The Experienced Social Security Disability Attorneys at Kalfus & Nachman

If you live in the Norfolk, Hampton, Newport News, Portsmouth, Virginia Beach or Roanoke, Virginia, areas and need assistance determining if you qualify for the SSD benefits, what your expected monthly benefit would be if you qualify for benefits, filing your SSD application, or filing an appeal, please contact Kalfus & Nachman PC by phone at (855) 880-8163 or through the form on this page to schedule a free consultation. Our experienced SSD attorneys can answer any and all questions you may have concerning the medical benefits you can expect to receive under Medicare if your SSD application is approved as well when you can expect to start receiving those benefits.

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