Medicare Coverage for People Under 65 With Disabilities

The age at which people traditionally qualify for Medicare is 65 years old. But in some cases, people under the age of 65 who have certain disabilities may also qualify for Medicare coverage.

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When can someone under 65 receive Medicare benefits?

If you qualify for Medicare coverage based on your Social Security disability status, you will automatically be enrolled in Part A and Part B of Medicare after first receiving disability benefits for 24 months.

You will receive your Medicare card in the mail approximately three months before your 25th month of receiving disability benefits.

If you have Amyotrophic lateral sclerosis (ALS, or Lou Gehrig’s disease), you typically will be enrolled in Medicare the same month that your disability benefits begin. There isn’t a 24 month waiting period as with other disabilities.

If you have End-Stage Renal Disease (ESRD), you typically will be able to enroll in Medicare three months after a course of regular dialysis begins, or after you receive a kidney transplant.

Those with ESRD generally must manually enroll in Medicare.

Disabilities that may qualify for Social Security benefits and Medicare eligibility

If you are under 65 years old and have a disability other than ALS or ESRD, you must first qualify for disability benefits through the Social Security Administration before you will qualify for Medicare.

The Social Security Administration’s impairment listing manual lists a number of types of disabilities that may qualify someone for disability benefits.

These include:

  • Musculoskeletal problems
  • Cardiovascular conditions
  • Speech and sense impairments
  • Respiratory illnesses
  • Neurological disorders
  • Mental disorders
  • Immune system disorders
  • Various syndromes such as Marfan Syndrome and Sjogren’s Syndrome
  • Skin disorders such as dermatitis
  • Digestive tract problems
  • Kidney disease and genitourinary problems
  • Cancer
  • Hematological disorders
  • Bone marrow disorders

An individual’s disability does not have to match the exact requirements outlined in this guide.

Applicants may be awarded disability benefits if aspects of their condition are determined by the Social Security Administration to be medically equivalent to the listed criteria.

Medicare for children

The minimum age at which you can collect Social Security disability benefits is 18. But under the following circumstances, children under the age of 18 can be eligible for Medicare.

  • The child has End Stage Renal Disease (ESRD) and requires dialysis or a kidney transplant.

  • The parent or legal guardian of the child has ESRD requiring dialysis or a transplant and is receiving Social Security disability benefits. The child may qualify for Medicare benefits as a dependent.

Getting Medicare at age 65

For people without a qualifying disability, eligibility for Medicare Part A requires each of the following:

  • You are at least 65 years old.

  • You are a U.S. citizen or permanent legal resident having lived in the U.S. for at least five years.

  • You are eligible to receive Social Security benefits or Railroad Retirement Board benefits.

If you have worked and paid Medicare taxes for at least 40 quarters (10 years), you will be eligible for premium-free Part A.

If you paid Social Security taxes for fewer than 40 quarters, you can still be eligible for Medicare Part A, but you will have to pay a monthly premium.

You may also become eligible for Medicare because of your spouse’s health care coverage.

If you are at least 65 years old and married to someone at least 62 years old who has worked and paid Social Security taxes for 40 quarters, you may qualify for Medicare as their dependent, even if you do not qualify for Medicare on your own.

How to sign up for Medicare

If you are not automatically enrolled in Medicare because of your disability, you can sign up for Medicare coverage in a few different ways:

Medicare Advantage plan options for people under 65 with a disability

A Special Needs Plan is a type of Medicare Advantage plan (Medicare Part C) that is designed for the specific needs of someone with a specific disability or medical condition.

For example, a Special Needs Plan designed for people with diabetes may likely include more coverage for insulin shots and specific medications used to treat the disease.

It may even include coverage for a diabetes self-management program, in which the beneficiary would receive counseling on diet and nutrition and other means of managing their diabetes.

Medicare Advantage plans provide all of the same hospital insurance and medical insurance coverage of Medicare Part A and Part B combined into one plan.

Medicare Advantage plans may also offer additional benefits that Original Medicare doesn’t offer, such as coverage for:

Some people with disabilities may opt for a Medicare Advantage plan because of the additional benefits some plans may offer.

Some Medicare Advantage plans also offer an increased focus on preventive and coordinated continued care, which could be important for a person with a disability.

To learn about Special Needs Plans or other types of Medicare Advantage plans available in your area, call to speak with a licensed insurance agent today.


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