Why does it take so long to get Medicare when you qualify for disability? For most people, it will take about 2 years to file, be declined a few times, appeal, appeal and finally get approved for Social Security Disability Benefits (SSDI). After that long slog to approval, many people are shocked to find out they don’t qualify for much. There is no set SSDI benefit. If you’ve worked and paid into the Social Security system long enough to qualify, you will get a monthly payment based on how much you paid in. Don’t guess. You can set up a free account at www.ssa.gov today and see how much the government estimates you will be paid if you are disabled, or retire.

The average disability payment is $800 – $1000 per month. If you are married, there is no limit to your partner’s income.  But if you live lone, it’s very hard to survive off SSDI alone. Many people inquire about some part time work, but the SSA limits the amount you can earn to $1,350 per month in gross income (the blind are allowed more.) Don’t go over your monthly earning’s limit or you will lose your hard-won SSDI.


You may be again shocked to learn that your access to Medicare won’t start for 2 years. This makes no sense. The government determined you are unable to work, so why does it take so long to qualify for healthcare? The answer is pure politics. 


History of Social Security Disability


Eighty years ago when FDR signed Social Security into law, it had no provision for the disabled. It took decades to enact legislation to allow disabled workers to tap into their Social Security retirement early. In the 1970s when this provision was advanced, the Republicans pushed back on the cost. To compromise and get the law passed, it was agreed that Medicare benefits would not start for 2 years. 


Now there are some conditions that are so severe that they qualify for Medicare immediately. Others qualify in a few months, but the vast majority of disabled have this two-year waiting period to contend with. They may qualify for Medicaid if their income and assets are low enough. Indiana is one of the hardest states to qualify for Medicaid. If they earn too much, they can get ACA. There are some subsidies for ACA, again based on income, but many people still can’t afford the ACA. 


Ready to be Shocked?


At the two-year mark from when your SSDI payments began, you will likely again be shocked that you have to pay for Medicare Part B. My clients tend to assume it will be free…because they can’t work.  Some people are on their spouses work insurance and don’t realize that Medicare began automatically. The Medicare Part B cost will be taken out of your disability payment.  For those who don’t need Medicare, they must file to stop it. For those that need Medicare, they are again—I think you know I’m going to say SHOCKED—that they can’t get the Medicare Supplement plan they want.


What to Watch Out For in the Future: the Golden Nugget


Most states don’t require insurance companies to sell all plans to those under age 65 on Medicare due to disability.  Florida does! Most states do not. Indiana doesn’t allow the disabled to purchase a Medicare Supplement Plan G until your 65th birthday. Those on SSDI in Indiana will typically purchase a private Medicare Advantage plan. Here is the golden nugget of information if you or someone you know is on SSDI: at age 65 you are eligible for a Medicare Supplement plan from any company, regardless of your health. Even if you have been on Medicare for years, you get a new entry into Medicare just like everyone else that is just turning age 65. Even if you are very ill.


Unfortunately, many people call the insurance companies to apply for a Medicare Plan G when they are under age 65. They are told the don’t qualify. They don’t realize that in the future they will be eligible for a seven-month window and if they don’t take advantage of that time to enroll, they will likely never be able to purchase a Medicare Supplement plan. Given that those on SSDI have health conditions, they are often better off on a traditional Medicare Supplement Plan. Especially if you are on kidney dialysis, you will save a lot being on a Plan G vs a PPO or HMO plan. The time to explore your Medicare options is typically in the 21st month after starting SSDI benefits. That gives you time to make a decision before your Medicare Part B kicks in at your 2 year mark.


Sylvia Gordon and her sister, Rebecca, run Gordon Marketing, one of the nation’s largest Medicare FMO/NMA offices. They have a team of over 100 that train and support independent insurance agents in all 50 states. You can find Sylvia’s weekly posts on LinkedIn and the sisters' Youtube channel posts 2 training videos each week. Contact Sylvia at sgordon@gordonmarketing.com or 800-388-8342.


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