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Can I Receive Medicare If I Am Disabled

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What Is The Best Course Of Action For Someone Living With A Disability

If I am found disabled, do I qualify for Medicare?

The easiest solution, especially if you arent sure whether you want full Medicare coverage or not, is to enroll in Part A premium-free and simply choose not to use it if you wish. By enrolling, you remain eligible for your other benefits and can decide to add additional Medicare coverage at a later date though again we advise that this will come with higher fees and larger premiums.

In short, Medicare is not mandatory in any case, but the process of declining and removing yourself from the service is not a simple one and in most cases, beneficiaries find that the cover offered is worth the enrollment.

For more information on whether you are eligible to receive Medicare insurance, and how to best use and apply it for your own gain, get in touch with our team at Bobby Brock Insurance.

What Does Medicare Cover

The type of coverage you are provided through Medicare depends on the type of Medicare you decide to accept. Medicare Part A is hospital insurance. In most circumstances, there is no charge for Medicare Part A coverage. This type of Medicare pays for inpatient hospital care, skilled nursing facilities, long-term hospital care, inpatient rehabilitation, hospice care, home health care, inpatient psychiatric care and obesity bariatric surgery.

Medicare Part B is different from Medicare Part A. Medicare Part B is more like a traditional medical insurance plan. In most cases, you will need to pay a premium in order to receive Medicare Part B. You can choose to refuse Medicare Part B coverage, but if you do so you will need to pay a surcharge if you wish to receive Medicare Part B in the future. Medicare Part B covers any services or supplies that are needed to diagnose or treat your medical condition as long as they meet the accepted standards of medical practice. Medicare Part B also covers preventative services such as vaccinations and routine physical exams.

Medicare Part A And Part B Coverage

If you obtain health insurance coverage through Medicare, youll benefit from the same type of coverage that millions of American seniors enjoy. This includes Medicare Part A and Medicare Part B .

Medicare Part A generally covers:

  • Hospital care
  • Skilled nursing facility care

Medicare Part B generally covers:

  • Medically necessary services, like doctor’s visits, surgeries, lab tests, clinical research, ambulance services, mental health and durable medical equipment
  • Preventive services to prevent illness or to detect an illness at an early stage

Though both parts of Original Medicare offer a wide range of health insurance coverage, they each leave some out-of-pocket costs to you as a beneficiary. These costs can include deductibles, copayments, coinsurance and other fees, and they can add up quickly.

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What Will Happen To Health Care Providers If A Majority Of Their Patients/residents No Longer Have A Payer Source

We expect this will have an impact on any provider who serves Medicaid patients. This is a major concern for the Department not only for now but for the future, as there is a possibility that some providers may go out of business and not be able to reopen if they lose Medicaid patients for as little as a month.

How Do Sources Of Supplemental Coverage And Prescription Drug Coverage Differ For Medicare Beneficiaries Under Age 65 With Disabilities And Older Beneficiaries

Medicare basics: Big questions, smart answers

Supplemental coverage

Most Medicare beneficiaries, including those under age 65 with disabilities, have public or private supplemental insurance to help cover Medicares cost-sharing requirements.9 A much larger share of beneficiaries under age 65 with disabilities than older beneficiaries rely on Medicaid to supplement Medicare because of their relatively low incomes .10 Medicaid helps with Medicare premiums and cost-sharing requirements, and covers services needed by many people with disabilities that are not covered by Medicare, particularly long-term services and supports.

Figure 3: Supplemental Coverage Among Medicare Beneficiaries Under Age 65 Compared to Those Age 65 or Older in 2012

Just over 1 in 5 beneficiaries under age 65 has no supplemental coverage, compared with 12% of those age 65 or older. Lack of supplemental coverage among Medicare beneficiaries is associated with higher rates of access problems, but rates of access problems are higher among younger beneficiaries with disabilities who lack supplemental coverage than among older beneficiaries, including not seeing a doctor for a health problem when they think they should and having trouble getting needed health care .12 Regardless of whether or not they have supplemental coverage, however, a larger share of younger beneficiaries with disabilities than older beneficiaries experience access and cost-related burdens .

Prescription drug coverage

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How Much Does Medicare Cost On Disability

If you qualify for SSDI, you’ll typically qualify for premium-free Medicare Part A based on your work record. Part B requires a monthly premium , automatically deducted from your Social Security check. You can technically opt out of Part B if you dont want to pay the premiums. Just know that without Part B, youll forego extensive medical coverage. Its usually not a good idea to opt out of Part B unless you have other health insurancelike from an employer.

