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Medicare Two-Year Waiting Period

What is the Medicare Two-Year Waiting Period?
Under current law, people living with disabilities must first receive Social Security Disability Insurance (SSDI) for 24 months before they are eligible for Medicare benefits. Millions of Americans who are caught in this waiting period are unable to work in order to remain on an employer-sponsored health plan, unable to afford COBRA coverage, and are ineligible for Medicaid. This leaves about 39 percent of these individuals without any form of coverage at some point during the 24-month period. Tragically, an estimated 4 percent die while waiting for Medicare coverage.

How does Health Reform fit in?
The Affordable Care Act (ACA) did not explicitly address the Medicare Two-Year Waiting Period, but it did make some changes to address the problems associated with this gap. In many cases, individuals receiving SSDI and with a pre-existing condition can now join high-risk insurance pools that were created under the ACA and receive immediate insurance coverage while they continue to wait for Medicare benefits to become available. Additionally, starting in 2014, individuals that find themselves in this waiting period will have access to expanded insurance options through state-based insurance exchanges and expanded Medicaid eligibility.

What's Next?
These new options under health reform are an imperfect solution to the problems created by the two-year waiting period. However, these changes will provide temporary relief for many affected individuals in the disabled community, and these alternatives should be taken advantage of to ensure continued coverage and treatment. In the mean time, the Reeve Foundation will continue the important work of communicating the devastating impact that the Medicare Two-Year Waiting Period has on the lives of individuals living with disabilities, and the increased costs associated with forcing individuals to forgo necessary medical treatments while waiting for coverage under Medicare.

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Continue Christopher Reeve's LegacyPhoto by Timothy Greenfield-Sanders