Elimination of Medicare's waiting period for seriously disabled adults: impact on coverage and costs.

M edicare provides health insurance coverage to people with disabilities and chronic illnesses who are entitled to cash benefits under the Social Security Disability Insurance (SSDI) program. In most cases, however, these individuals must first wait five months for disability benefits and then an additional two years before they can receive Medicare benefits.We estimate that there were 1.26 million SSDI beneficiaries in the Medicare waiting period as of January 2002, all of whom are unable to work because of their disability and most of whom have serious health problems, low incomes, and limited access to health insurance. Our research shows that eliminating the two-year wait for Medicare could improve access to health insurance for many seriously disabled Americans, including as many as 400,000 who may be uninsured, those with Medicaid coverage who may have limited access to health benefits and providers, and those with private coverage who, because of their health problems, are paying unusually high premiums to maintain their coverage. Dropping the waiting period would also be of great benefit to cashstrapped states, which are currently experiencing the most serious budget problems they have faced in decades (National Conference of State Legislatures, 2003). Shortfalls in revenues, combined with double-digit increases in Medicaid expenditures, have already caused many states to cut Medicaid benefits, remove people from the Medicaid rolls, or both (Smith et al., 2003). Employers would also gain from a change in policy, since their payments for COBRA coverage of former employees, and for coverage of disabled spouses and dependents of current employees, could be signifiThe Commonwealth Fund is a private foundation supporting independent research on health and social issues.The views presented here are those of the authors and should not be attributed to The Commonwealth Fund or its directors, officers, or staff, or to members of the Task Force on the Future of Health Insurance.