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Medicare Coverage for Disabled 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.

What Disabilities Qualify for Medicare Under 65?

When you’re 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 enroll 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.

Medicare Advantage Plans 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 fits 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.

Medicare Supplement Plans for Disabled Under 65

Medicare pays a large portion of the cost, but not all of it. 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.

Medicare Part D for Disabled Under 65

If you choose Medicare, you’ll need a Part D drug plan. You’ll pay a premium, and a copay or coinsurance. 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.

Medicare for Disabled Youth

Children under the age of 20 with ESRD can qualify for Medicare if they need regular dialysis treatment and at least one of their parents is eligible for or receives Social Security retirement benefits.

If your child is over the age of 20, they qualify for Medicare after receiving SSDI benefits for at least 24 months. In the case that your child was disabled before turning 22, is unmarried, and one parent receives Social Security retirement benefits, no work history is required for SSDI.

Children 19 years of age or older who don’t qualify for Medicare may qualify for Medicaid. Lastly, children under the age of 18 who don’t qualify for Medicare could qualify for a state Children’s Health Insurance Program (S-CHIP) if their family has a lower income.

FAQs

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.
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.
Is Medicare free for the disabled?
Part A of Medicare is free if you pay into Medicare taxes for enough quarters. Those with lower incomes can get assistance with premium payment.
What are the best Medicare Supplement plans for disabled individuals under 65?
Carriers who offer Medigap to those under 65 always offer Plan A, which includes the most basic benefits. Additionally, premiums for this plan are lower since it includes fewer benefits. As Medigap premiums are much higher when you’re under 65, it can be beneficial to enroll in a Plan such as A to control costs and switch to a plan with more benefits after you turn 65.
Can you get Medicare if you're disabled?
Yes, you can get Medicare if you are receiving SSDI for 24 or more months or if you have ESRD or ALS.
How do I apply for Medicare on disability?
You won’t need to apply; you’ll automatically get Parts A and B of Medicare once you collect SSDI for 24 months. If you have ALS or ESRD, you’ll get Parts A and B automatically, as soon as your SSDI begins.
How does Medicare work for the disabled?
Medicare works in the same way for the disabled as it does for those who age into the program at 65.
How much does Medicare cost on disability?
How much Medicare costs on disability depends on how long you pay Medicare taxes as well as your income level.
When can a disabled person enroll in Medicare Part D?
It’s best to sign up for a Part D plan when you first enroll. Your seven-month Initial Enrollment Period for Part D begins three months before Medicare benefits start.
When does Medicare start after disability?
You can enroll in Medicare when you receive SSDI benefits for 24 months.
Does my Social Security disability change when I turn 65?
No, your SSDI benefits don’t change when you turn 65 and don’t impact your Medicare.
Do you automatically get Medicare with a disability?
You automatically get Medicare when your disability benefits begin for ALS or ESRD. Otherwise, they automatically begin 24 months after you start receiving SSDI benefits.
How long do you have to be disabled before you can get Medicare?
To enroll in Medicare, you must be receiving SSDI for 24 months.
What happens with Medicare when a disabled person turns 65?
If you chose not to take Part B when first eligible, you’ll be enrolled in Part B when you turn 65.
Do I have to wait two years for Medicare?
Once you start collecting SSDI, you must wait 24 months before becoming Medicare-eligible if you don’t have ESRD or ALS.

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

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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.

8 thoughts on “Medicare Coverage for Disabled Under 65

  1. I have had Parkinson disease since 2015 and try to work (construction) as much as possible. Can I apply for disability under Medicare? If so, how do I apply

    1. Hi Kat! You’re eligible for Medicare if you’re 65+ OR if you’ve been collecting Social Security Disability Income for at least 24 months. If you don’t meet one of these two criteria, you won’t be eligible for Medicare.

  2. 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.

  3. 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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