People With Disabilities And Medicare

Medicare isn't just for people over the age of 65. According to the Centers for Medicare & Medicaid Services, nearly 8 million people with disabilities will be eligible for Medicare benefits as of April 2022, accounting for just under one-eighth of all Medicare beneficiaries.

To be eligible for Medicare before the age of 65, most people with disabilities must first qualify for Social Security Disability Insurance, or SSDI. People on SSDI typically have a two-year waiting period before they can enroll in Medicare.

Here's what you need to know about how people with disabilities can qualify for Medicare, as well as how Medicare works for people under the age of 65.

Do You Get Medicare If You Have A Social Security Disability?

No. There are some conditions that apply if you receive SSDI. After receiving SSDI, you must wait two years before applying for Medicare (unless you qualify for certain exceptions).

To qualify for SSDI, you must meet the requirements for both your condition and your work history.

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What are the principal types of Medicare insurance?

What Disabilities Qualify For Medicare Before The Age Of 65?

SSDI benefits are not available for all disabilities or conditions. The Social Security Administration, or SSA, defines its SSDI as "strict."

According to the SSA, all of these must be true in order to qualify for SSDI benefits:

•Because of a medical condition, you are unable to work or engage in other "substantial gainful activity."

•Because of the condition, you are unable to perform previous tasks or adjust to new ones.

•Your medical condition has been present for at least one year, is expected to last at least one year, or will result in death.

Work Credits For Social Security

To be eligible for SSDI, you must have a certain amount of work experience. You qualify through Social Security work credits, which are calculated similarly to Social Security retirement benefits.

Work can earn you up to four credits per year. In 2022, you receive one credit for every $1,510 in earned wages or self-employment income, for a total of $6,040

To qualify for SSDI, most applicants must have 40 Social Security work credits. If you earn all four each year, you'll need ten years of experience. However, at least some of the work must be recent: You must have earned 20 work credits during the 10-year period ending in the year your disability began.

If you are under the age of 31, you may be able to qualify for SSDI with fewer work credits.

Medicare Frequently Has A Two-Year Waiting Period.

If you are under the age of 65 and receive SSDI, you must generally wait 24 months before becoming eligible for Medicare.

During that 24-month period, you may be eligible for additional healthcare assistance, such as

Medicaid: If you receive SSDI or Supplemental Security Income, or SSI, you may be eligible for Medicaid in many states. Because each state administers its own Medicaid program, you must check your state's rules to see if you qualify.

Marketplace coverage: In the health insurance marketplace, you can look for coverage from a private insurance company. Depending on your income, you may be eligible for low-cost coverage — but keep in mind that your SSDI income counts toward those limits.

Certain Conditions Do Not Necessitate A 24-Month Wait.

The 24-month waiting period for Medicare does not apply if you have certain conditions.

End-Of-Life Renal Disease

If you have end-stage renal disease or ESRD, you can generally get Medicare starting on the first day of your fourth month of dialysis treatments if you meet certain Social Security and health-related conditions.

You may also be able to qualify for Medicare coverage sooner if you receive home dialysis training.

If you need a kidney transplant, Medicare coverage begins the month you are admitted to a Medicare-certified hospital for the transplant or related services prior to the transplant. This coverage, however, is only available for two months before your transplant. If the transplant is postponed or rescheduled, you are eligible for Medicare coverage beginning two months before the new date.

Lou Gehrig's disease, also known as amyotrophic lateral sclerosis, is a neurological disorder.

If you receive SSDI benefits because you have Lou Gehrig's disease or ALS, you are eligible for Medicare the first month you receive your benefits.

Considerations For People With Disabilities Enrolling In Medicare

When should you sign up for benefits?

When you become eligible for Medicare due to disability, you enter an initial enrollment period, just like beneficiaries who qualify based on age. This is the time when you decide what kind of Medicare coverage you want.

The initial enrollment period begins before the end of your 24-month waiting period. It begins in the 22nd month of receiving SSDI benefits and lasts for seven months.

What types of Medicare plans are there?

If you qualify for Original Medicare due to a disability, you will receive it automatically. Original Medicare consists of Medicare Parts A and B (hospital insurance) (medical insurance). You are not, however, required to remain on Original Medicare.

If you want to add or change one or more of the following options, you must first sign up:

•Plans for Medicare Advantage, also known as Medicare Part C.

•Prescription drug plans under Medicare Part D.

•Medigap is an abbreviation for Medicare Supplement Insurance.

Only Medicare Part A Is Provided For Free.

For those receiving SSDI benefits, Medicare Part A is free. Because Part B is technically voluntary, you must pay premiums unless you opt-out and postpone Part B coverage.

If you sign up for a Medicare Advantage plan, a Medicare Part D prescription drug plan, or Medicare Supplement Insurance, you will also have to pay premiums.

You may be unable to obtain Medicare Supplement Insurance.

If you have Original Medicare (Parts A and B), you may want to consider purchasing Medicare Supplement Insurance, or Medigap, to help cover some of your out-of-pocket costs. However, if you are under the age of 65, insurance companies may refuse to sell you a Medigap policy.

If you qualify for Medicare for reasons other than age, your state's laws may determine which Medigap policies — if any — are available to you:

•A third of the states have no law requiring companies to sell Medigap to beneficiaries under the age of 65.

•The remaining two-thirds of states require insurance companies to sell at least one type of Medigap policy to certain Medicare beneficiaries under the age of 65 The specifics, however, vary. Not all beneficiaries will be eligible, and not all policy types will be required.

Insurance companies can still sell you a Medigap policy in states where it is not required, so it's worth looking to see what's available in your area.

Medicare Supplemental Insurance Plans

You may be able to purchase a special needs plan, or SNP, under Medicare Advantage. SNPs provide benefits that are tailored to the specific care needs of specific groups.

SNPs are classified into three types -

•Chronic Illness Beneficiaries with certain severe chronic conditions are eligible for SNPs.

•Institutional SNPs are available to beneficiaries who require the types of care provided by certain facilities or who will reside in certain facilities for at least 90 days.

•Dual-Eligible SNPs, or D-SNPs, are available to beneficiaries who are eligible for both Medicare and Medicaid in order to coordinate benefits.

At medicare.gov/plan-compare, you can learn about the different types of plans available in your area, their benefits, and membership requirements.

When You Reach The Age Of 65, You Are Eligible For Another Initial Enrollment Period.

When you become eligible for Medicare based on your age, you will have another chance to choose your coverage. Even if you already have Medicare, you are eligible for an additional seven-month initial enrollment period around your 65th birthday. That period begins three months before your 65th birthday including your birthday month and ends three months after your 65th birthday