How to Get Medicare Coverage for People with Disabilities: Medicare for People Under 65 and have a Disability
In the U.S., people can start receiving Medicare benefits at age 65, but what do you do if you’re receiving social security disability benefits due to a disability and under 65? This can be a confusing question with no easy answer.
Fortunately, there are some things you can do to help make the process a little easier for people who qualify for Medicare benefits.
Here we will outline your options as Medicare Beneficiaries and provide some advice on how to get Medicare if you’re under 65 with a disability.
Keep in mind that these steps are not definitive, so please consult with a healthcare professional for more information specific to your situation.
Table of Contents
What is Medicare?
What are Original Medicare Part A and Part B
The Center for Medicare and Medicaid is a government-run health insurance program in the United States that provides coverage for people over 65 and people with disabilities.
There are over a million people with disabilities that meet the criteria for social security disability and are entitled to continue receiving Medicare.
Original Medicare is divided into two parts: Medicare Part A, which covers hospital expenses, while Medicare Part B pays for doctor visits.
Medicare beneficiaries under 65 with a qualified disability may also qualify for Medicare Part D, which covers your prescription medications.
People with disabilities who are under age 65 will automatically enroll in Medicare Part A and Part B on the 25th month. Medicare coverage begins on the first day of the 25th month.
You can learn more about Medicare and how to sign up for Medicare Part A and Part B by continuing to read on.
Medicare Supplement Plans for Disabled Americans Under 65
Medigap policy benefits offer a way for these people to pay for the medical expenses that aren’t covered by Orignal Medicare, like copays, deductibles, coinsurance, and out-of-pocket costs.
Medicare beneficiaries with disabilities prefer staying on Original Medicare and buying a Medigap plan as they often need the flexibility to see multiple doctors and medical facilities.
It can be challenging to cover all doctors under a Medicare Advantage plan. All of the red tape goes away for those Medicare beneficiaries who remain on original Medicare with a Medicare Supplement policy.
With a Medigap plan, you can receive health care coverage to cover your supplemental medical expenses, such as occupational therapy services, home health care, kidney dialysis treatment, speech therapy, and inpatient care.
Are there Disadvantages of Medicare Supplement Plans?
While supplement plans can provide valuable coverage, there are some potential disadvantages.
First, supplement plans are only available to people who already have Medicare. This means that if you are not eligible for Medicare, you will not be able to purchase a supplement plan.
In addition, supplement plans can be expensive. The monthly premiums can add up, and you may also be responsible for paying an annual deductible.
Finally, supplemental coverage is not always comprehensive. Depending on which Medigap plan you buy, there may be gaps in your coverage, which could leave you with some out-of-pocket costs.
While supplement plans can be a helpful way to fill in the gaps in Medicare coverage, it is essential to weigh the potential disadvantages before enrolling in a plan.
Is Medicare Advantage a good choice for People with Disabilities under 65?
We understand that the day you lost your employer group health plan could not have come at a worse time. Medical bills don’t stop just because you are no longer working. Now you have higher costs without a paycheck.
Many people who qualify for disability benefits choose to enroll in Medicare Advantage plans because many of their plans do not require an additional monthly premium and no medical underwriting to qualify. Medicare Advantage plans also provide comprehensive coverage that can include additional benefits such as hearing aid coverage, basic dental, and glasses.
Those who collect social security disability benefits need to stretch their dollars, making these plans more attractive. However, it is critical also to consider the costs of using a Medicare Advantage plan for individuals who have disabilities and are more likely to be heavy health care users.
Often, Medicare Advantage plans come with cost-sharing requirements and may cost more than Traditional Medicare with a Medigap plan. This is why it is vital to work with a Medicare insurance agency with a team of experts from which you can ask questions.
Before choosing a Medicare Advantage plan, it’s essential to research all of your options and decide which one is best for you.
If you’re eligible for Medicare and have a disability, we recommend you consider enrolling in a Medicare Advantage plan. You can find out more about what’s available through our website or by calling our office at (562) 735-3553.
Are there Disadvantages of a Medicare Advantage Plan?
Medicare Advantage plans are an alternative to the Original Medicare Plan and typically offer additional benefits such as prescription drug coverage, dental, and vision.
While these plans may seem like a good option, there are some disadvantages to consider before enrolling.
One drawback is that you may have to pay more for services not covered by your plan. In addition, you may have to see specific providers that are in-network, and you may need referrals for specialists.
Another downside is that Medicare Advantage plans can change yearly, so you may need to switch plans if your current one is discontinued.
