Although Social Security and Medicare are two separate programs overseen by two separate federal agencies, they are intertwined in key ways. Navigating the relationship can be complicated, but it mainly involves Social Security Disability Insurance (SSDI).
If you receive SSDI benefits, you automatically qualify for Medicare, according to the AARP — but it will probably take some time to capitalize on the benefit. Medicare is mainly available to seniors 65 and older, but you can also qualify at a younger age if you have a disability.
As the AARP noted, most SSDI recipients qualify for Medicare 24 months after they become eligible for disability benefits. The waiting period is waived for those with amyotrophic lateral sclerosis (ALS) or end-stage renal disease.
The waiting period was included in a 1972 Congressional bill that expanded Medicare to cover people with disabilities. The reason for the two-year delay was to help “mitigate the cost of adding those beneficiaries to the rolls,” according to the AARP. It also aimed to avoid replacing coverage some disabled workers would be able to get from their former employers through COBRA.
A couple things to keep in mind: The Social Security Administration counts each month in which you are entitled to receive an SSDI payment toward the 24-month Medicare qualifying period. In addition, there is a waiting period for SSDI payments to begin that lasts five calendar months after the month in which the SSA determines that your disability began. As the AARP noted, in most cases this means you become eligible for Medicare 29 months after what Social Security terms the “onset” of your disability.
Another thing to note is that if you have both SSDI and Medicare, you are considered covered under the healthcare law. In most case, you can’t enroll in an Obamacare Marketplace plan to replace or supplement your Medicare coverage if you have SSDI benefits. The exception is if you enrolled in a Marketplace plan before getting Medicare. In this case, you can keep your Marketplace plan as supplemental insurance when you enroll in Medicare. Just keep in mind that doing this means losing any premium tax credits and other savings for your Marketplace plan.
There might be ways to work around the 24-month waiting period in terms of Medicaid coverage. According to Healthcare.gov, if you get SSDI benefits and are in a 24-month waiting period, you could still get Medicaid coverage while you wait by doing the following:
- Create a Medicaid account or log in to complete an application. Answer “yes” when asked if you have a disability. Your application will be forwarded to your state Medicaid agency.
- Apply directly to your state Medicaid agency. You can select your state from the menu on this Medicaid page for contact information.
If you’re eligible for Medicaid, your Medicaid eligibility may continue even after you enroll in Medicare.
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