For Those with Disabilities, the Wait for Medicare Comes at a High Price

The goal of the Social Security Disability Insurance (SSDI) program is to provide a safety net for workers who must stop working because of a disability. But there is a major catch: although Medicare coverage is available to people with disabilities, most beneficiaries must wait 24 months after their eligibility for SSDI for coverage to begin.

In the new Commonwealth Fund report, Health Insurance and Health Care Access Before and After SSDI Entry, Gina Livermore and David Stapleton of Mathematica Policy Research, Inc., and Henry Claypool of Independence Care System profile the characteristics, health insurance status, and health care access and utilization patterns of SSDI beneficiaries during the years before and after their entry into the program. Their findings shed new light on the experiences of people with disabilities and raise the question of why people who are eligible for Medicare are denied coverage when they are perhaps most in need of it. The analysis shows that:

• Compared with the period before their entry into the program, SSDI beneficiaries are more than twice as likely to live in families with incomes below the federal poverty level.
• While about 12 percent of individuals in the second year prior to SSDI entry report being in poor health, that percentage more than doubles among those in the year prior to SSDI entry and rises substantially for those in the first year after disability.
• People who will become eligible for SSDI benefits are significantly more likely to be uninsured than other workers.

In a new Perspectives on Health Reform essay, the Fund's Stuart Guterman and Heather Drake say that although the cost of eliminating the waiting period - estimated to be $12 billion a year - seems high, it represents only a small percentage increase in Medicare spending. Moreover, eliminating the waiting period could bring important benefits to the program and to beneficiaries, while helping states reduce their spending on public programs.