Social Security Disability Insurance (SSDI) and Medicare: The 24-Month Waiting Period for SSDI Beneficiaries Under Age 65

^Pr^ep^ar^{ed f}^o^r^M^e^m^b^ers^an^d^Com^mⁱ^t^t^ees^of^C^ong^r^e^ss

Recipients of Social Security Disability Insurance (SSDI) benefits are eligible for Medicare
benefits after a 24-month waiting period. This report explains this waiting period and its
legislative history. This report also provides information on other programs that may provide
access to health insurance during the required waiting period.This report will be updated to reflect
legislative activity.

Exceptions to the 24-Month Waiting Period...................................................................................1
Other Persons Under Age 65 Who Are Eligible for Medicare Because of a Disabling
Conditi on ...................................................................................................................... ................ 2
Legislative History of Medicare Eligibility for SSDI Beneficiaries..............................................3
Congressional Reasoning for the 24-Month Waiting Period.....................................................3
Changes to the Waiting Period Criteria.....................................................................................4
Programs That May Provide Health Insurance During the 24-Month Waiting Period....................4
Medicaid .................................................................................................................................... 4
Consolidated Omnibus Budget Reconciliation Act of 1985 (COBRA), P.L. 99-272................4
Other Programs.........................................................................................................................5
Costs of the 24-Month Medicare Waiting Period............................................................................5
Some SSDI Beneficiaries Die Within 24-Months.....................................................................5
Medicare Costs..........................................................................................................................5
Medicaid Cost Savings..............................................................................................................6
Table 1. Persons Under Age 65 Who Receive Medicare (Part A and/or Part B) on
Account of Disability, 2006..........................................................................................................3
Author Contact Information............................................................................................................6

ection 1811 of the Social Security Act provides that Social Security Disability Insurance ¹
(SSDI) beneficiaries are eligible for Medicare hospital insurance (Part A). Individuals are
also eligible to purchase Medicare supplementary medical insurance (Part B) or enroll in a S

Medicare Advantage plan (formerly known as a Medicare+Choice plan). SSDI beneficiaries are ²
also eligible for voluntary prescription drug benefits (Part D).
Generally, SSDI beneficiaries under age 65 are eligible for Medicare coverage in the month after
they have received 24 months of SSDI benefits. Because of the five-month waiting period from
onset of the disabling condition for disabled individuals to be qualified to receive SSDI benefits,
this results in a total of 29 months after the onset of the disability before an individual is eligible ³^th
for Medicare benefits. Thus, at the beginning of the 30 month since the onset of the qualifying
disability, SSDI beneficiaries become eligible for Medicare coverage.

For SSDI beneficiaries under 65 years of age, there are exceptions to the required 24-month
waiting period for certain diseases. Specifically, SSDI beneficiaries qualify for Medicare
• after 24 months of receiving SSDI benefits (the general rule described
previously); or
• at the first month of receiving SSDI benefits if the beneficiary has amyotrophic
lateral sclerosis (ALS, or Lou Gehrig’s disease); or
• after the third month when a beneficiary has end-stage renal disease (ESRD) or
kidney failure; or
• in the month in which a beneficiary receives a kidney transplant.
The ALS exception went into effect July 1, 2001 as a result of the Consolidated Appropriations
Act of 2001, P.L. 106-554. The ESRD provision was part of Social Security Amendments of

1972, P.L. 92-603.

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^O’Sulliv^aⁿ^.
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In addition to SSDI beneficiaries, other individuals who are under age 65 may be eligible for
Medicare on account of a disabling condition as described below.
• Certain disabled local, state, and federal employees who do not receive SSDI
benefits may be eligible after the waiting period.
• Disabled widows and widowers ages 50 to 65 (and disabled divorced widows and
widowers ages 50 to 65) are eligible for Medicare after a 24-month qualifying
period if they are receiving Social Security benefits based on disability. For
disabled widows/widowers, previous months of eligibility for Supplemental
Security Income (SSI) based on disability may count toward the qualifying
period.
• Certain dependent adult children of Medicare beneficiaries are eligible for
Medicare if they developed a permanent and severe disability before age 22 and
thus qualify for SSDI benefits based on a parent’s work history. The two-year
waiting period applies and starts when an individual turns 18 or when he or she is
determined to be disabled if it is after age 18.
• A spouse or child may be eligible for Medicare, based on a worker’s record, if the
spouse or child is on continuing dialysis for ESRD or has a kidney transplant,
even if no other family member participates in the Medicare program.
Table 1 shows the number and percentage of persons under 65 years old who received Medicare
in July 2005 due to disabling conditions. In 2006, just over 7 million beneficiaries under the age
of 65 received Medicare on account of disability status. More than 43% of disabled beneficiaries
were between the ages 55 and 64. More men (53.3%) than women (46.7%) received this benefit
and the vast majority (73.5%) were white.

