How do I qualify for Medicare if I’m disabled?
- Anyone approved for Social Security disability insurance (SSDI) benefits will also qualify for Medicare.
- People approved to receive Supplemental Security Income (SSI) receive Medicaid benefits.
- Medicare will automatically start for SSDI recipients 24 months after their date of entitlement.
Individuals with qualifying disabilities are eligible to enroll in Medicare, including:
- Part A – Hospital insurance
- Part B – Medicare insurance
- Part C – Private HMO, PPO and PFFS health insurance plans
- Part D – Private prescription drug plan coverage
People under age 65, who have been receiving Social Security disability benefits for more than 24 months, qualifies to receive Medicare benefits. Enrollment is automatic on the 25th month of SSDI benefits. There are two exceptions. People diagnosed with End Stage Renal Disease (ESRD) or Amyotropic Lateral Sclerosis (ALS, also known as Lou Gehrig’s disease), do not have a waiting period.
Medicare Disability Eligibility Requirements
- You are disabled, of any age, and receiving worker’s disability benefits.
- You are a disabled widow/widower age 50 or older, or
- You are a disabled beneficiary over the age of 18 receiving benefits based on a disability that occurred before age 22.
- Individuals disabled by renal disease, who requires dialysis or a kidney transplant, and who is fully or currently insured or entitled to payments either under the Social Security Act or the Railroad Retirement Act is entitled to enroll in Medicare. His or her spouse and dependent children are also entitled to enroll in Medicare.
- Individuals disabled by ALS.
Medicare Disability Benefits After Returning to Work
If you go back to work and no longer receive Social Security disability benefits, you qualify for Medicare coverage for an additional 93 months after going back to work. The extension in coverage only applies if your disabling condition still exists, even though it does not prevent you from working. After the coverage extension ends, you can purchase Medicare Part A. In this case, you may qualify for premium assistance through your state’s Medicaid program.
If you re-qualify to receive Social Security disability benefits you are automatically eligible for Medicare coverage. In this case there’s no waiting period. This rule only applies to workers who re-qualify within five years of their previous entitlement period (seven years for widows/widowers and dependent children).
What Medicare Benefits are available to people with disabilities?
Medicare is Medicare. The benefits are the same no matter how you qualify (age or disability). If you have SSDI, the full range of healthcare coverage benefits are available to you. Coverage includes medically necessary hospital, skilled nursing, home health, and physician services. Unless you qualify for a low-income assistance program, you are responsible for about 20 percent of your major medical costs.
- Medicare Special Needs Plans
- Medicare Medical Savings Account (MSA) Plans
- What are My Medicare Cost Sharing Obligations?