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Why the Wait?
September 27, 2007 • Volume 7, Issue 38Older Americans can sign up for Medicare within three months of their 65th birthday—while millions of Americans with disabilities must wait at least two years after they are deemed eligible to receive the benefit.
When Congress expanded eligibility for Medicare in 1972 to cover people with disabilities, it sought to limit costs by including a 24-month waiting period between the start of Social Security disability benefits and Medicare coverage.
After determination of disability, applicants must wait five months to receive their first disability check, and from there endure an additional two years before receiving Medicare, often while suffering from debilitating illness or injury.
The wait for Medicare inflicts tremendous physical and financial strains on Americans with disabilities. During the waiting period, SSDI checks, which average $900 per month, often push recipients above the Medicaid income thresholds, but leave them with too little to pay for COBRA premiums or private insurance.
Of the 1.5 million people in the waiting period each year, 39 percent—or 468,000—are left without medical coverage at some point. Over one-quarter lack coverage for the entire two years.
These individuals suffer from a range of disabling conditions such as incapacitating mental illnesses, musculoskeletal disorders, lung disease and cancer. Nearly one-third are Americans under 50 who have become ill or injured and would like to return to work once they receive proper medical treatment.
However, most in the waiting period have to forgo or delay therapies and medications, leaving 59 percent in poor health at the onset of Medicare coverage. Others have to take on thousands of dollars of debt; 77 percent end up poor or nearly poor before receiving medical coverage. Inconsistent care and financial troubles take an irrevocable toll on their financial and physical well-being.
This not only burdens them, but the whole of Medicare. A study in the New England Journal of Medicine this year showed that people who had previously been uninsured and suffer from chronic conditions used Medicare coverage more frequently than those who had previously been insured, visiting the hospital 20 percent more and incurring 51 percent greater medical expenses than other people with Medicare.
Senator Jeff Bingaman, Democrat of New Mexico, introduced a bill on Wednesday to gradually end the 24-month waiting period and allow exceptions for those with life-threatening diseases to become immediately eligible for Medicare coverage. This legislation, if passed, will ease the suffering of the 1.2 million people with disabilities waiting for Medicare and protect all Americans since anyone is at risk of a sudden debilitating injury or illness.
Medical Record
“Individuals in the waiting period for Medicare suffer from a broad range of debilitating diseases and are in urgent need of appropriate medical care to manage their conditions. Eliminating the two-year wait would ensure access to care for those already on the way to Medicare” (Karen Davis, president of the Commonwealth Fund, “Waiting Period for Medicare Leaves More Than 1.2 Million Seriously Disabled Americans Without Secure Health Insurance,” July 16, 2003).
“I would assert that there is no reason, be it fiscal or moral, to tell people that they must wait longer than two years after becoming severely disabled before we… provide them access to much needed health care” (Senator Jeff Bingaman, Introduction of “Ending the Medicare Disability Waiting Period Act of 2005,” June 9, 2005).
When Pamela Votava was in her mid-50s, she was diagnosed with post-polio syndrome, a condition affecting those who have recovered from polio that weakens muscles infected by the disease. Pamela was approved for SSDI in January 2005, but would not be eligible for Medicare until January 2007. Without insurance, Pamela could not afford to see her doctors or buy braces, which cost thousands of dollars. Fortunately, due to her state’s local laws, Pamela was able to purchase a private insurance policy through her former employer’s insurance company–at a cost of $2,500 per month. Due to the policy’s high premiums and network restrictions, Pamela had little choice but to forgo the therapy treatments prescribed by her doctor and discontinue physical therapy. After a year, Pamela had lost the ability to walk and was depending on an electric scooter for mobility. Had it been available earlier, Medicare coverage might have prevented such a rapid deterioration of her condition (Medicare Rights Center, Too Sick to Work, Too Soon for Medicare: The Human Cost of the Two-Year Medicare Waiting Period for Americans with Disabilities, April 2007).
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Asclepios—named for the Greek and Roman god of medicine who, acclaimed for his healing abilities, was at one point the most worshipped god in Greece—is a weekly e-newsletter designed to keep you up-to-date with Medicare program and policy issues, and advance advocacy strategies to address them. Please help build awareness of key Medicare consumer issues by forwarding this action alert to your friends and encouraging them to subscribe today.
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