Examining Medicare’s Two-Year Waiting Period for Individuals with Disabilities

October 18, 2004

In addition to providing health insurance coverage for 35 million seniors, Medicare covers about 6 million disabled beneficiaries under age 65 who are entitled to cash benefits under the Social Security Disability Insurance (SSDI) program. SSDI is designed to assist adults who are unable to work due to severe, long-lasting disabilities. However, disabled people who wish to receive coverage under Medicare must first qualify for SSDI cash benefits and wait five months before receiving the benefit. These individuals must then wait an additional two years before becoming eligible for Medicare.

What is the origin of the two-year waiting period? Do the original reasons for applying it still make sense? How would expanding Medicare to immediately cover SSDI beneficiaries affect Medicare spending? What impact would such a change have on state Medicaid program costs? How many disabled individuals caught in the two-year waiting period lack access to other sources of health coverage? How might possible returns to work be affected by speeding up Medicare coverage to these individuals?

To help examine these questions and others, the Alliance for Health Reform and The Commonwealth Fund cosponsored an October 18, 2004 briefing. Panelists were: James M. Verdier, senior fellow at Mathematica Policy Research, Inc.; Henry Claypool, a disability expert and principal at Advancing Independence; and Lorne Fox, a disabled individual currently receiving SSDI benefits and a proponent of eliminating the waiting period. Barbara Cooper of The Commonwealth Fund made brief remarks and Ed Howard of the Alliance moderated the discussion.

A new study of the impact of the two-year requirement, Waiting for Medicare, was available at the briefing. Authored by Henry Claypool and others, the paper was commissioned by The Commonwealth Fund and the Christopher Reeve Foundation.

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