Medicare Supplement Insurance Helps Cover Costs

One way that millions of Medicare beneficiaries get help paying for some of these health care costs is by purchasing a Medicare Supplement Insurance plan .

The 10 standardized Medicare Supplement Insurance plans offered in most states each cover a different combination of health insurance costs.

If you are enrolled in Medicare because of a disability and are younger than age 65, you may be able to purchase Medigap insurance in your state. However, not all states require insurers to sell Medigap plans to people under 65.

Its important to find out if health insurance companies in your state offer Medigap plans to those with disabilities.

Speak with a licensed insurance agent at , or read through our other guides to learn more.

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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 dont qualify for Medicare may qualify for Medicaid. Lastly, children under the age of 18 who dont qualify for Medicare could qualify for a state Childrens Health Insurance Program if their family has a lower income.

When Can I Become Eligible For Premium

Do I Get Medicare If I’m Getting Social Security Disability Benefits?

When your eligibility begins depends on when you enroll in the Premium-HI program.

Initial Enrollment Period. Your Initial Enrollment Period begins when you first lose free coverage, due to your earnings being too high for SSDI. It lasts for eight months from the time you get your notice from Social Security that the free coverage has ended. Here is the chart that shows when coverage can begin if you enroll during the IEP.

When Your Enrollment Is Filed

When Coverage Begins

â¦then your coverage begins the month after you enroll.

If you enroll during the second month of Premium-HI eligibilityâ¦

â¦then your coverage begins the second month after the month you enroll.

If you enroll during the remainder of your IEPâ¦

â¦then your coverage begins the third month after the month of enrollment.

GEP. The General Enrollment Period runs from January to March of each year. If you enroll during the GEP, your coverage will begin on July 1 following the GEP in which you enrolled.

Special Enrollment Period . If you get insurance from your employer, there is a Special Enrollment Period . The SEP lets you enroll at any time as long as you, your spouse, or if you are disabled, a family member, are working and you are covered by insurance through the employer or a union based on that employment.

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S A And B Overview And Costs

Traditional Medicare costs include those for Part A, which is for hospitalization insurance, and those for Part B, which is for preventive and medically necessary insurance.

Through Medicare, healthcare coverage for a person with a disability is identical to the coverage for an individual who qualifies because of their age.

Areas of coverage include certain hospital and nursing home stays, along with doctor visits and community-based services.

Most People Who Are Approved For Disability Benefits Through The Social Security Administration Get Medicare Or Medicaid Eventually

By Bethany K. Laurence, Attorney

Generally, if you are approved for Social Security disabilityinsurance benefits, you will receive Medicare, and if you are approvedfor Supplemental Security Income , you will receive Medicaid. However, thisisnât true in all states. Medicaid is operated by the states,and the states are allowed to set eligibility criteria that are different thanSSIâs criteria. As a result, whether getting approved for SSI gets you Medicaiddepends on your state, as weâll discuss below.

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The Disability Application Process

Whether you apply online, by phone, or in person, the disability benefits application process follows these general steps:

  • You gather the information and documents you need to apply. We recommend you print and review the . It will help you gather the information you need to complete the application.
  • You complete and submit your application.
  • We review your application to make sure you meet some for disability benefits.
  • We check whether you worked enough years to qualify.
  • We evaluate any current work activities.
  • We process your application and forward your case to the Disability Determination Services office in your state.
  • This State agency makes the disability determination decision.

To learn more about who decides if you are disabled, read our publication .

Once You’ve Applied

Once we receive your application, well review it and contact you if we have questions. We might request additional documents from you before we can proceed

Look For Our Response

Youll receive a letter in the mail with our decision. If you included information about other family members when you applied, well let you know if they may be able to receive benefits on your record.

Check The Status

You can check the status of your application online using your personal mySocial Security account. If you are unable to check your status online, you can call us 1-800-772-1213 from 8:00 a.m. to 7:00 p.m., Monday through Friday.

Appeal A Decision

  • Reconsideration.

How Do People With Disabilities Qualify For Medicaid

Can I Be Eligible For Medicare If I Am Under 65?

