Social Security Benefits, Medicare and Medicaid – How these Programs Overlap

If you are approved for SSDI, you automatically become eligible for Medicare as of the 25th month following your first eligibility for an SSDI payment.  It is easy to get confused about what constitutes your first eligibility for payment because you may see several other dates in your favorable decision and in the payment letters issued by Social Security.  An example might help you understand what constitutes your first eligibility for payment:

Sam stops working on May 17, 2006 because of severe back problems, diabetes and knee pain.  He hopes that a few months rest will help him feel better but his condition does not improve.  Sam is not aware of Social Security disability until his doctor mentions it in 2009.  Sam finally gets around to applying for benefits on October 23, 2009.  He alleges an onset date of May 18, 2006 – the day after he stopped working.

Social Security denies his initial application for benefits and his reconsideration appeal.  Finally in July, 2011, Sam appears before a Social Security judge at a hearing.  On August 25, 2011, the judge issues a fully favorable decision finding Sam disabled as of May 18, 2006.

What can Sam expect in terms of payment and Medicare?


Vaughn Clauson is a US Air Force veteran, and an experienced disability attorney. Vaughn is a board certified specialist in Social Security disability law and has dedicated his career to representing the disabled. Vaughn and his associates have represented thousands of clients, and have experience with any type of disability claim.

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