Disability Qualifications for Medicare | Medicare Under 65

Medicare is often associated with people over the age of 65.

But you may be surprised to learn that this federal health insurance program is also available to people with certain disabilities and End Stage Renal Disease, regardless of age.

Learn more about Medicare disability qualifications below.

Man talks with his doctor

Qualifying for Medicare because of a disability

The qualification for Medicare on the basis of a disability includes the following scenarios: 

  1. You have received disability benefits for at least 24 months
    If you receive disability benefits from either Social Security or the Railroad Retirement Board for at least 24 months, you may be eligible for Medicare.

    If you meet this requirement, you will be automatically enrolled in both Part A and Part B of Medicare (known as Original Medicare) on your 25th month of disability benefits.

    Approximately three months prior to this date, you should receive a package in the mail containing your Medicare card and information about how Medicare works.
  1. You have been diagnosed with ALS (Lou Gehrig’s disease)
    You will be automatically enrolled in Original Medicare if you have been diagnosed with amyotrophic lateral sclerosis (also known as ALS and Lou Gehrig’s disease) during the first month in which you receive disability benefits as a result of the disease.
  1. You have End Stage Renal Disease (ESRD)
    If you have End Stage Renal Disease requiring either a kidney transplant or dialysis, you may be eligible for Medicare. However, you typically must enroll in the coverage manually.

Qualifying for other coverage options

If you qualify for Original Medicare because of a disability, you may be eligible to enroll in a Part C or Part D plan. Those with End Stage Renal Disease usually can’t enroll in a Medicare Advantage plan.

  • Part C is known as Medicare Advantage and consists of a collection of private health insurance plans that offer the same benefits as Medicare Part A and Part B.

    Most Medicare Advantage plans also offer prescription drug coverage, and some plans may offer things like routine dental and vision coverage.

  • Part D provides prescription drug coverage.

    You can receive Part D benefits through a Medicare Advantage plan that offers drug coverage, or through a standalone Prescription Drug Plan (PDP) that can be used with Original Medicare or a Medicare Advantage plan that doesn’t offer drug coverage.

Medicare Special Needs Plans (SNPs)

A Medicare SNP is a certain type of Medicare Advantage plan that is designed for people who have a specific health condition or qualify for both Medicare and Medicaid.

For example, a Special Needs Plan designed for beneficiaries with congestive heart failure provides coverage for the type of prescription medication used to treat heart failure and will include a network of doctors who specialize in treating the condition.

To qualify for a Special Needs Plan, you must have Medicare Part A and B and meet one of the following qualifications:

  • Have one or more severe or disabling chronic conditions
  • Live in a nursing home or need nursing care at home
  • Have both Medicare and Medicaid

The list of health conditions that may qualify you for a Special Needs Plan include:

  • Chronic alcohol and other dependence
  • Autoimmune disorders
  • Cancer
  • Cardiovascular disorders
  • Chronic heart failure
  • Dementia
  • Diabetes Mellitus
  • End-stage liver disease
  • End-stage renal disease requiring dialysis
  • Severe hematologic disorders
  • HIV/AIDS
  • Chronic lung disorders
  • Chronic and disabling mental health conditions
  • Neurologic disorders
  • Stroke

Qualifying for Medicare Supplement Insurance under 65

Medicare Supplement Insurance, or Medigap, helps cover out-of-pocket costs that Original Medicare doesn't cover.

These costs include things like deductibles, copayments and coinsurance.

Insurance companies are not required to sell Medigap to anyone under the age of 65 in most states, but some Medigap insurance companies may do so voluntarily.

Insurance companies that sell Medigap in the following states are required to make at least one Medigap plan available to people under 65 who qualify for Medicare because of a disability.

Can I keep my Medicare coverage if I return to work?

Yes, you may keep your Medicare coverage for as long as you are still considered medically disabled, even if you return to work.

If you obtain employer health insurance upon returning to work and your employer has fewer than 100 employees, Medicare will be the primary payer for your care.

That means Medicare will pay up to the limits of its coverage first, and then your employer insurance will contribute its share as the secondary payer.

If your employer has more than 100 workers, the employer insurance will serve as the primary payer and Medicare will be the secondary payer.

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If you have any additional questions or wish to learn more about qualifying for Medicare because of a disability, call to connect with a licensed insurance agent today.

 

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