People under the age of 65 who get certain benefits may have a 2-year waiting period before they can get Medicare benefits. However, Medicare may waive this waiting period under some conditions.
In 1973, Medicare extended healthcare coverage to people under the age of 65 if they receive Social Security Disability Insurance (SSDI) benefits due to having a chronic illness or disability.
This article looks at the Medicare waiting period, when Medicare may waive this waiting period, and other coverage options.
We may use a few terms in this piece that can be helpful to understand when selecting the best insurance plan:
- Deductible: This is an annual amount that a person must spend out of pocket within a certain time period before an insurer starts to fund their treatments.
- Coinsurance: This is a percentage of a treatment cost that a person will need to self-fund. For Medicare Part B, this comes to 20%.
- Copayment: This is a fixed dollar amount that an insured person pays when receiving certain treatments. For Medicare, this usually applies to prescription drugs.
The Medicare waiting period lasts for 2 years and applies to people who receive SSDI benefits. It does not apply to those aged 65 or older.
When the Social Security Administration (SSA) approve SSDI benefits for someone under the age of 65, the person must wait for 2 years to receive Medicare benefits.
Typically, eligible people can first enroll in Medicare 3 months before their 65th birthday. If someone with SSDI benefits turns 65 during the 2-year Medicare waiting period, their Medicare benefits begin at that point.
If someone has received SSDI benefits for 24 months, Medicare will extend healthcare benefits to them regardless of their age.
To qualify for SSDI benefits, an individual must have worked in a job that Social Security covers. They must also have a medical condition that meets the SSA disability definition and be unable to work for a year or more.
The Medicare waiting period starts after the SSA approve an application. A qualifying individual receives their Medicare cards for Medicare Part A (hospital insurance) and Medicare Part B (medical insurance) in the 22nd month of the waiting period. Medicare coverage will start during the 25th month.
Although most people with SSDI benefits have to wait for 2 years before their Medicare coverage begins, there are certain exceptions.
For example, if someone has end stage renal disease (ESRD) or amyotrophic lateral sclerosis (ALS), Medicare waives the waiting period so that the person can get their healthcare benefits sooner.
Waiver for people with ESRD
When someone has chronic kidney disease, the renal system can fail, leading to ESRD.
ESRD is a serious health condition that requires dialysis or kidney transplant surgery. Without treatment, the kidneys do not function well enough to maintain health.
People with ESRD do not need to wait for 2 years before Medicare coverage begins. The waiting period is shorter, and Medicare begins on the first day of the fourth month of the person’s dialysis treatment.
Medicare coverage may start up to a year before someone applies. Medicare calls this retroactive coverage. For example, if someone starts dialysis in a clinic on November 1 and they delay signing up for Medicare until the following June, Medicare backdates their coverage to February 1.
Medicare coverage could begin in the first month of dialysis for people who complete a Medicare-approved training program for at-home dialysis treatment.
People should note that those with ESRD cannot enroll in a Medicare Advantage plan. Instead, they must receive their healthcare benefits through original Medicare.
Waiver for people with ALS
ALS is a chronic health condition. Doctors may also call the condition motor neuron disease or Lou Gehrig’s disease.
When someone has ALS, the neurons controlling voluntary muscle movement break down. This leads to a loss of muscle control. Currently, there is no treatment to halt ALS, and there is no cure.
The average life expectancy for someone with ALS is 2–5 years from diagnosis. People with ALS need medication and supportive care. For these reasons, Medicare waives the 2-year waiting period.
If someone has ALS, Medicare allows them to enroll in the first month the SSA approve them for SSDI benefits.
Some people may not feel comfortable living without healthcare coverage during the 2-year waiting period.
However, there are alternatives. The sections below will look at these in more detail.
If someone has a low income, they may qualify for Medicaid. People under 65 may also be eligible for Medicaid on the basis of disability.
A person can apply for Medicaid on the government website by using this tool to create an account or by applying to their state Medicaid agency.
The Consolidated Omnibus Budget Reconciliation Act (COBRA) is a law that allows certain employees and their families to keep their group healthcare coverage after they leave their employment.
People can keep the coverage for 18–36 months, but they must pay the full cost of the premium, including the portion the employer used to pay.
Health Insurance Marketplace
The federal government manages the Health Insurance Marketplace, where people can enroll in an affordable private health plan.
People can access this service through the website HealthCare.gov, where they can also check plans, costs, and local contacts.
People who receive SSDI benefits have to pay for Medicare. There are premiums, deductibles, and copayments, though people may be able to find help with these costs.
An individual has to pay a premium for Medicare Part A if Social Security do not fully insure them. Typically, someone must work for 40 quarters or 10 years in a job paying Federal Insurance Contributions Act taxes for Social Security to fully insure them.
If someone does not have enough work credits, in 2021, they need to pay a premium of $471 per month. If they have 30–39 credits, the premium is $259.
People must also pay the first $1,484 in costs as the deductible before Medicare will contribute.
For most people, the 2021 Part B premium is $148.50 each month. Those with higher incomes could pay more. The Part B deductible in 2021 is $203.
Part D premiums vary by plan. The maximum Part D deductible in 2021 is $445. There are subsidies called Extra Help that can help people with a low income pay for their Part D coverage.
People who receive SSDI benefits and are under the age of 65 can benefit from Medicare. However, there is a 2-year waiting period for most people before their healthcare coverage begins.
Medicare waives the waiting period for those who have ESRD or ALS.
People can find alternative healthcare coverage during the waiting period through Medicaid, COBRA, or the Health Insurance Marketplace.