Medicare is a federal health insurance program designed to provide affordable health coverage to those over 65 and those with certain conditions. Medicare for people with disabilities does not require the recipient to be over 65 years old.

What Disabilities Qualify for Medicare?

If you are under the age of 65 you can qualify for Medicare under the following conditions:

• You are disabled and have received Social Security Disability benefits for a minimum of 24 months
• You have received disability benefits from the Railroad Retirement Board for at least 24 months
• You have End-Stage Renal Disease (ESRD)
• You have Lou Gehrig’s disease or Amyotropic Lateral Sclerosis (ALS)

Do you automatically get Medicare with disability?

You do not automatically get Medicare coverage if you have a disability. To qualify for Medicare disability insurance if you are under the age of 65 you need to have received Social Security Disability benefits for at least 24 months.

If you are eligible for Social Security Disability Insurance (SSDI), you will automatically qualify for Medicare insurance after 24 months. The enrollment will be effective automatically on the 25th month, so you do not need to contact Medicare or apply to be enrolled. Your Medicare card will be mailed to you 90 days before the start of your Medicare coverage.

The 24-month waiting period was put in place to ensure that Medicare disability insurance is only extended to people with severe and long-term disabilities. If you meet the criteria for Social Security Disability Insurance you will be enrolled in Parts A and B of Medicare.

For people with ALS, there is no 24 month waiting period. You can enroll in Medicare as soon as your Social Security Disability Insurance (SSDI) benefits start.

Is Medicare mandatory if on disability?

If you are disabled and a beneficiary of Social Security Disability Insurance benefits you are required to enroll for Medicare Part A even if you have another insurance plan. You will be automatically enrolled in Medicare Part A and B after 24 months of receiving social security disability benefits.

Medicare Part A does not attract any premiums, but if you fail to enroll you will be required to pay back social security disability benefits. This means that as long as you have received disability benefits for 24 months or more, you have to sign up for Medicare Part A.

You will also be automatically enrolled in Medicare Part B, but this part attracts a premium that will be deducted from your social security disability benefits. However, unlike Medicare Part A, you can opt out of Medicare Part B if you have another insurance plan. It is important to note that if you decide to take up Medicare Part B after declining it initially, you may have to pay higher premiums for it.

What Medicare benefits are available for people with disabilities?

Medicare disability benefits are similar to the coverage benefits that Medicare members who qualify based on age receive. This means that you will receive:

• Medicare Part A coverage – covers hospital care, skilled nursing facility, hospice care, and home health;
• Medicare Part B coverage – covers doctor visits, certain medical equipment, outpatient services, home health services, and other specified medical services.

Medicare recipients who qualify on disability also have the option to go for Medicare plans offered by private insurance companies, including Medicare Part C (or Medicare Advantage) and Medicare Part D, which offers prescription coverage.

You may not be eligible for Medigap or Medicare Supplement plans. If you are under age 65 and qualify for Medicare benefits because of a disability.

If you are disabled and on Medicare, but you have another health insurance plan, Medicare will only pay for covered services after your primary insurance plan has paid. This means it will act as secondary coverage in this situation.

Medicare coverage for working people with disabilities

If you have a disability and are working, your Medicare coverage can fall into one of three plans.

1. Trial Work Period (TWP): You will be entitled to continue receiving Medicare and Social Security disability benefits for a maximum 9-month trial work period during any rolling 5 year period. The nine months of trial work do not have to be consecutive but you must meet the set guidelines for gross income or work more than 80 hours per month.
2. Extended Period of Eligibility (EPE):In some cases, your gross income may meet the substantial gainful activity level but you are still disabled. In this case, you may continue to receive Medicare coverage after completing the trial work period. You may remain eligible for Medicare coverage for up to eight and a half years under EPE. Even if the SSDI cash benefits cease during this period you will still be eligible for Medicare coverage.
3. Indefinite Access to Medicare:Working Medicare recipients under 65 years with disabilities may continue to receive Medicare coverage as long as they remain disabled. However, the individual may need to pay premiums for both Part A and B of Medicare based on their income. If you fall in this category, you may get assistance with premiums from a state-run buy-in program that caters to qualified working persons who are disabled.

Medicare disability requirements list

You can qualify for Medicare disability benefits only if you meet either of these set criteria for disability.

