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Medicare Plans for Disabled Individuals Under 65


You can enroll in Medicare before you’re 65 if you have a disability and meet certain other conditions. You can choose Medicare or a Medicare Advantage plan. For many people under 65, an Advantage plan is the most cost-effective option.

How to Qualify for Medicare If Under 65

When you are under 65, you become eligible for Medicare if:

  1. You’ve received Social Security Disability Insurance (SSDI) checks for at least 24 months. At the end of the 24 months, you’ll automatically be enrolled in Parts A and B.
  2. You have End-Stage Renal Disease (ESRD) and need dialysis or a kidney transplant. You can get benefits with no waiting period by applying at your local Social Security office.
  3. Also, if you have Lou Gehrig’s Disease, you’ll automatically be enrolled when you begin receiving disability benefits.

If you’re under 65 and Medicare-eligible you can sign up for an Advantage plan.

Do I Have to Pay for Medicare Part B if I’m Disabled?

Yes, you need to pay the Part B premium when you have a Medicare disability. Generally, the premium will come out of your Social Security check before you get the funds. Now, if you have Medicaid, the state may help cover some of the cost of the Part B premium or Part D premium.

Medicare Advantage Plan for Disabled Under 65

Most Social Security Disability Advantage plans combine Medicare coverage with other benefits like prescription drugs, vision, and dental coverage. Medicare Advantage can be either HMOs or PPOs.

You may have to pay a monthly premium, an annual deductible, and copays or coinsurance for each healthcare visit. Your costs will vary depending on your insurance company and the plan you choose.

You may also be eligible for a Medicare Advantage Special Needs Plan. These plans are only available to people who meet specific criteria, such as having a particular chronic and disabling health condition or being eligible for both Medicare and Medicaid.

A Special Needs Plan is designed around the healthcare needs of the people in the policy. The availability of this type of policy can vary by location.

Many people on Social Security Disability also qualify for their state’s Medicaid program. If you’re on Medicare and Medicaid, you can still sign up for an Advantage plan. The two programs together will usually cover almost all your healthcare costs. But, it’s important to note, Medicare isn’t free.

If you’re under 65, here’s when you can enroll in Advantage Plans:

You can also switch from one Advantage plan to another or drop Advantage coverage during the Medicare Advantage Open Enrollment Period from January 1st to March 31st.

Can You Get a Medicare Supplement if You’re on Disability?

Medicare pays a large portion of the cost, and Medigap can help cover what Medicare doesn’t cover. But if you’re under 65, it can be hard to find an affordable Medigap plan.

While some states require companies to offer at least one Medigap plan to people under age 65, others do not. In some states, Medigap plans are only available to certain types of beneficiaries, such as people with end-stage renal disease.

In several states, you can’t buy a Medigap plan at all if you’re under 65. And rates tend to go up from one year to the next. So, Medigap can be both hard to get and expensive if you’re under 65. Often, the best solution is an Advantage plan.

When you turn 65, you’ll qualify for the Medicare Supplement Open Enrollment Period. Then, you can get a policy without having to answer any questions about your health.

Social Security Disability Income and Medicare Part D

If you choose Medicare, you’ll need a Part D drug plan. You’ll pay a premium, and a copay or coinsurance. And, don’t worry about Medicare and Social Security going away. The National Committee to Preserve Social Security and Medicare works to protect those in need of the federal health program.

Many people on Social Security Disability qualify for Extra Help with Part D costs. Eligibility for Extra Help is based on income and assets. If you’re on Medicaid, you automatically qualify for Extra Help.

FAQ’s

What is Medicare disability?
Medicare is available to people under 65 who have a disability and meet other requirements. If you have a disability and you’re over age 65, you’re automatically eligible because of age.
What disability qualifies for Medicare under 65?
If you have ALS, you qualify for automatic enrollment. You can enroll right away if you have End-Stage Renal Disease. If you have another disability, you can get Medicare if you’ve been collecting Social Security disability for 24 months.
When can a disabled patient enroll in Medicare Part D?
It’s best to sign up for a Part D plan when you first enroll. Your 7-month Initial Enrollment Period for Part D begins three months before Medicare benefits start.
Do I have to pay for Medicare Part B if I am disabled?
Yes, if you are on Medicare, Part A will likely be free and you’ll pay a premium for Part B that is determined by your income.

How to Get Help with Medicare if You’re Disabled and Under 65

We understand Medicare is confusing. That’s why our agents take their time to answer all your questions. Our agents consider the coverage you need and make the best recommendation based on your situation. Don’t waste your time calling each company individually. Call us and get a quote for all the top insurers. We can help you make the best choice. To get started with a free quote, call us at the number above or fill out a quote form.

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Lindsay Engle

Lindsay Engle is the Medicare expert for MedicareFAQ. She has been working in the Medicare industry since 2017. She is featured in many publications as well as writes regularly for other expert columns regarding Medicare. You can also find her over on our Medicare Channel on YouTube as well as contributing to our Medicare Community on Facebook.

6 thoughts on “Medicare Plans for Disabled Individuals Under 65

  1. I’m 61 and have to take a Medicare Advantage plan. It has it’s pros and cons and nothing is perfect. My biggest complaint is the high co oys for everything. I have refused surgeries, tests and therapies because I just can’t afford the cost pays. I make $8 a month too much to be duel eligable. I know there has to be a cut off somewhere but I’m drowning in debt from the medical bills.

    1. Hi Nina! That’s the biggest complaint we hear regarding Medicare Advantage Plans. You have to weigh out the pros and cons… is it better to have a Medigap plan with a higher monthly premium and no copays or out of pocket costs, or is it better to have lower monthly premiums with higher out of pocket costs. Since your on disability, Medigap plans are expensive. However, when you turn 65 you’ll get another Open Enrollment Period that allows you to enroll in a Medigap plan with Guaranteed Issue, and the monthly premium will be significantly lower than it is when you’re under 65. Hopefully, in a few more years you can switch back to Original Medicare and pick up a Medigap plan that won’t have copays and other out of pocket costs.

  2. Please contact me to see if I’m qualified. I will be 63 in July and have COPD and recent surgery for carpal tunnel which may put me out of work.

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