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Disabled and Waiting for Medicare

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 of 2010 but did not make it into the final law. 

Even so, the Affordable Care Act (also known as Obamacare), did change things. It gives people access to health insurance — without past or present health problems being taken into account — to all U.S. citizens and legal residents (green card holders) who don’t have insurance from an employer. For the first time, people with disabilities (who by definition have at least one pre-existing medical condition) have guaranteed access to health coverage  while they wait 24 months for Medicare to kick in.

Here's how it works:

  • Many state now have a health insurance exchange (also called the “marketplace”), which offers a number of different private health plans that you can choose from.

  • To see plans available in your area, and compare their costs and benefits, you must go to the website of your state health exchange. Some exchanges are run by the state; others (where state legislatures have decided not to operate them) are run by the federal government. Go to the government website, to be directed to the site you need. You can also enroll in a plan from that site.

  • All plans must offer the same set of essential health benefits — including care from primary and specialist doctors; hospitalization; laboratory and other outpatient services; mental health care; maternity, newborn and pediatric care; rehabilitation services; prescription drug coverage; and preventive care.

  • Premiums vary according to the plan you choose and the level of coverage it provides.

  • You may receive automatic discounts on your premiums, depending on your income level. The federal government provides subsidies for everyone with incomes up to a certain level — for example, up to about $46,000 for single people; up to about $94,000 for a family of four.)

  • If your income is below a certain level, you may qualify for Medicaid (the state-run health system for people with very limited incomes). If so, your coverage would be virtually free. However, this depends on where you live. The U.S. Supreme Court ruled that Obamacare is constitutional, but made the expansion of Medicaid something that each state could decide for itself. Some states have decided not to expand their Medicaid programs.

  • If you qualify for subsidies or Medicaid, this is taken into account in determining your premium at the time you sign up for a plan.  You don’t have to apply separately for this assistance.

  • If you enroll before December 15, 2013, your coverage will begin January 1, 2014. The first enrollment period for Obamacare runs until March 31, 2014. After that, there will be an annual sign-up period (when you can change plans if you want) from October 15 to December 7 each year. But you can also enroll at any time of the year in certain circumstances — for example, if you lose employer insurance. 

If you enroll in one of these plans, you can cancel it as soon as you become eligible for Medicare — which usually happens during the 24th month after you were approved for Social Security disability benefits. Under the law, people with Medicare are regarded as fully insured and not required to buy extra insurance.

* 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