Waiting for Medicare

Waiting for Medicare

A recent Kaiser Health News article addresses the issue of Medicare and persons younger than 65 years of age who have disabilities.  Under current federal rules, such persons are not eligible for Medicare until two years after they start receiving Social Security Disability Income.  Persons with amyotropic lateral sclerosis (also known as ALS, or Lou Gehrig's disease) have no waiting period, and persons with end-stage renal disease have a waiting period of three months or less, depending on treatment.  Congress created the waiting period in 1972 when Medicare was expanded to cover persons with disabilities.  The waiting period was designed to control costs and to ensure that only those with ongoing, severe disabilities received Medicare coverage.  According to the Kaiser Family Foundation, approximately seventeen percent of Medicare's 47 million beneficiaries receive disability benefits.

Many patients waiting for Medicare face financial hardship.  They may be currently unable to get health insurance because of their conditions.  Some patients may receive coverage through a spouses's insurance plan, or continue to pay for their employer-sponsored coverage through COBRA, the federal law that allows laid-off or disabled workers the opportunity to purchase insurance for 18 months.  Workers with disabilities are eligible to extend COBRA coverage for an additional 11 months, although the price of COBRA coverage can be prohibitive.

The new health care overhaul will provide some relief to patients with disabling conditions, according to Joe Baker, president of the Medicare Rights Center.  Starting in 2014, insurers will not be able to bar patients with disabilities from purchasing insurance because of their pre-existing conditions.  The coverage is also expected to be more comprehensive as a result of the new federal requirements.  The patient groups are continuing to press for the end of the waiting period, because nearly 39% of patients are uninsured for at least part of the waiting period, while another 26% have no insurance for the entire two years. 

The Medicare Rights Center is leading a coalition of over 65 organizations pushing Congress to eliminate the waiting period.  This effort has stalled because, according to the Congressional Budget Office, eliminating the waiting period would cost an estimated $113 billion over ten years.  This cost takes into account a corresponding $32 billion decrease in federal spending on Medicaid that would result from moving persons with disabilities from Medicaid to Medicare.  Many people with disabilities receive Medicaid benefits during the waiting period.  Edmund Haislmaier, a senior policy research fellow at the Heritage Foundation, said that eliminating the waiting period "is always going to be an issue in Congress.  Some of it is money, some of it is politics, too.  For members of Congress, irrespective of party or where they stand on the issue, it's kind of all-or-nothing because if they did it for some diseases, they're immediately going to be inundated with 'Why didn't you do it for us?'"  Some groups, however, such as the Huntington's Disease Society of America, are asking Congress for specific waivers from the waiting period for their diseases.  They believe it may be more politically feasible to press for relief for specific diseases, because the cost of doing so would be less than the cost of across-the-board relief.    


Oast & Hook has been providing quality legal services in Southeastern Virginia and North Carolina for more than 80 years. The attorneys at Oast & Hook can assist clients with their estate, financial, insurance, long-term care, veterans' benefits and special needs planning issues. Visit their website at www.oasthook.com for more information.

Sandra L. Smith joined the firm in 2003. She practices primarily in the areas of elder law, estate planning, estate and trust administration, special needs planning, asset protection planning, long-term care planning and Veterans' benefits. Ms. Smith is certified as an Elder Law Attorney (CELA) by The National Elder Law Foundation (NELF).

In 2008, Ms. Smith was named as a Rising Star by Virginia Super Lawyers magazine. Rising Stars names the state's top up-and-coming attorneys.