Disabled and Waiting for Medicare

by: Patricia Barry, from: AARP Bulletin, Updated September 2011

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Q. I’m 55 and filing for Social Security disability benefits. I’m told I have to be on disability for two years before getting Medicare. What are disabled people supposed to do without health insurance for two years when we are in desperate need of coverage?

A. It’s true that most people* under age 65 who qualify for Social Security disability must wait 24 months before becoming eligible for Medicare. Consumer advocates, including AARP, have long opposed this two-year delay. A proposal to abolish it was originally included in the health care reform legislation but did not make it into the final law.

Even so, the new law did change things. It gives people with disabilities more options for other coverage while waiting for Medicare.

Immediate help

The law provides some immediate help for people who have preexisting medical conditions—as anybody with disabilities does—and have been uninsured for at least six months. If you’re in this situation, you can apply to a government-run “high-risk pool” program to get health coverage that is guaranteed—in other words, you can’t be turned down. This temporary program runs until 2014 when the main insurance reforms kick in and nobody can be denied coverage for preexisting conditions.

This coverage—known as the PreExisting Conditions Insurance Plan (PCIP)—is not necessarily inexpensive. Premiums vary according to the state you live in, but they are less costly than what you would pay if you tried to buy insurance on your own—in some states significantly less. Other out-of-pocket costs (deductibles and copayments) are limited to an annual cap—currently $5,950 for a single person. For details of costs and coverage in your own state, go to the program’s website.

Alternative help

If the high-risk pool insurance is beyond your means, you may be able to get medical treatment from a community clinic that provides health care for free or at a low cost depending on your income. Under the new law, these clinics received $11 billion to expand services.

Go to the NeedyMeds website andclick on “Free Clinics” at the top of the home page. Although this website focuses mainly on ways to get prescription drugs if you aren’t insured, it also provides a comprehensive list of low-cost community clinics nationwide. Click on the name of your state, or enter your ZIP code, to find phone numbers and addresses of clinics nearest to where you live.

Or, find a clinic through the U.S. Health Resources and Services Administration’s online directory.

More options starting in 2014

The outlook for anyone not covered by employer insurance or government-run programs like Medicare and Medicaid starts to improve after January 1, 2014. From then on, you’ll be able to go through new state-run insurance exchanges to select a private health plan from a menu of options—to suit your needs and pocketbook. Subsidies or tax credits will be available if your income is under a certain level. And eligibility for Medicaid, the state-run health program for low-income people, will be expanded so that many more people can qualify.

If the law is fully implemented as written, all of these new measures will help people with disabilities gain coverage while waiting for Medicare.

* Although most people must wait two years for Medicare after qualifying for Social Security disability benefits, there are exceptions. People with amyotrophic lateral sclerosis—better known as Lou Gehrig’s disease—and those with permanent kidney failure can get Medicare coverage without a wait after diagnosis.

Patricia Barry is a senior editor at the AARP Bulletin.