February Question of the Month

February 8, 2016

Do you automatically get Medicare benefits if you are approved for Social Security disability benefits?

Everyone who is approved for Social Security Disability Insurance (SSDI) benefits is also entitled to Medicare, but the Social Security Administration requires a 24-month waiting period before Medicare begins. SSDI is the disability benefit based on a person’s wage record, not the need-based disability benefit known as “SSI.” After you have received Social Security disability benefits under SSDI for 24 months, the Social Security Administration will automatically enroll you in Medicare. They start counting the 24 months from the first month in which you are entitled to receive disability cash benefits. There is a five-month waiting period after the established disability onset date before those cash benefits kick in.

A premium is charged by the Social Security Administration for Medicare. This amount is $121 per month in 2016. In certain cases, the State of Illinois will reimburse a Social Security Disability recipient for the Medicare premium, but this must be requested through the Illinois Department of Human Services. If you prefer not to receive Medicare and not to pay the premium, you may waive it.

There are a few exceptions to the 24-month qualifying period. For example, individuals with amyotrophic lateral sclerosis (Lou Gehrig’s disease) and chronic renal disease with dialysis may be able to get Medicare earlier. However, in most cases, the waiting period applies.

During the waiting period for Medicare, you may be eligible for health insurance through a former employer or you may be able to get Illinois Medicaid benefits. If you are between 18 and 65, and earn less than 133% of the federal poverty line, you may qualify for Medicaid in Illinois. For more information on obtaining health insurance, you can visit getcovered.illinois.gov.

Those who are eligible for Supplemental Security Income (SSI) benefits in Illinois (and 31 other states and the District of Columbia) are also eligible for Medicaid, which is a jointly funded, federal-state health insurance program for low-income and needy people. Medicaid eligibility starts the same month as SSI eligibility. Because Illinois (and several other states) use their own eligibility rules for Medicaid, which are different from SSA`s SSI rules, a separate application for Medicaid must be filed with the Illinois Department of Human Services. Generally, however, if you qualify for SSI with the Social Security Administration, and provide proof of that, you will qualify for Medicaid.