CASE FLASH: MEDICARE 24-MONTH WAITING PERIOD REGULATIONS

Ms. R was 28 when she became eligible for Medicare due to a disability. Over time Ms. R's condition improved, and she was able to go back to work full time. Since she was no longer disabled, she lost her Medicare eligibility. Ten years later, Ms. R became disabled again and could no longer work. However, after her Social Security Disability Insurance was reinstated, the Social Security Administration (SSA) told Ms. R that she would have to wait 24 months for her Medicare coverage to begin because her current health condition was different from the health condition that made her eligible for Medicare a decade ago. She called her local State Health Insurance Assistance Program (SHIP) for advice.

A SHIP counselor advised Ms. R to appeal Social Security's decision because if the second disability is the same as or directly related to the person's first disability, she is not subject to the 24-month waiting period. The SHIP counselor advised her to get statements from her doctor explaining how her current condition was directly related to her previous condition. SSA agreed that Ms. R's two conditions are directly related, and she gained retroactive Medicare coverage.

-Adapted from Medicare Watch, a biweekly electronic newsletter of the Medicare Rights Center, Vol. 10, No. 1: January 9, 2007

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