Medicare Disability (Pre 65)
Are you closing in on your 24th month of eligibility?
Eligibility for Medicare on Social Security Disability?
Everyone eligible for Social Security Disability Insurance (SSDI) benefits is also eligible for Medicare after a 24-month qualifying period. The first 24 months of disability benefit entitlement is the waiting period for Medicare coverage. During this qualifying period for Medicare, the beneficiary may be eligible for health insurer through a former employer. The employer should be contacted for information about health insurance coverage.
You will have a five month waiting period that must be completed after you are determined to be disabled before being eligible for Social Security Disability Benefits. During this 5 month waiting period to qualify for Social Security Disability Benefits, the five months is counted towards your 24 month qualification period for Medicare. There is not a 24 month timeline for those with ESRD or ALS.
Medicare is available for certain people with disabilities who are under age 65. These individuals must have received Social Security Disability benefits for 24 months or have End Stage Renal Disease (ESRD) or Amyotropic Lateral Sclerosis (ALS, also known as Lou Gehrig’s disease). People with ESRD and ALS, in contrast to persons with other causes of disability, do not have to collect benefits for 24 months in order to be eligible for Medicare.
ALS qualification for Medicare eligibility is effective immediately upon collecting Social Security Disability Benefits.
ESRD qualification for Medicare eligibility is effective upon completing 3 months of dialysis or after receiving a kidney transplant.
After your 5 month waiting period to begin Social Security Disability Benefits
Once the 5 month Social Security Disability waiting period is up, you’ll be able to begin receiving your Social Security Disability monthly income. As you’re nearing the 21th month of disability and continue to meet the criteria of Social Security Disability Benefits, you’ll be automatically enrolled in Medicare Part A and B to begin the 1st of the month after you reach the 24th month. In the 1-3 months prior to your Medicare start date you’ll have an opportunity to enroll in a Medicare Supplement Plan guaranteed-issue with a Medicare Prescription Drug Plan (Part D) or sign over your Medicare to a Medicare Advantage Plan (Part C that typically includes a Part D plan). This is considered your enrollment window to select the additional Medicare insurance products you would like to add to your Medicare Part A and B. Whichever plan or plans you choose to enroll in during this 3 month window before Medicare will start along with your Medicare coverage on the 1st of the month your coverage begins– see Medicare effective dates on Medicare card.
If you qualify for Medicaid or Medi-Cal, you may be eligible for special programs such as, Extra Help/Loe income subsidies for Part D plans as well as Medicare Part B reimbursement if your income level is low enough to qualify for this reimbursement. In 2022, the Part B premium is $170.10 and is typically taken out of your benefits check each month. If you qualify for the reimbursement, you will not see this Part B premium of $164.90 taken out of your check. To qualify, please contact your Social Security representative. Also, if you’re slightly over the income limit, contact my office to discuss a “spend down”. It may be possible for you to purchase a Medicare Supplement Plan to reduce your income below the limit and then receive the Medicare Part B reimbursement of $164.90. Many times in this scenario, the cost of the Medicare Supplement and the reimbursement is a wash, however, you’ll have great coverage with a Medicare Supplement plan that your reimbursement is paying for. Contact my office is you have more questions about this “spend down” strategy.
How is the 24 month Medicare eligibility counted?
SSA counts one month for each month of disability benefit entitlement.
Months in previous periods of disability may be counted towards the 24-month Medicare qualifying period if the new disability begins:
– Within 60 months after the termination month of the worker receiving disability benefits, or
– Within 84 months after the termination of disabled widows or widowers benefits or childhood disability benenfits, or
– At any time if the current disabling impairment is the same as, or directly related to, the impairment which was the basis for the previous period of disability benefit entitlement.
Medicare Planning prior to your 24th month of Medicare on disability
As you approach your 24th month of disability for Medicare eligibility, you’ll have an opportunity to plan for your Medicare coverage. Just like someone who is turning 65, you have an opportunity to enroll in a Medicare Supplement Plan with a Medicare Prescription Drug plan, or a Medicare Advantage Plan prior to Medicare start date.
I recommend that you speak with your Social Security representative to make sure your Medicare coverage begins on the 1st of the month following your 24th month of disability. You should receive your Medicare card 1-3 months before your Medicare start date. Because you are currently receiving Social Security Disability Benefits, you should be automatically enrolled in Part A and Part B of Medicare. Part A of Medicare is typically “premium free” so you should not see a charge for this portion of Medicare. As for Part B, you will likely see $164.90 (2023 Part B premium) taken out of your benefits check for each month you’re covered under Medicare. This is the standard Part B premium for all Medicare beneficiaries throughout the United States. This is the same premium that those who qualify for Medicare Part B based on their age qualification for Medicare when they reach 65. As I mentioned above, some Medicare beneficiaries will be eligible for a Part B reimbursement with qualifying income and/or have the option to look into a “spend down” strategy of purchasing insurance to drop you below the income limit and then receive the $164.90 reimbursement.
Typical costs for Medicare when on Social Security Disability Benefits:
Medicare Part A – premium free
Medicare Part B – $164.90 (2023)
Supplement Medicare Part A and B with:
Medicare Supplement Plan: Rates vary. Contact me for rates in your Zip code.
Medicare Prescription Drug Plan (Part D) – 25 Part D Rx plans in CA. Contact me to review your Medication list and shop all 25 Part D Rx plans.
OR SIGN OVER MEDICARE…
Medicare Advantage Plan (Part C with a Part D included) – Contact me to review plans in your zip code as well as run medication review for Medicare Advantage Plans in your service area.
Note: Medicare Advantage Plans or Part C plans are not offered in all zip codes of CA like Medicare Supplement Plans and Medicare Prescription Drug plans. These plan types are not to be used to “supplement” your Medicare Part A and B. Rather, think of these plans as substituting your Medicare A and B with a networked insurance plan in your service area (i.e HMO or PPO) that typically includes a Part D plan as a “bundled” plan. See more on Medicare Advantage Plans under Medicare 101 as well as view the coverage path with the Medicare Map as well as the Medicare Roadmap.
Request Help with your Medicare insurance plan enrollment before your 24th month of disability.
Additional information on qualifying for Medicare with a disability.
Are there Medicare benefits available for people with disabilities? Also, do people with chronic conditions qualify for Medicare?
Medicare coverage is the same for people who qualify based on disability as for those who qualify based on age. For those who are eligible, the full range of Medicare benefits are available. Coverage includes certain hospital, nursing home, home health, physician, and community-based services. The health care services do not have to be related to the individual’s disability in order to be covered.
People with these and other long-term conditions are entitled to coverage if the care ordered by their doctors meets Medicare criteria:
- Alzheimer’s Disease
- Mental Illness
- Multiple Sclerosis
- Parkinson’s Disease
If it seems that Medicare enrollment or coverage has been unfairly denied, ask the individual’s doctor to help.
Medicare eligibility for those with Chronic conditions:
Medicare coverage can be available for health care and therapy services even if the patient’s condition is unlikely to improve.
Medicare coverage for medically necessary services for chronic, long-term conditions should be equally available in both the traditional Medicare program and in Medicare Advantage (MA) plans. The rules for determining what Medicare covers are the same for both delivery systems.
The Medicare program recognizes the need for skilled care and related services for chronic, long-term conditions. For care to be covered, the patient must require skilled services which may be designed to:
- Maintain the status of an individual’s condition; or
- Slow or prevent the deterioration of a condition; or
- Improve the individual’s condition