Finally, if you travel frequently, you may not have the same coverage outside your home state.
Although Medicare Advantage Plans offer some advantages, it’s essential to be aware of the potential disadvantages before deciding.
Medicare Part D for People Under Age 65 with Disabilities
Medicare Part D was created to help disabled individuals receive disability benefits for at least 24 months and those individuals age 65 and older who do not have private health insurance.
The program offers affordable premiums and discounts on prescription drugs. If you’ve received disability benefits and qualify for Medicare you have two options to obtain your Part D prescription drug coverage.
Option 1:
If you are enrolled in Original Medicare with a Medigap plan you have the freedom to buy a standalone Medicare Part D prescription drug plan.
Option 2:
If you are enrolled in a Medicare Advantage plan you will be required to accept the Part D plan that is included with the plan selected. A standalone Part D plan is not an option with a Medicare Advantage plan.
Do People Under 65 with Disabilities Qualify for Medicare: How to Get Medicare with a Disability
How Disabled Adults Under 65 Qualify for Medicare Coverage
Disabled adults under the age of 65 may qualify for Medicare coverage if they meet certain criteria. To be eligible, adults must have a disability that has lasted or is expected to last for at least one year or have a terminal illness.
They must also be enrolled in Social Security Disability Insurance (SSDI) or have been approved for Supplemental Security Income (SSI). In addition, they must be legal residents of the United States and have either a valid Social Security number or a Medicare Beneficiary Identifier.
If they meet all of these criteria, they will automatically be enrolled in Medicare Part A and Part B after receiving disability benefits from social security for 24 months. Disability benefits begin on the 25th month for your Medicare coverage that you’ve received disability benefits from social security.
How Disabled Children Qualify for Medicare
Medicare is a federal health insurance program that is available to people who are 65 years of age or older, as well as those who meet certain criteria. Disabled children may also qualify for Medicare benefits. Younger Medicare beneficiaries with disabilities may qualify if they are under the age of 18 and have a disability that is expected to last for at least one year or result in death.
Following are some of the conditions that may qualify:
- Blindness
- Deafness
- Cerebral Palsy
- Down Syndrome
- Muscular Dystrophy
- Severe Intellectual Disability
- Symptomatic HIV Infection
- Low Birth Weight
If a child meets these criteria for Medicare eligibility, he or she will automatically qualify for Medicare Part A and Part B. Part A covers hospitalization expenses, while Part B covers outpatient care, such as doctor’s visits and laboratory tests. Medicare benefits can help to cover the costs of necessary medical care for disabled children and their families.
This benefit is also available to adults who have been disabled since childhood (prior to age 22), and who may be eligible for Social Security Disability Insurance (SSDI) benefits. We refer to this SSDI benefit as a “child’s” benefit because it is paid on the parent’s Social Security earnings record.
Is there a waiting period for Medicare for People with Disabilities: 24-Month Medicare Benefits Waiting Period
Individuals receiving social security disability insurance benefits must wait for their disability benefits for 24 months prior to being eligible to sign up for Medicare disability benefits.
Once you become eligible for Medicare you can apply for your Medicare card as you now qualify for disability Medicare benefits.
You will be automatically enrolled in Medicare once you have been receiving disability benefits for 24 months. On the 25th month, you will need to confirm you are enrolled in both Part A and B of Medicare to ensure you are receiving your full benefits.
How can you apply for my Medicare Red, White, and Blue Card: By Mail, Phone, and Online
To apply for your Medicare Red, White, and Blue Card, you’ll need to visit a participating Medicare office, complete the online registration, or call your local Medicare office.
Am I Required to Enroll in Medicare Part B if I am Disabled?
If you are disabled and under the age of 65, you may be required to enroll in Medicare Part B. While we understand that money may be tight, in order to obtain your full health care benefits you will need to enroll in both Part A and Part B of Medicare.
Integrity Now Insurance Brokers also recommends buying a Medigap plan or enrolling in a Medicare Advantage plan. Speak to one of our licensed Medicare agents for help.
What are the Costs of Medicare: How to Reduce your Health care Spending on Copays and Medications?
The costs of Medicare vary depending on your age, health status, and income. Medicare is a government-run health insurance program for people who are over 65 years old and those who qualify for social security disability benefits.
There are different types of Medicare plans that you can choose from which include:
Original Medicare with a Medigap Plan – Original Medicare (Part A and Part B) is a health insurance program that covers hospitalization, medical care, and some preventive services. People with Original Medicare must pay deductibles and coinsurance out of pocket.
