Health Insurance and Access to Care among Social Security Disability Insurance Beneficiaries during the Medicare Waiting Period

Abstract

For most Social Security Disability Insurance (SSDI) beneficiaries, Medicare entitlement begins 24 months after the date of SSDI entitlement. Many may experience poor access to health care during the 24-month waiting period because of a lack of insurance. National Health Interview Survey data for the period 1994–1996 were linked to Social Security and Medicare administrative records to examine health insurance status and access to care during the Medicare waiting period. Twenty-six percent of SSDI beneficiaries reported having no health insurance, with the uninsured reporting many more problems with access to care than insured individuals. Access to health insurance is especially important for people during the waiting period because of their low incomes, poor health, and weak ties to the workforce.

The effect of expanding access to health insurance on the health and mortality of Social Security Disability Insurance beneficiaries

“…While many SSDI beneficiaries are able to maintain or obtain health insurance coverage during the waiting period, some do not have health insurance coverage. Studies have estimated that between 24% and 27% of beneficiaries lack health insurance coverage during the Medicare waiting period (Muller, 1989;Riley, 2006;Short and Weaver, 2008). Other studies show that beneficiaries who do not have health insurance coverage are much more likely to experience financial hardship and unmet medical needs than those who have health insurance during the waiting period (Riley, 2006;Livermore et al, 2010;Williams et al, 2004).…”

“…Studies have estimated that between 24% and 27% of beneficiaries lack health insurance coverage during the Medicare waiting period (Muller, 1989;Riley, 2006;Short and Weaver, 2008). Other studies show that beneficiaries who do not have health insurance coverage are much more likely to experience financial hardship and unmet medical needs than those who have health insurance during the waiting period (Riley, 2006;Livermore et al, 2010;Williams et al, 2004). Organizations have used some of these findings to recommend eliminating the waiting period in order to help beneficiaries obtain the health care they need to stabilize their disabling health condition and facilitate a return to employment (Consortium for Citizens with Disabilities, 2008).…”

The Health Care Financing Maze for Working-Age People with Disabilities

“…Between one-quarter and one-third of the 1.26 million SSDI beneficiaries in the two-year waiting period are uninsured (Riley 2006, Dale andVerdier 2003) and often have limited access to medical care (Riley 2006) Under the Ticket Act, an individual who returns to work may continue receiving Medicare benefits for up to 93 months after their SSDI benefits cease.…”

Would Insuring Near-Elderly Persons Reduce Medicare Spending in Patients Aged 65 Years or Older?

“…For example, persons who quality for Medicare before age 65 years because of participation in Social Security Disability Insurance (SSDI) qualify only after a 24-month waiting period after SSDI entitlement. Because they must be too disabled to work to qualify for SSDI, many are uninsured during the waiting period (3). According to our estimates based on the authors' sample definitions, 25% of the “uninsured” transitioned to public insurance before age 65 years, as opposed to only 11% of the “insured.” Because disabled persons are more likely to use health care services and because their health characteristics are not adequately captured in the control variables, the authors' estimate includes spending that could not be avoided by insuring the uninsured.…”