• To qualify for Medicare on disability, you need to have received Social Security Disability Insurance (SSDI) benefits for at least 24 months. These benefits are only paid to those who work in jobs covered by Social Security and have a qualifying medical condition that meets the set criteria for a disability.
• You have end-stage renal disease (ESRD): You are eligible for Medicare disability benefits if you have ESRD. Your Medicare coverage will begin 90 days after your dialysis treatment begins. If you get a kidney transplant, your Medicare coverage will last for up to three years after the transplant surgery. If the transplant is successful, your Medicare coverage will cease after three years.
• You have amyotrophic lateral sclerosis (ALS): If you have ALS or Lou Gehrig’s disease, you immediately qualify for Medicare disability coverage. There is no waiting period for this eligibility criteria, and you can apply for Medicare coverage immediately after your diagnosis.

Social Security disability and Medicare

Being a recipient of Social Security Disability benefits is one of the qualifications that can make you eligible to receive Medicare coverage before the age of 65 years. However, to receive SSDI, you must have worked and paid Social Security taxes for some time.

Social security also has strict guidelines on the conditions that can be classified as a disability and make you eligible to receive SSDI benefits. These conditions include:

• Musculoskeletal disorders including amputation, chronic joint pain, and spinal disorders
• Impaired hearing, sight, or speech
• Respiratory disorders including asthma, chronic obstructive pulmonary disease (COPD), and cystic fibrosis
• Neurological disorders, including ALS, Parkinsons, epilepsy, multiple sclerosis, and traumatic brain injuries
• Mental health disorders including dementia and schizophrenia
• Cancer
• Cardiovascular illnesses including heart disease and heart failure
• Digestive disorders including liver and bowel disorders
• Chronic kidney disease
• Disorders of the blood including anemia, sickle cell disease, and bone marrow disorders
• Congenital disorders such as Down syndrome
• Auto-Immune diseases, including lupus, HIV, and inflammatory arthritis

If you qualify for SSDI benefits under any of these conditions, you will be automatically enrolled for Original Medicare coverage after 24 months.

Medicare vs Medicaid disability

As a disabled person, you can qualify for medical coverage under Medicare or Medicaid. Medicare is a federal program that offers affordable Medicare coverage to individuals over 65 years and disabled people who qualify under the guidelines set for disability. To qualify for Medicare as a disabled person, there are no income limits. However, you need to have a qualifying illness or have received Social Security Disability Insurance benefits for at least 24 months.

Medicaid is a needs-based program meaning that it is designed to cater to people with limited income with no age restrictions for eligibility. Unlike Medicare, Medicaid disability has certain income and asset limits since eligibility is assessed on a needs basis. If you are disabled, you can apply for Medicaid through the state agency for your local area. You will be required to provide proof of your income and assets which will be the main rating factors used to determine your eligibility. Medicaid coverage typically covers hospitalization, doctor services, family planning, nursing services, dental services, clinic treatment, pediatric services, and screening services.

What happens to my Medicare disability when I turn 65?

If you have been enrolled on Medicare based on a disability, once you turn 65, you will lose the disability qualification and become eligible based on age. This means that you will still be enrolled in Medicare Part A and B to cover your hospitalization and medical expenses. However, once you qualify for Medicare based on age, you have the option to apply for a Medicare Supplement plan or Medigap.

Medigap is not available to individuals under 65 years enrolled on Medicare based on a disability. However, once you reach the age of 65, you become eligible to apply for it. This is important since Medigap helps to cover the out-of-pocket costs that are not covered by Original Medicare, including deductibles and copayments.

When you turn 65, you can also choose to purchase Medicare Part C or Medicare Advantage plans. You can also opt for Part D coverage if you want to have a plan that also includes prescription coverage. These options are also available for those who are disabled and under 65 years.

Bottom line

Medicare is not just available for those who are over the age of 65. Some disabilities that meet the strict criteria set by Social Security Disability insurance can make you eligible for Medicare coverage before you turn 65. Medicare coverage benefits for disabled persons are similar to those for individuals aged over 65. However, options like Medigap may not be available until you turn 65 years. Disabled people may also qualify for Medicaid coverage at any age, but eligibility is tied to income levels and assessed based on how financially needy the applicant is.