In 2024, more than 620,000 people in the United States qualified for Social Security Disability Insurance (SSDI) after being determined to have a disease or disability severe enough to prevent them from working for at least one year. Despite being in poor health, most will not become eligible for health insurance through Medicare this year, 2026, because of a mandatory 24-month waiting period.

“There’s no system in place to provide health insurance for this group [during the waiting period] so they have to rely on Medicaid if they qualify, spousal coverage if that’s an option, purchase insurance from an exchange, or find insurance from some other source,” LDI Senior Fellow David Powell said. “Many probably just go uninsured.”

Powell’s recent Health Affairs study is the latest to describe death rates among SSDI beneficiaries during the 24-month Medicare waiting period, which was initially introduced to contain Medicare costs. The research found that among SSDI beneficiaries, those with systemic diseases, like heart failure, COPD, and cirrhosis, had the highest mortality rates, and the overall mortality rates for beneficiaries were substantially higher than in the general population. 

This disparity is not surprising because SSDI eligibility is limited to people with severe illnesses. Beneficiaries tend to have high rates of uninsurance and report delaying care and skipping medications.

People with end-stage renal disease and ALS are already exempt from the Medicare waiting period because of the rapid onset of illness and immediate need for treatment.

The study’s new findings could help policymakers as they consider legislation to expand exemptions to the waiting period to include people with metastatic breast cancer and individuals who cannot afford insurance, such as the Stop the Wait Act of 2025. 

Study Used National Data From Social Security Administration and the Census

Powell and colleagues used the Social Security Disability Analysis File (DAF) to identify new beneficiaries from 2000 to 2019 who were ages 18-62 years old when they first became entitled to SSDI benefits. The researchers calculated mortality rates by year, age group, and primary impairment, which consisted of three broad categories: primarily functional impairments, systemic diseases, and mental disorders. They compared the SSDI population mortality rates with those of the general population ages 18 to 62 using the 2000 to 2020 data from the National Vital Statistics System (NVSS), adjusting for the age and sex distribution of new SSDI beneficiaries in each year.

Big Difference in Two-Year Mortality Among SSDI Recipients and General Population

Figure 1. Mortality Rates Among SSDI Beneficiaries and the General Population, 2000-2019

As shown in Figure 1, the mortality rate for SSDI beneficiaries declined overall during the study period, ranging between 5.20% and 7.30%, while the adjusted rate for the general population hovered around 1%. The increase in mortality from 2011 to 2019 among SSDI beneficiaries can be attributed to changes in the demographics and primary impairments of new beneficiaries.

According to Powell, the increase may be an artifact of people not being counted before.  

“The composition of new beneficiaries is changing in a meaningful way. It is an open question as to why. But when you adjust for compositional changes, mortality [in the group] is actually declining,” he said. 

Substantial Variation in Mortality Within SSDI Population

Among SSDI beneficiaries, those with mental and functional impairments had the lowest mortality rates, while beneficiaries with cancer had the highest rate at 39.3%. The next highest mortality rate was for beneficiaries with digestive system impairments, at 11.3%. The 24-month mortality rate among new SSDI beneficiaries was 8.4% for those with blood and blood-forming diseases and 8.1% for those with a primary impairment related to HIV/AIDS. 

Limitations and Implications

The mortality findings are striking—but descriptive. They do not indicate that the current policy causes excess deaths. “We are just describing the vulnerability of the SSDI population. We aren’t saying the lack of Medicare is driving mortality,” Powell said. 

The work highlights the vulnerability of this population and furthers the conversation about recent legislative attempts to expand the scope of who is exempt from the 24-month Medicare waiting period. 

“We are potentially excluding a vulnerable population from public insurance, and we should reconsider this policy,” he said.

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The study, “SSDI Beneficiaries Had Elevated Mortality During The 2-Year Waiting Period For Medicare, 2000–21,” was published March 2, 2026 in Health Affairs. Authors include David Powell, Seth Hartig, and Mireille Jacobson.

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