Recommending Elimination of the 24 Month Medicare Waiting Period

Elimination of the Twenty-Four Month Medicare Waiting Period for Social Security Disability Beneficiaries

Most Social Security disability beneficiaries have serious health problems, low incomes and limited access to health insurance.  Many cannot afford private health insurance due to the high cost secondary to their pre-existing health conditions.  Members of the National Association of Disability Examiners (NADE) are deeply concerned about the hardship the 24 month Medicare waiting period creates for these disabled individuals, and their families, at one of the most vulnerable periods of their lives.

NADE is a professional association whose mission is to advance the art and science of disability evaluation. Although our membership includes treating sources and consultants, attorneys, claimant advocates and others interested in the Social Security and Supplemental Security Income (SSI) disability programs, the majority of our members work in the state Disability Determination Service (DDS) agencies, on the “front-line” of the disability evaluation process and are directly involved in processing claims for Social Security and SSI disability benefits.  The diversity of our membership, our extensive program knowledge, our “hands-on” experience and our ongoing communication with both claimants and beneficiaries enables NADE to offer a unique perspective on those disability programs.

In 1972, Congress passed Social Security legislation extending Medicare coverage to persons who had been receiving disability cash benefits for 24 consecutive months.   Congress is to be commended for providing these health care benefits for the disabled American population.   The original purpose of the Medicare waiting period was to “help keep program costs within reasonable bounds, avoid overlapping private insurance protection and provide assurance that the protection will be available to those whose disabilities have proven to be severe and long lasting.”

In the original 1972 legislation there was one exception to the 24 month Medicare waiting period. Individuals with chronic renal disease would only have to wait three months before receiving Medicare benefits.  In 2000, Congress passed legislation, implemented in 2001, that eliminated the Medicare waiting period for those individuals with amyotrophic lateral sclerosis (ALS), commonly known as Lou Gehrig’s disease.   In both of these situations, it was felt that the health of the affected individuals warranted more timely access to Medicare coverage.

Currently nearly six million disabled individuals receive Medicare benefits, and Medicare plays a vital role in ensuring that these individuals have access to appropriate and affordable health care.  NADE believes that requiring some disabled individuals to serve a waiting period before receiving health care benefits and not requiring others to do so is fundamentally unfair and causes a tremendous hardship for individuals with disabilities at one of the most vulnerable periods of their lives.

All Title II Social Security disability beneficiaries, except for the two groups mentioned above, are required to serve a 24 month waiting period before becoming eligible for Medicare benefits.  The Medicare waiting period begins with the first month of receiving Social Security disability cash benefits which is five full months after the onset of a disability.  This means that the majority of Social Security disability beneficiaries actually wait twenty-nine months after the onset of their disability before becoming eligible for Medicare health insurance benefits.

The majority of Social Security disability beneficiaries have impairments that are severe and long lasting.  Currently less than one percent of Social Security disability beneficiaries have their benefits terminated each year.  Another four percent die during the Medicare waiting period.  Many beneficiaries suffer irrevocable physical and mental deterioration while waiting for Medicare coverage and needed health care services.  Early intervention and provision of needed health care services as soon as possible after the onset of disability, and at a time when the individual needs it most, could improve both these statistics and  the quality of life for individuals with disabilities.  NADE supports the elimination or, at the very least a reduction, of the 24 month waiting period for Medicare benefits for all Title II disability beneficiaries.  This change is needed to ensure fundamental fairness in the program and equity to all Social Security disability beneficiaries. 

Eliminating, or reducing, the 24 month Medicare waiting period for Social Security disability beneficiaries would address the insurance needs of a high-risk, high-need population and provide financial relief and access to health care services at a time when health care needs are especially pressing and few alternatives exist.

Social Security beneficiaries in the Medicare waiting period face enormous problems.  Research conducted by the Commonwealth Fund, in conjunction with the Henry J. Kaiser Family Foundation and the Christopher Reeve Paralysis Foundation, found that Social Security disability beneficiaries reported “skipping medications, putting off needed care, feeling depressed and anxious about the future, and believing they were not in control of their own lives” during the 24 month Medicare waiting period.

Although some Social Security disability beneficiaries may initially be found eligible for SSI (thereby receiving Medicaid benefits), many lose that health care coverage when they complete their five-month waiting period and begin receiving Social Security disability cash benefits.  Thus many disability beneficiaries are without any health insurance for at least some portion of their 24 month Medicare waiting period.  Without health care coverage, individuals’ health conditions cannot improve, nor can they return to work, participate in their communities or stop depending on family members and friends for their basic needs.  Beneficiaries need better access to health services before they can consider working again.   Many individuals with disabilities might return to work if afforded access to necessary health care and related services.

