Medicare Coverage for People Under 65 With Disabilities

Medicare is traditionally thought of as health insurance for older adults. But in some cases, people under the age of 65 who have certain disabilities may also qualify for Medicare coverage.

If you are under 65, have a disability and want to learn more about your Medicare eligibility and any Medicare Advantage plans that may be available in your area, you can speak with a licensed insurance agent by calling TTY Users: 711 24 hours a day, 7 days a week.

Woman smiles as doctor gives prescription

When can someone with disabilities 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.

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:

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

The manual is only a guide. An individual’s disability does not have to match the exact requirements outlined in the 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 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 dental, hearing and vision care, as well as prescription drug coverage.

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, speak with a licensed insurance agent by calling TTY Users: 711 24 hours a day, 7 days a week.

Copyright © 2018 TZ Insurance Solutions LLC. All rights reserved.

MedicareAdvantage.com is a website owned and operated by TZ Insurance Solutions LLC. TZ Insurance Solutions LLC and TruBridge, Inc. represent Medicare Advantage Organizations and Prescription Drug Plans having Medicare contracts; enrollment in any plan depends upon contract renewal.

Plan availability varies by region and state. For a complete list of available plans, please contact 1-800-MEDICARE (TTY users should call 1-877-486-2048), 24 hours a day/7 days a week or consult www.medicare.gov.

Medicare has neither reviewed nor endorsed this information.