While nearly a quarter of nonelderly adults with Medicaid report having a disability, relatively few of these enrollees qualify for Medicaid because they receive SSI benefits . While people who receive SSI generally automatically qualify for Medicaid, the SSI population encompasses only a subset of all people with disabilities. Over six in 10 nonelderly Medicaid adults with disabilities do not receive SSI . This group can be eligible for Medicaid as ACA expansion adults or Section 1931 parents . There is no way with federal survey data to separate people who qualify due to the Medicaid expansion from those who would have qualified under pre-ACA eligibility rules. They also may be eligible for Medicaid through an optional disability-related pathway .2 Without the expansion pathway, Medicaid coverage for people with disabilities typically is limited to people who receive SSI because other disability-related pathways are provided at state option. And, in addition to using a more restrictive definition of disability compared to other measures, SSI income and asset limits are more restrictive than those required for Medicaid expansion adults and many optional disability-related Medicaid coverage pathways.3

Figure 1: Disability and SSI Status of Nonelderly Adults with Medicaid, 2019

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What Is Extra Help

Extra Help is a Social Security program that provides additional financial assistance for people of limited means who need prescription drug coverage through Medicare.

To qualify for Extra Help, an individual must have less than $14,610 in resources. Married couples who live together must have less than $29,160 in combined resources.

The SSA defines resources to include the following:

  • bank accounts

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Returning To Work With Medicare Disability Enrollment

You are allowed to keep your Medicare coverage for as long as a medical professional deems you medically disabled.

If you under age 65 and return to work, you wont have to pay a premium for Part A for the next 8.5 years.

If youre still younger than age 65 once that 8.5-year time period as passed, youll begin paying the Part A premium. In 2021, the standard Part A premium is $259.

Your Medicare costswill depend on your specific circumstances. Its important to know that unlikestandard insurance plans, each Medicare part has its own costs and rules.

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Information You Need To Apply

Before applying, be ready to provide information about yourself, your medical condition, and your work. We recommend you print and review the . It will help you gather the information you need to complete the application.

Information About You

  • Your date and place of birth and Social Security number.
  • The name, Social Security number, and date of birth or age of your current spouse and any former spouse. You should also know the dates and places of marriage and dates of divorce or death .
  • Names and dates of birth of children not yet 18 years of age.
  • Your bank or other and the account number.

Information About Your Medical Condition

  • Name, address, and phone number of someone we can contact who knows about your medical conditions and can help with your application.
  • Detailed information about your medical illnesses, injuries, or conditions:
  • Names, addresses, phone numbers, patient ID numbers, and dates of treatment for all doctors, hospitals, and clinics.
  • Names of medicines you are taking and who prescribed them.
  • Names and dates of medical tests you have had and who ordered them.

Information About Your Work:

  • Award letters, pay stubs, settlement agreements, or other .

We accept photocopies of W-2 forms, self-employment tax returns, or medical documents, but we must see the original of most other documents, such as your birth certificate.

Do not delay applying for benefits because you do not have all the documents. We will help you get them.

If You Live Outside The 50 United States And District Of Columbia

If I am approved for Social Security Disability, will I get Medicare and Medicaid health insurance?

If you do not live within the 50 United States or Washington D.C., but you do live in a U.S. territory , any qualified automatic enrollment will be limited to Medicare Part A . You will otherwise have to enroll yourself when you become eligible. Enrollment in Medicare Part B and a Medicare prescription drug plan is always separate.

You can enroll in Original Medicare through Social Security:

  • Online at
  • In person at your local Social Security office.

Medicare information is everywhere. What is hard is knowing which information to trust. Because eHealthâs Medicare related content is compliant with CMS regulations, you can rest assured youâre getting accurate information so you can make the right decisions for your coverage.Read more to learn about our Compliance Program.

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What Disabilities Qualify For Medicare

In some cases, individuals under 65 may qualify for Medicare if they have certain disabilities. Depending on the disability, there may be a 24-month waiting period before individuals can enroll in Parts A and B.

You can qualify for Medicare if youre under 65 and you have:

  • Amyotrophic lateral sclerosis
  • End-stage renal disease
  • Qualified for Social Security retirement benefits and received Social Security Disability Insurance for 24 months
  • Qualified for certain disability benefits from the Railroad Retirement Board for 24 months

Qualifying For Social Security Disability And Medicare Benefits

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In addition, your medical condition must prevent you from performing your normal job function, and you must have been unable to find a suitable replacement position or new line of work because of your age, education levels, or physical limitations. If you do not continue to follow your doctorâs recommended treatment plan to improve your condition, you may be disqualified from Social Security disability benefits.

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What If Youre Under Age 65 And Have A Disability

People under age 65 with disabilities automatically qualify to get Original Medicare after theyve been receiving disability benefits from Social Security for 24 months. If you also qualify for Medicaid or Medicaid disability, your state Medicaid program may help pay for costs and services that Medicare does not cover. For any services that are covered by both Medicare and Medicaid , Medicare will pay first. Medicaid may also pay for added costs or services, but only after the Medicare share has been used up.

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