Exceptions to the Rule: Medicare Waiting Period

In Benefits Articles, Blog by Megan Koch

Previous Medicare Waiting Period Months Count in Reentitlement Cases

If you’ve been around Title II disability benefits and Medicare long enough, you know that generally there is the 24 month waiting period for Medicare benefits to begin.  There are, of course, some exceptions to this rule.  We know that:

  • Individuals with Amyotrophic Lateral Sclerosis (ALS), or Lou Gehrig’s disease, are automatically eligible for Medicare the month that disability benefits begin,
  • Individuals restarting benefits who were entitled to Disability Insurance Benefits (DIB) within the past 60 months are exempt from the waiting period, and
  • Individuals restarting benefits who were entitled to Childhood Disability Benefits (CDB) or Disabled Widow(er) Benefits (DWB) within the past 84 months are also exempt from the waiting period.

But, here is another, lesser known, exception to the Medicare waiting period rule:

Title II beneficiaries whose benefits were terminated after February 28, 1988 may not have to serve a waiting period for Medicare entitlement regardless of when the previous entitlement was terminated (it can be well past 5 years).  In certain situations, an individual can have past months served in the Medicare waiting period count under reentitlement.  This is true for individuals if “…the current disabling impairment is the same as, or directly related to, the impairment which served as the basis for disability during a previous period of disability benefit entitlement.”  In this case, “months from previous periods of disability benefit entitlement may be counted in determining when the 24-month D-HI [Medicare] qualifying period requirement is met” (POMS HI 00801.152).

The Claims Representative (CR) at Social Security who takes the application would have to know that the individual is applying with a potential “same as, or directly related to” disability criteria.  The CR then has to ask the Disability Determination Services/Bureau (DDS/DDB) to make the determination and code the case properly.

So keep your eyes open, and ask the CR about this when someone with a previous entitlement files again well after 5 years since the last entitlement!

More information about “Counting Months in Reentitlement Cases” can be found in section HI 00801.152 of the Program Operations Manual System (POMS) at: https://secure.ssa.gov/apps10/poms.nsf/lnx/0600801152.

About the Author
Megan Koch

Megan Koch

Megan manages the Wisconsin Disability Benefits Network training and educational projects and is a work incentives benefits specialist. Megan holds a Master’s of Science degree in Rehabilitation Psychology from the UW-Madison. Megan is a Certified Rehabilitation Counselor (CRC). Her many past experiences working with individuals with disabilities include internships working at the Division of Vocational Rehabilitation (DVR), the Wisconsin Council of the Blind & Visually Impaired, and Community Living Alliance (CLA). More about Megan