Some people choose to supplement their Original Medicare coverage with a Medigap plan, which is a private health insurance policy that helps pay some of the costs not covered by Original Medicare.
Medigap Plan G is the most common plan bought by Medicare beneficiaries, as it covers all costs minus your annual Part B deducible.
Medicare Advantage Plan – A Medicare Advantage Plan is a type of health insurance that is offered by a private company and approved by Medicare. This plan provides all of the benefits of Original Medicare, Part A and Part B, but may also include extra benefits, such as prescription drug coverage or basic dental and vision care.
You may be able to enroll in a Medicare Advantage Plan if you have Medicare Part A and Part B and live in the service area of the plan.
What is Medicare Advantage Special Needs Policies and are they right for me?
Medicare Advantage Special Needs Plans (SNP) is a type of health insurance plan that helps people with disabilities and chronic illnesses access Medicare benefits.
The goal of a Medicare Advantage SNP is to provide affordable, high-quality coverage for people with special needs.
Medicare covers most medical expenses for people with disabilities and chronic illnesses, but some costs may still be too high for a person on Medicaid or without insurance. A Medicare Advantage SNP can help cover those costs by supplementing the government program.
People who are covered under a Medicare Advantage SNP have the same rights and protections as everyone else in the program. They can use all their usual doctor and hospital networks, and they’re eligible for prescription drug coverage through Part D just as anyone else in the program is.
Most SNP plans are HMO plans which require you to use their covered doctors and medical facilities.
What happens when you turn 65 and I was already enrolled in Medicare due to a qualified disability?
When you turn 65, you are automatically enrolled in Medicare Part A and Part B, also known as Original Medicare. If you are already enrolled in Medicare due to a qualified disability, your coverage will continue without any changes.
You will still be responsible for paying your monthly premiums, as well as any deductibles, coinsurance, and copayments associated with your coverage.
In some cases, you may also be eligible for additional benefits, such as prescription drug coverage or a Medicare Advantage plan.
As you reach your retirement age, your social security disability income will stop and you will need to activate your regular social security retirement income.
If you have any questions about your coverage or benefits, you can contact your local Social Security office or the Medicare hotline at 1-800-MEDICARE.
I was Diagnosed with ALS (Lou Gehrig’s Disease) do I qualify for Medicare Disability Coverage?
If you have been diagnosed with ALS, you may be able to qualify for Medicare disability coverage without the need for the 24-month waiting period.
You would first need to speak with a doctor about your diagnosis and see if it qualifies as a medical condition that meets the qualifications for Medicare disability coverage.
Once your doctor has determined that you meet the requirements, you would then need to file an application for Medicare disability coverage.
The process of filing an application can take some time, but it’s important to remember that it will help ensure that you’re receiving the benefits and services you deserve while living with ALS.
I was Diagnosed with End-Stage Renal Disease (ESRD) do I Qualify for Medicare Disability Insurance
If you have been diagnosed with end-stage renal disease ESRD, which is a type of renal failure, you may be eligible for Medicare disability insurance. This insurance covers your medical expenses if you can’t work because of your illness.
To qualify for this insurance, you must meet certain requirements and meet the standards set by the Social Security Administration (SSA).
Eligibility depends on many factors, so talk to an expert about your situation to find out if it’s possible for you to qualify.
Medicare disability Insurance is a valuable coverage option that can help cover some of your medical expenses.
When Should I Call a Medicare Insurance Agent to Enroll in a Medicare Plan?
When should you call a Medicare insurance agent to enroll in a Medicare plan?
You should call a Medicare insurance agent 3 months prior to you or your spouse turning 65 years old or 3 months prior to your 24 months of being on social security disability insurance.
Give us a Call and Ask for Help with your Medicare Enrollment and Eligibility Questions
If you are disabled and under 65 we understand all of the difficulties of the Medicare process. Integrity Now Insurance Brokers also understands you have been waiting nearly two years to obtain your health insurance coverage through Medicare.
On the 25th month of receiving social security disability insurance you automatically get Medicare Part A and B however, you must sign up for either a Medicare Advantage plan or Medicare Supplement plan through a certified insurance agent.
You will also need to enroll in a Medicare Part D plan.
One of our Medicare insurance agents will help with both of these options and explain the pros and cons of each Medicare plan option.
We are here to help explain all available options for people with disabilities and look forward to your call.
We hope you have learned a lot from this article. Now you know when Medicare benefits are available and what steps to take.