NADE members, who work on the “front-line” of the disability program, have first-hand experience with the hardships that the 24 month Medicare waiting period places on disabled beneficiaries.    During continuing disability reviews NADE members all too often see individuals whose conditions, without proper health care coverage, have markedly deteriorated and who are significantly worse than when they were initially awarded disability benefits.  The financial and emotional toll this has taken on the disabled beneficiary and their families is disheartening.  Many individuals who could have been cured and/or found to be no longer disabled continue to be disabled due to the lack of access to needed health care services during the early stages of their disability.  Such medical care could, in many cases, have improved both their disabling condition(s) and their overall situation in life.

The Medicare waiting period is an often insurmountable barrier for individuals with disabilities.  It offers frustration and emotional distress to people and families who are already hurting.  Individuals with disabilities perceive the waiting period as being “punitive” and inherently unfair.   Some individuals feel that the government is “just waiting for” people to die. Moreover, for many individuals, it will cost more in the long run for health care and services as individuals’ conditions deteriorate because they are not receiving appropriate treatment. NADE strongly believes that Social Security disability beneficiaries and their families who are forced to deal with the trauma of disability, should not then be forced to deal with deteriorating health, financial pressures and emotional frustration caused by the Medicare waiting period.  Medicare coverage at the onset of an individual’s disability would relieve not only a significant financial, but also a significant emotional burden for disability beneficiaries and their families.

Most Americans with disabilities wish to lead active, healthy and productive lives and believe that employment is an important key to achieving this goal. Improvements in health care and early intervention of needed medical services could increase rehabilitation successes, provide greater employment opportunities and enhance the ability of people with disabilities to be more active and productive. Early interventions and access to needed health care services would provide not only greater emotional and economic stability for disabled individuals, it would decrease costs to the Social Security disability program as well.

The Social Security Administration has proposed some new demonstration projects under their Work Opportunity Initiative to help overcome the barrier that the 24 month Medicare waiting period poses for those disability beneficiaries and applicants who wish to work.  The demonstration projects provide supports, incentives and work opportunities to people with disabilities at the early stages of the disability determination process.  Three of these proposed demonstration projects provide immediate medical benefits to applicants for disability benefits by offering comprehensive, affordable health care coverage.  This allows beneficiaries to receive needed medical services early on in the onset of disability to enhance their vocational profile to return to work.  Such interventions are not only good business practice from a financial standpoint, but from a humane and public relations aspect as well.  NADE fully supports all initiatives and demonstration projects designed to assist disabled individuals in their efforts to obtain needed health care, promote self-sufficiency and return to work.

NADE members strongly believe that claimants and their families, who are forced to deal with the onset of disability, should not then be forced to deal with the lack of health care coverage.  For both Social Security and SSI disability, the definition of disability is the same, the medical listings are the same, and the adjudicative procedures used to process the claims are the same.  However, the health care benefits provided to those who are found disabled are not.

Disabled individuals who receive SSI disability benefits are eligible to receive health care coverage under the Medicaid program immediately upon being found eligible for SSI benefits.  Because the SSI disability beneficiaries can receive health care benefits immediately, the perception clearly exists that the individual who has worked and contributed to the nation’s workforce and economy is penalized for having done so!   Most Social Security disability beneficiaries face a daunting combination of low income, poor health status, heavy prescription drug use and high medical bills.  They spend their days trying to survive and get their most basic human and health care needs met.  Access to the health care services provided by Medicare is crucial if individuals with disabilities are to maximize their potential, avoid far more costly hospitalizations and long-term institutionalization and lead fuller and more productive lives. 

Congress passed the Americans with Disabilities Act in 1990 with the specific goals of ensuring equal opportunity, full participation in society, independent living and economic self-sufficiency for individuals with disabilities.  Eliminating, or at least reducing, the 24 month Medicare waiting period would not only be an extremely humane gesture for these disabled workers and their families, it is perfectly aligned with the American with Disabilities Act and it is the “right thing to do!”

NADE recognizes that there are costs involved with eliminating the 24 month Medicare waiting period.  Thus, our members would also support an incremental approach to reducing this.  Some of the costs could be offset by a reduction in federal Medicaid expenditures.  The Government Accountability Office (GAO) stated in their report on transforming government to meet the 21st century challenges that “policymakers must confront a host of emerging forces and trends shaping the United States … and …accompanying these changes are new expectations about the quality of life for Americans and …testing the continued relevance and relative priority for our changing society” of existing federal programs is critical to ensure “fiscal responsibility and facilitating national renewal.”    NADE agrees with GAO and feels it is time to change the Medicare waiting period to bring it into the 21st century.

NADE Position Paper, Approved by the NADE Board, August, 2005