What Insurance Do You Get with Social Security Disability?
Suffering a disabling injury or illness that prevents you from earning enough income to support yourself and your family is a devastating experience. The Social Security Administration (SSA) oversees two programs designed to provide some financial support to people in these situations: Social Security Disability Insurance (SSD or SSDI) and Supplemental Security Income (SSI). While both programs do use some common standards to determine disability, the two programs differ significantly in other aspects. One of the central differences is what insurance coverage is provided with disability benefits and when that insurance coverage begins.
At the Social Security Disability Law Firm of Kathleen Day in Corpus Christi, Texas, we want all our clients and others in the South Texas community to understand exactly what benefits are available to them when they suffer a disabling injury or illness. Benefit payment amounts, eligibility requirements, and health insurance coverage are tremendously important subjects when you suffer a disability. Attorney Kathleen Day and her team specialize in getting you the maximum benefits for which you qualify.
Two Federal Disability Programs – Very Different Health Insurance Coverage
The Social Security Disability (SSD) program and the Supplemental Security Income (SSI) are sometimes confused for one another but are actually very different programs. The SSD program makes monthly benefit payments available only to people who worked a sufficiently long time and contributed payroll taxes before becoming too disabled to work. The SSI program is needs-based and provides payments to disabled people with low income and minimal resources, regardless of whether they worked or paid taxes.
Other than differences in benefit payment amounts and income eligibility, the most striking difference between the programs is that SSI benefit recipients get immediate Medicaid Insurance coverage. Those who win the approval of their SSD benefits claims get Medicare Insurance coverage only two years from the date their benefit payments began. Remember, though, there is a five-month waiting period between the disability onset date and the beginning of benefit payments. So the actual Medicare waiting period works out to 29 months.
The Two-Year Medicare Waiting Period for Social Security Disability
The Social Security Disability program’s two-year waiting period before Medicare covers their healthcare costs is a source of great controversy in and out of Congress. Many advocates condemn the long waiting period as unnecessary and inconsistent with the purpose of a program called “Social Security Disability Insurance.”
Why Is There a Two-Year Wait for Medicare?
The reason cited to justify the long 24-month waiting period before an SSD benefits recipient gets Medicare coverage has several prongs:
- 2-year Medicare waiting period ensures only truly long-term disabilities are covered,
- any proposed shorter Medicare waiting period would deplete Medicare’s funds too quickly,
- alternate sources of health insurance coverage is available to most SSD recipients during the waiting period.
Are these three justifications supported by evidence? Let’s examine the individually.
- The first argument for the long wait for Medicare coverage is based on the idea that only SSD claimants with genuinely long-term, permanent disabilities should have healthcare covered by government funds. However, Social Security eligibility rules provide that all SSD applicants whose disability last for 12 months qualify for monthly payment benefits. If 12 months is the measure to qualify for full disability benefits, why require an additional one-year wait for Medicare?
- Medicare is paid from money in two trust funds, one of which is financed by payroll taxes of employees and employers, by income taxes on Social Security benefits, by returns on the fund’s investments, and by Medicare Part A premiums. The second trust fund is financed by Congress, by Medicare Part B and D premiums, and by return on investments. Given these funding sources, Medicare may be more self-sustaining than some argue. Would the additional Medicare cost to cover SSD beneficiaries who have no other coverage and who have been disabled for a year or more truly bankrupt the trust funds?
- The final argument in favor of the long Medicare eligibility wait for SSD beneficiaries it that most of them have alternate sources of healthcare insurance. Since a substantial number of SSD claims arose from work-related injuries and illnesses, many SSD benefit recipients have work-injury related healthcare costs paid by worker’s compensation. But any non-work-related medical costs are not covered, nor are family members healthcare expenses.
Other SSD claimants’ medical costs will be paid by court judgments or settlements if their disability resulted from another party’s negligence. If the number of SSD claimants who have alternate sources of healthcare insurance is a large as the opponents of coverage claim, then the population of those whom Medicare would need to cover is even smaller. Fewer claimants needing earlier access to Medicare means less of a strain on the program’s finances.
Key’s to Dealing with the Long Medicare Waiting Period
Any SSD claimant who must wait for the full 24 months for Medica(plus the 5-month benefit waiting period) may have options. Many states administer their own healthcare assistance programs and expand Medicaid eligibility to cover more people. Your disability lawyer should strongly advocate for the earliest possible “disability onset date,” the date recognized by SSD as when your disability began.
Be aware that your disability onset date (DOD) can be as early as 12 months before your SSD claim was filed. If your DOD were set at 10 months before you filed your SSD benefits application, you would be eligible to receive payments beginning 5 months before your filing date. Your 24-month Medicare waiting period would then be completed 19 months after you filed for SSD benefits.