Question of the Month: If I am found disabled, do I qualify for Medicare?

January 4, 2019

If Social Security says you are eligible to receive disability insurance benefits, you will qualify for Medicare benefits. However, you must wait two years from your date of entitlement in order to receive them.

To know exactly when you can start receiving Medicare benefits, it is important to understand what “date of entitlement” means to the Social Security Administration (SSA). The date of entitlement is the first month in which you are eligible to receive cash benefits. The general rule is that you are eligible for cash benefits five full months after SSA finds that you became disabled. That is your “date of entitlement.” You are then eligible for Medicare two years after the date of entitlement.

An example will help to clarify SSA’s rules in this situation. If SSA decides that your disability began on June 1, your date of entitlement would not be until November of that year, due to the five-month waiting period. You would then be eligible to join Medicare two years from that November. As with many other SSA rules, there are always exceptions and caveats. First, while Medicare Part A is included, Medicare Part B deducts a premium from your monthly benefit check. Also, if you wait too long to apply for benefits, your date of entitlement may be later than in these examples.

It is important to note that Medicare only comes along with benefits paid on a person’s wage record (SSDI, including disabled widow’s and disabled adult child claims). There is a second Social Security disability benefits program: Supplemental Security Income (SSI). SSI is a need-based benefit program for individuals with little or no income and very limited assets. SSI recipients are not eligible for Medicare benefits based on disability from SSA, but most are eligible for benefits under the Medicaid program. Medicaid is a program administered by the individual states and eligibility rules vary from state to state. In Illinois, approval for SSI benefits does not automatically qualify you for Medicaid benefits. Illinois uses its own eligibility rules for Medicaid, which are different from the SSA’s rules, and you must file a separate application for Medicaid with the Department of Human Services.