Medicare waiting periods may not apply to ALS or ESRD patients. Although, most beneficiaries with disabilities have a waiting period that is essential before coverage begins.
For most, the wait time is two years before coverage starts. However, those with ESRD or ALS Social Security disability don’t have to wait the full 24 months.
Most Medicare Advantage (MA) plans include all benefits for those with pre-existing conditions or disabilities. The exception is coverage from an advantage plan for those with ESRD unless the MA policy is a Special Needs Plan.
Medicare Waiting Periods
Many ailments may qualify someone for a disability. However, most SS recipients have a 2-year waiting period once disability benefits begin before they’re eligible for coverage.
Of course, this is after the 5-month waiting period for disability to begin. Although, if your disability is backdated far enough, you may already qualify. However, it’s usually likely that benefits begin 2 years and 5 months after you apply for disability.
Waiving Medicare Waiting Periods
Waiting periods under certain circumstances may not apply. Due to the harsh nature of these medical conditions, a fast-track process may allow beneficiaries to receive benefits sooner.
Individuals suffering from one of the following conditions are exempt from the waiting period.
End-Stage Renal Disease (ESRD) patients enduring kidney failure that may need daily dialysis treatments or a kidney transplant. While coverage is available, beneficiaries must wait 3 months from the start of dialysis.
Patients with Amyotrophic lateral sclerosis (ALS) may also qualify for benefits under Medicare. Coverage starts as early as an ALS patient is receiving disability benefits.
Medicare Advantage and Medigap Eligibility
Individuals under the age of 65 with ESRD may not be eligible for Medigap. Although, state rules vary. Those with serious health conditions should apply for coverage while they have Guarantee Issue rights; then, pre-existing conditions won’t apply.
For example, applying outside of an individual’s Medigap Open Enrollment Period (OEP) puts their application at risk for medical underwriting. Medical underwriting bases their decisions on an individual’s pre-existing health conditions.
Private companies offer Supplements. Medigap helps pay for the gaps in coverage left by Parts A and B. Each of the 10 letter plans, offers a different level of benefits.
Depending on the plan, coverage may include allowable-costs for deductibles, copayments, and coinsurance. Unlike Parts A and B, Medigap plans have their own restrictions and rules for coverage.
The standard MA plan only requires beneficiaries to not have ESRD. However, if an ESRD-SNP is available then the ESRD patient would have access to that policy.
Medicare Pre-Existing Condition Waiting Period
Any health condition a patient has before enrolling in a new health plan is a pre-existing condition. Individuals with pre-existing conditions or disabilities may qualify for SNP enrollment.
The benefits of SNPs are different from other MA plans because they’re specific to the beneficiary. A Chronic Condition SNP is a subcategory. Individuals with one or more of the following chronic conditions may qualify for enrollment.
Including, drug and alcohol addiction, autoimmune disorders, cancer, cardiovascular disorders, chronic heart failure, diabetes, ESRD, and ESRD with kidney dialysis.
Pre-existing conditions such as HIV/AIDs, chronic lung conditions, both disabling and chronic behavioral health disorders, dementia, stroke, and severe hematologic disorders may also qualify a patient for Chronic Condition SNP.
Other exceptions like developing ESRD while already receiving benefits through an MA plan. Patients who’ve had a successful kidney transplant to treat their ESRD and are still Medicare-eligible may also join an MA plan.
Pre-Existing Conditions Not Covered by Medigap
Medigap doesn’t exclude any specific pre-existing conditions. Although, any company offering Supplement insurance must establish guidelines for pre-existing conditions.
However, federal law states that Medigap policies may refuse coverage of pre-existing conditions for the first 6 months of coverage. This time is known as a pre-existing condition waiting period.
Beneficiaries may avoid these wait-periods by buying a policy while they have a GI right. When a person has GI rights, the carrier may not impose any waiting periods of coverage due to prior health issues.
Medicare Disability Coverage
Disability coverage is equivalent to the coverage of beneficiaries qualifying because of their age. Full benefits are available for eligible enrollees.
Benefits include specific hospitals, nursing homes, home health, physician and other services.
How Long Until Medicare Begins After Being Approved for Disability
Individuals eligible for Social Security Disability Insurance benefits are eligible for Medicare after 24 months following the approval of benefits. The first 24 months of disability benefits are the waiting period for beneficiaries after being approved for disability.
Is Medicare Coverage Mandatory for those with Disabilities
While coverage isn’t mandatory for those with disabilities, there’s no real good reason to refuse coverage. A disability diagnosis automatically qualifies an individual for coverage.
Once a beneficiary has a disability for five-months, SSDI payments will begin, typically on the sixth-month of disability. Although coverage isn’t mandatory, most will find enrollment for Part A is automatic.
Individuals may qualify for coverage due to a pre-existing condition. Enrollment isn’t mandatory, although enrollees will face a late penalty for enrollment in any plan outside of the annual enrollment periods. However, coverage is recommended for those eligible to enroll.
Although beneficiaries must understand that waiting may result in unnecessary, additional, healthcare costs and/or treatments.
Patients suffering from a pre-existing health condition or disability may qualify for health coverage. Coverage isn’t mandatory; although, beneficiaries should get coverage when it’s available.
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