Why Does My Daughter Receiving SSDI Have to Wait Two Years to Get Medicare?

 In Social Security, Special Needs Planning

Photo by CDC on Unsplash


I have a 27-year-old severely handicapped daughter who I take care of 24/7. She qualifies for Social Security Disability Income (SSDI) under her father’s work record. My question is that she lost her insurance and I was told that she has a 2-year wait. Why would they do this to an adult child who is handicapped, not to give her insurance coverage?


There’s a two-year wait for Medicare coverage after beginning to receive Social Security Disability Income (SSDI). But I wonder whether some or all of the two-year waiting period has already passed for your daughter, since it should have begun as soon as your daughter began receiving SSDI. In addition, your daughter is most likely eligible for Medicaid coverage in the meantime. That’s probably the insurance you say she lost.

If your daughter was receiving Supplemental Security Income (SSI) prior to switching over to SSDI, she would have been automatically eligible for Medicaid. Now that she’s no longer receiving SSI, you will need to apply for Medicaid directly. In fact, if your daughter is eligible for Medicaid, you may want her to continue receiving it even after Medicare kicks in, to pay for Medicare’s deductibles, co-pays and Part D insurance coverage. In addition, in some instances, Medicaid might even be able to compensate you for some of the services you provide your daughter.  That will depend on your state’s Medicaid program.

In terms of your policy question about why there’s a two-year wait, according to a 1989 policy brief on the Social Security Administration website titled “Eliminating the Medicare Waiting Period for Social Security Disabled-Worker Beneficiaries,” the purpose of the waiting period is “primarily to limit program costs”  and prevent cost-shifting from private health insurance to Medicare. While your daughter receives SSDI as the result of a disability she was born with or incurred during childhood, the main role of the SSDI program is to assist workers who can no longer earn a living due to their disability. Many of them are able to retain their employer-provided health insurance for some period of time after they can no longer work. Congress was concerned that if they offered immediate eligibility for Medicare, these employers would cut off coverage to their disabled former employees, shifting the cost to the taxpayers. According to the policy report, eliminating the two-year waiting period would be very expensive. It would be interesting to see updated figures, since it may be that more of those disabled workers are now depending on Medicaid rather than private health insurance.


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