Can I get medical coverage if I win my Social Security Disability case? Stop the Wait Act

In September, a bill was introduced to Congress that could have a drastic impact on individuals claiming Disability Insurance Benefits under the Social Security Act.

As noted on other pages of our website, Social Security can be paid to disabled individuals under two programs.  One is called Disability Insurance Benefits and the other is called Supplemental Security Income.  Supplemental Security Income (SSI) is paid to individuals who have very limited financial means.   Disability Insurance Benefits are paid to individuals who have a substantial work record and who have paid sufficient Social Security taxes.

Presently, SSI is payable the month after an individual files for disability.  Disability Insurance Benefits can be payable up to one year before an application is filed, but no earlier than five months from the time that the individual became disabled.

In the most common disability scenario, an individual is working, they get sick or injured, and in a month or two they file a claim for benefits.  If this occurs, the claimant filing for Disability Insurance Benefits cannot be paid any money for the first five months that they are considered disabled.  Moreover, this individual must wait 24 months from the time that benefits are first payable to become eligible for Medicare.  By contrast, an SSI claimant is eligible for Medicaid immediately and can receive monthly payments the month after the application date.  In Ohio, a Disability Insurance Benefits claimant may also be eligible for Medicaid while they are waiting for Medicare to kick in, but this is only the case if your income and assets are under the Medicaid threshold.  These asset and income restrictions often prevent those who are found disabled under the Disability Insurance Benefits program from being able to obtain health insurance.

Under the proposed Stop the Wait Act, the above waiting times would be eliminated for Disability Insurance Benefits claimants.  If this Act passes, those who become eligible for Social Security Disability based on their work record/paid taxes will no longer have to wait five months from the time that they became disabled to receive benefits.  Furthermore, these individuals will not have to wait 24 months to receive medical coverage under Medicare.  This is only fair.  These individuals are getting benefits based on the Social Security and Medicare taxes that came out of their paychecks for years.  There is little logic behind making them wait 24 months for Medicare and 5 months for disability payments to start.  Not only does this wait time often cause these vulnerable claimants to go into debt, but it can also prevent them from receiving necessary healthcare at the time that they need it most- when they are disabled.

Hopefully, this bill is enacted into law.  It would be highly beneficial for those who are claiming Social Security Disability based on their work record.  We would urge anybody who cares about somebody who is filing for disability to contact their local congressperson and express support for this bill.

Please give us a call if you have any questions about Social Security’s SSI or Disability Insurance Benefits programs.