Academic journal article Care Management Journals

Too Sick to Work, Too Soon for Medicare: The Human Cost of the 2-Year Medicare Waiting Period for Americans with Disabilities

Academic journal article Care Management Journals

Too Sick to Work, Too Soon for Medicare: The Human Cost of the 2-Year Medicare Waiting Period for Americans with Disabilities

Article excerpt

In the United States, nearly 7 million people under age 65 qualify for Medicare due to severe and permanent disabilities. However, these individuals must wait 2 years after they are deemed eligible for Social Security Disability Insurance to receive this coverage. As a result, there are as many as 1.5 million men and women who are too disabled to return to work but who must wait to receive Medicare coverage for their health care needs. Nearly 39% are uninsured for at least some of this time, and 26% have no insurance throughout the waiting period. This article tells the stories of three individuals struggling to survive the 24-month waiting period. These reallife stories expose the financial hardship, pain, and suffering caused by the waiting period and provide evidence of the need for the swift enactment of legislation to eliminate the waiting period. In this article, these individuals give their accounts of what it means to become too sick or disabled to work, and to learn that it is too soon to get health care coverage through Medicare. In all cases, we have tried to stay as close as possible to the language and the spirit of the participants' stories.

Keywords: Medicare; disability; waiting period; social security; disability insurance; health security

In 1965, President Lyndon B. Johnson made the creation of Medicare-a federal health insurance program designed to meet the needs of older Americans priced out of the private health insurance market-a cornerstone of his Great Society. In 1972, President Richard M. Nixon signed legislation extending Medicare to people under age 65 who have severe physical and mental disabilities. The promise of secure health care coverage to younger people who, through illness or injury, had lost their ability to work was a natural extension of a program that already brought health and security to older Americans.

However, people who are deemed eligible by the Social Security Administration for Social Security Disability Insurance (SSDI) due to severe and permanent disability receive Medicare coverage only after a 2-year waiting period. That is, they must wait 2 years after receiving their first disability benefit check before becoming eligible for Medicare. As a result of this policy, there are as many as 1.5 million men and women who are too disabled to return to work but who are waiting to receive Medicare coverage for the health care they need. Of these, nearly 39% are uninsured for at least some of the time during the waiting period (Short, Shea, & Powell, 2001), and 26% have no insurance throughout the waiting period (Riley, 2006).

This article tells the stories of three of those Americans.

Most people who become disabled were, before their disability, working at full-time jobs and paying into Medicare like all other employed Americans. But what happens when, like Chris Richmeier, they have a car accident or, like Jo Henderson, they are diagnosed with macular degeneration? Life takes a mean turn, and at the moment when these men and women need coverage the most-just when they have lost their health, their jobs, their income, and their health insurance-federal law requires them to wait 2 full years to become eligible for Medicare.

In a tragic and regrettably typical story, one project participant was left with $50,000 in debt and compromised health caused by lack of medications and treatment after two heart attacks, severe spinal compression, diabetes, and anemia. Other individuals see their marriages fall apart as they wait. Still others attempt suicide to escape the shame and depression of having to ask for handouts and go without treatment. Many sell their homes or go bankrupt. And more than 16,000 people-like Richard Schadt-do not make it through the waiting period. They die before their Medicare coverage ever begins.

For years, the cost of ending the waiting period has been known. Expert analyses have shown that providing men and women with Medicare at the time that Social Security certifies them as disabled would cost $8. …

Search by... Author
Show... All Results Primary Sources Peer-reviewed

Oops!

An unknown error has occurred. Please click the button below to reload the page. If the problem persists, please try again in a little while.