Medicare is not only a health insurance program for people 65 and older, it is also health insurance for some disabled individuals. If awarded Social Security Disability Insurance (SSDI) benefits, you are eligible for Medicare after a 24-month waiting period, which begins the date you first become eligible to receive social security disability benefits.

Understanding The Medicare Waiting Period

The 24-month waiting period can be confusing because there is also a 5 month waiting period between the date an individual is determined disabled and the date that individual begins receiving SSDI benefits.  Therefore, an individual who is found disabled could wait as long as 29 months before being entitled to Medicare benefits.

For example*, imagine you applied for disability benefits in February of 2012, after your doctor said you wouldn’t be able to go back to work. Then, assume the SSA found you disabled, with an onset date of January 1, 2012 – that would be the day the 29 month waiting period would begin. The first 5 months would be the initial waiting period for disability benefits. Therefore, the date you would be eligible to receive disability benefits would be June 1, 2012. The following 24 months would be the waiting period for Medicare. Therefore, on June 1, 2014 you would be eligible for Medicare coverage.

Keep in mind, your application date has a large effect on your back due disability benefits, and can also affect when the 29 month clock starts ticking. So, continuing the example, imagine that you didn’t actually apply until January 1, 2015. In that situation your disability benefits wouldn’t start until January 1, 2014 (because of the way retroactive benefits are calculated) and that’s when the 24-month waiting period would be begin. You only have to count 24 months in this situation, because the first 5-month waiting period would have happened right after your onset date, back in 2012. So, if you applied on January 1, 2015, your “29 month” waiting period would actually be 24 months starting in January of 2014 and ending in January 2016, and that’s when you’d be eligible for Medicare benefits.


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Two Notable Exceptions

Two notable exceptions to the 24 month waiting period are cases involving End-Stage Renal Disease (ESRD), which affects the kidneys, and Amyotrophic Lateral Sclerosis (ALS, also known as Lou Gehrig’s Disease). In ESRD cases, Medicare begins in the 4th month of dialysis, or sooner in certain rare & specific situations. In ALS cases, Medicare begins with SSDI benefit eligibility.

Which Parts of Medicare Coverage Are Involved?

While Medicare is a multi-part program, disabled individuals are eligible for hospital insurance (Part A) and medical insurance (Part B). Due to the length of time it can take to be awarded disability benefits, some people will be eligible for Medicare and receive their back due disability benefits at the same time. Please consult our claims representatives for more information on SSDI and Medicare eligibility.

*Please note that this example is meant to be illustrative of the process, not a precise representation of a real case; in a real-life situation the exact dates may be different.

About Citizens Disability, LLC:

Since 2010, Citizens Disability has been America’s premier Social Security Disability institution. Our services include helping people in applying for SSDI benefits, managing the process through Reconsideration, and representing people in person at their Hearing, and if necessary, bringing their case to the Appeals Council. Our mission is to give a voice to the millions of Americans who are disabled and unable to work, helping them receive the Social Security Disability benefits to which they may be entitled. Learn more about us and disability benefits like SSDI & SSI or give us a call (800)492-3260.