Medicare due to Disability

Navigating healthcare can be challenging, especially when you are living with a disability. While many people associate Medicare with being 65 or older, it is also a vital program for younger individuals who qualify due to a disability. Here's a guide to understanding how to receive Medicare when you have a disability.

How to Qualify for Medicare with a Disability

To be eligible for Medicare due to a disability, you must first be approved for Social Security Disability Insurance (SSDI) benefits. Generally, there is a waiting period before your Medicare coverage begins.

The 24-Month Waiting Period: Most individuals who qualify for Medicare based on a disability must have received SSDI benefits for 24 months before their Medicare coverage starts. This means that your Medicare Part A and Part B will automatically begin on the 25th month of receiving your disability benefits.
Automatic Enrollment: In most cases, you will be automatically enrolled in Medicare Parts A and B once you have met the 24-month waiting period. You can expect to receive your Medicare card in the mail about three months before your coverage begins.

Special Rules for Specific Conditions

There are a few exceptions to the 24-month waiting period for certain medical conditions:

Amyotrophic Lateral Sclerosis (ALS): If you have been diagnosed with ALS (also known as Lou Gehrig's disease), you are automatically eligible for Medicare as soon as you begin receiving SSDI benefits. There is no waiting period.
End-Stage Renal Disease (ESRD): Individuals with permanent kidney failure who require regular dialysis or a kidney transplant may also qualify for Medicare. Eligibility can begin as early as three months after a course of regular dialysis starts or after a kidney transplant. You must have worked the required amount of time under Social Security, the Railroad Retirement Board, or as a government employee, or be the spouse or dependent child of someone who meets these requirements.

Understanding Your Medicare Coverage

Once you become eligible for Medicare, your coverage is the same as it is for people who qualify by age. You'll have access to the full range of Medicare benefits.

Medicare Part A (Hospital Insurance): This part of Medicare helps cover inpatient hospital stays, care in a skilled nursing facility, hospice care, and some home health care. For most people who have worked and paid Medicare taxes, Part A is premium-free.
Medicare Part B (Medical Insurance): Part B covers medically necessary doctors' services, outpatient care, durable medical equipment, and preventive services. Most people pay a monthly premium for Part B.
Medicare Advantage (Part C) and Part D: When you become eligible for Medicare, you also have the option to enroll in a Medicare Advantage Plan (Part C) or a stand-alone Medicare Prescription Drug Plan (Part D). These are private plans that offer an alternative to or work alongside Original Medicare.

What to Do During the Waiting Period

If you are approved for SSDI benefits but are still in your 24-month waiting period for Medicare, you have a few options for health coverage:

Medicaid: Depending on your income and resources, you may be eligible for Medicaid, which provides low-cost or free health coverage.
Marketplace Plans: You can explore health plans available through the Health Insurance Marketplace. You may qualify for lower costs based on your income.
Employer Coverage: If you or a family member has job-based health insurance, you may be able to stay on that plan while you wait for your Medicare to begin.