Table 1. Persons Under Age 65 Who Receive Medicare
(Part A and/or Part B) on Account of Disability, 2006
^{All Disabled}^{All Disabled (%)}^{Disabled with ESRD}^{Disabled with ESRD}
^{and SRD Only}^{and ESRD}^{Only (%)}
^Age
^{Under 3}⁵^614,⁷⁷⁸^8.8^23,6⁰⁴^11.3
^35-4^{4 1,18}^3,32⁶^16.9^36,5³²^17.5
^45-5^{4 2,19}^2,06⁵^31.2^64,3⁸⁶^30.8
^55-6^{4 3,03}^1,80⁸^43.2^84,5⁸⁹^40.5
^Sex
^{Male 3,74}^5,17¹^53.3^121,⁷⁴⁷^58.2
^{Female 3,27}^6,80⁶^46.7^87,3⁶⁴^41.8
^Race
^{White 5,16}^4,15⁸^73.5^94,1²⁴^45.0
^{Black 1,32}^6,48⁵^18.9^83,6⁵³^40.0
^{All other}
^{races 515,}¹⁸⁶^7.3^29,9³⁰^14.3
^{Unknown 16,1}⁴⁸^0.2^1,40⁴^0.7
^{Total 7,02}^1,⁹⁷⁷^100.⁰^209,¹¹¹^100.⁰
^Source:^{Congressional Researc}^h^{Service (CRS) tabulations using}^{data from Social Security Adminis}^tration,
^{Annual Stat}^{istical Supplement, 2007}^{(Washington: GPO 2}⁰⁰^{8), Table 8.B5.}

The Social Security Amendments of 1972, P.L. 92-603, extended Medicare to persons with
disabilities who had been entitled to Social Security Disability Insurance (SSDI) benefits for at
least 24 consecutive months. The provision required the waiting period to begin with the first
month of SSDI entitlement, which is five months after the onset of the disability.
In 1971, the House Committee on Ways and Means Report recommended extending Medicare
protection to the disabled and stated that the Committee felt it was “imperative to proceed on a
conservative basis.” The report stated that the 24-month waiting period was intended to
^{... h}^e^{lp k}^{eep th}^{e cos}^t^s^wⁱ^thⁱⁿ^re^as^on^{able bou}ⁿ^d^s^,^av^{oid ov}^erla^ppin^g^priv^{ate h}^eal^thⁱⁿ^s^u^ran^ce
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^sev^e^r^e^an^d^loⁿ^g^las^tin^g^.
A similar statement was included in the report to the Senate from the Committee on Finance.
The Social Security Disability Amendments of 1980, P.L. 96-265, permitted an individual
becoming re-entitled to SSDI benefits to count the months of the earlier spell of disability in
satisfying the 24-month waiting period if the spell occurred within the previous five years or
seven years for disabled widow(er)s and those who were disabled since childhood. The
amendments also provided that if an individual was in a trial work period after the termination of
the SSDI benefits, and had not completed the 24-month waiting period, the months of the trial
work period could count toward satisfying the required waiting period for Medicare eligibility.
Effective October 1, 2000, the Ticket to Work and Work Incentives Improvement Act of 1999,
P.L. 106-170, extended Medicare Part A coverage to certain working former SSDI beneficiaries
for a total of 8.5 years.

Those SSDI beneficiaries with limited incomes and assets may qualify for Supplemental Security
Income (SSI) benefits. Under SSI, disabled, blind, or aged individuals who have low incomes and ⁵
limited resources are eligible for benefits regardless of their work histories. In most states SSI ⁶
receipt will entitle a person to Medicaid benefits. Certain working SSDI beneficiaries who had
been receiving Medicaid benefits may be eligible for a Buy-In Option allowing maintenance of
Medicaid coverage. Thirty-two states currently provide a Medicaid Buy-In Option.
Title X of the Consolidated Omnibus Budget Reconciliation Act of 1985 (COBRA), P.L. 99-272,
requires employers who offer health insurance to continue coverage for persons who would
otherwise lose coverage due to a change in work or family status. Coverage generally lasts 18

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months but, depending on the circumstances, can last for longer periods.⁷ If the Social Security
Administration (SSA) makes a determination that the date of an individual’s onset of disability
occurred during the first 60 days of COBRA coverage or earlier, the employee and the
employee’s spouse and dependents are eligible for an additional 11 months of continuation
coverage. This is a total of 29 months from the date of the qualifying termination or reduction of
hours of employment. This provision was designed to provide a source of coverage while
individuals wait for Medicare coverage to begin.
Some SSDI beneficiaries may qualify for other government programs including veterans’ ⁸
programs for hospital and medical care.

According to research based on new SSDI beneficiaries in 1995 who qualified upon their own
work record, 11.8% died within the waiting period, 2.1% recovered, and 86.1% became entitled
to Medicare. The study estimated hypothetical Medicare costs for the first 24 months of SSDI
entitlement to be $10,055 in 2000 dollars per person. Costs varied substantially by diagnostic
group and by whether the person died or recovered during the waiting period. On average,
beneficiaries who died during the waiting period were estimated to cost $25,864, whereas those ⁹
who recovered were estimated to cost $1,506.
One research study suggested that eliminating the 24-month Medicare waiting period would cost ¹⁰¹¹
$5.3 billion while another study estimated the cost at $8.7 billion. The differences in the
estimates are because: (1) the $5.3 billion used 2000 dollars while the $8.7 billion is in 2002
dollars: (2) the $5.3 billion estimate is for only SSDI beneficiaries that qualified under their own
work record while the $8.7 billion estimate includes disabled adult children and disabled

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widow(er)s; and (3) each used substantially different estimation methodologies. Neither of these
estimates include the cost of the prescription drug benefit that started in January 2006.
In 2002, approximately 40% of SSDI beneficiaries in the Medicare waiting period were enrolled
in Medicaid. One study estimated that the federal government would save $2.5 billion in
Medicaid if the 24-month waiting period was eliminated; however, these federal Medicaid
savings would more than be offset by the aforementioned cost increases to the Medicare program.
Additionally, the states would realize $1.8 billion in Medicaid savings if the waiting period was ¹²
eliminated.
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