Qualify for Medicare under Age 65 on the Basis of Disability - dummies

Qualify for Medicare under Age 65 on the Basis of Disability

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People with disabilities have historically had a hard time finding affordable health insurance because of their medical problems. But Medicare helps by covering three categories of disabled people — those who

  • Have received Social Security disability payments for at least two years

  • Have permanent kidney failure (ESRD)

  • Have Lou Gehrig’s disease (amyotrophic lateral sclerosis, or ALS)

If you have any illness, injury, or disability that prevents you from earning more than a certain amount of money each month and this medical condition is expected to last for at least one year, you may be eligible for Social Security Disability Insurance (SSDI).

After Social Security has reviewed your application, it will let you know whether you qualify for SSDI. If you do, you’ll receive monthly cash payments, starting five months after the date that Social Security determines your disability began.

And eventually, you’ll also qualify for Medicare benefits that are exactly the same as those for people who are 65 or older. The catch, though, is that the law generally requires you to wait 24 months before your Medicare coverage kicks in.

How does the 24-month waiting period work?

Most often, Medicare coverage begins on the first day of the 25th month that you receive SSDI payments. That 25th month counts as the fourth month of your seven-month initial enrollment period.

However, you don’t need to actively apply for Medicare. When you receive SSDI, Social Security automatically enrolls you in Part A and Part B and mails your Medicare card to you two or three months before your coverage becomes effective. (If you want to opt out of Part B, you can do so, but you should also be aware of possible pitfalls.)

However, in some cases the waiting period may be shorter than two years. For example, if you apply for SSDI and get turned down, you can file an appeal against the decision. If you win the appeal, Social Security’s approval of your application is backdated to the first month in which you should have been entitled to receive SSDI.

So the 24-month waiting period for Medicare begins on that date — which may be many months or even years earlier — and not on the date when you actually begin receiving SSDI payments.

The 24 months of waiting for Medicare don’t have to be consecutive. For example, if you got SSDI for a few months and then lost eligibility but qualified again at some later date (even years later), all the months you received SSDI collectively count toward the 24-month waiting period.

If you haven’t received your Medicare card by, say, your 23rd month of receiving SSDI, call Social Security at the number listed earlier to see whether a problem has occurred.

How long does Medicare coverage last?

If you qualify for Medicare through disability, your Medicare benefits continue for as long as you receive SSDI payments and maybe longer. If you lose SSDI because you return to work, your Medicare benefits will continue for an additional 93 months (eight and a half years) under some circumstances and up to a certain level of income.

If your employer offers health benefits, you must accept them, and then Medicare becomes available to you as secondary insurance. (But if the employer’s health insurance includes having a Health Savings Account, you probably won’t be able to use it.)

Beyond the 93 months, if you still have disabilities and are working, your Medicare benefits can continue, but you need to pay a monthly premium for Part A services as well as for Part B (unless you qualify for help from your state through a Medicare Savings Program).

If you’re still receiving Medicare when you reach 65, your coverage will continue seamlessly, but you’ll then be entitled to it on the basis of age and not disability. During this transition, you don’t have to do anything. But you do get another seven-month initial enrollment period (starting three months before you turn 65) in which you can

  • Get a better deal on Medigap supplemental insurance, which may have been unaffordable or denied to you under age 65

  • Change your Medicare coverage choices if you want to

  • Stop paying for any late enrollment penalties that you incurred earlier

Does railroad retirement disability work in the same way?

If you have disabilities and are insured under the railroad retirement system rather than Social Security, the rules are a little different depending on the classification of your disability:

  • Total: If you have total disability (you’re unable to work at any job), you qualify for Medicare coverage after you’ve been receiving disability payments for 24 months.

  • Occupational: If you have occupational disability (you can’t do your regular railroad job but may be able to work at something else), you don’t qualify for early Medicare benefits under age 65.

    However, if at some stage you’re granted a disability freeze because you develop a severe medical condition that prevents you from performing any work or because you’re 55 or older and blind, you’ll become eligible for Medicare 29 weeks after the freeze period begins.