Do Disabled People Get Medicare

If You Are Applying For Social Security Disability When Does Medicare Start

file for Social Security Disability benefits and are approvedSocial Security DisabilityHowever, in most cases, individuals who have been approved for Social Security Disability do not actually have to wait two years to receive medicareNorth CarolinaNY TimesLA TimesFor assistance on a disability application or Appeal in NC, Most popular topics on SSDRC.com

Information About Your Medical Condition

• Name, address, and contact information of someone who knows your medical condition
• Information about your medical condition or injury, such as contact information and dates of treatment for all doctors, hospitals and clinics, names of medicines you’re taking, and names and dates of medical tests you’ve had, as well as who ordered them

Medicare Vs Medicaid: Which Plan Covers People Getting Ssdi Benefits

If youre approved for SSDI benefits, you must wait two years after your claims approval date to qualify for Medicare. When Congress expanded Medicare to cover seriously disabled Americans in 1972, the law also mandated that SSDI two-year waiting period. For this reason, the Social Security Administration isnt likely to change that requirement anytime soon. However, the Medicare expansion law provides exceptions to this mandatory two-year waiting period for SSDI recipients who:

• Require regular dialysis or an organ transplant due to permanent kidney failure . Those SSDI claimants qualify for Medicare coverage during the third month after beginning dialysis treatments.
• Have Lou Gehrigs disease .

While that two-year waiting period sounds like a long time, its calculated using your original SSDI entitlement date. For most people, that means five months after the date when your disability began. But if your disability started long before you applied for SSDI, that time counts toward your mandatory two-year waiting period.

In addition, individuals with very low income and assets may qualify for Medicaid during the two-year Medicare waiting period. Check Medicaid eligibility qualifications by state, or speak to a disability advocate about qualifying for local healthcare assistance programs.

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Exceptions To The Two

The 24-month waiting period does not apply to ESRD and ALS. Medicare coverage with these two conditions starts as soon as you begin receiving SSDI payments.

In addition, if you apply for disability and are turned down but qualify following an appeal, approval of the application is backdated to the first month you would have received SSDI. The 24-month waiting period begins on that date.

If you receive SSDI for a few months and lose eligibility only to regain eligibility months or even years later, all the months and years you should have been collecting SSDI count collectively toward the 24-month waiting period. There is, however, a coverage gap because you will not receive Medicare benefits during the time the appeal is pending.

Enrolling In Medicare Advantage

Anyone eligible for Medicare can enroll in a Medicare Advantage plan. Once you get your Medicare ID card and effective date, you can apply for any plan sold in your area.

If you choose Medicare Advantage, you may have to pay a separate premium to your insurance company in addition to your Part B premium. Most people have access to a $0 premium, $0 deductible Medicare Advantage plan.

If you are concerned about out-of-pocket spending with Original Medicare, a Medicare Advantage plan might be a good option. All Medicare Advantage plans have an annual out-of-pocket maximum. This means that once you reach your plans limit, the insurance company pays 100% of your costs.

While the government maximum is $7,550 in 2021, the average out-of-pocket maximum among Medicare Advantage plans is about $4,900.

Some people with disabilities qualify for a Medicare Advantage Special Needs Plan . These plans always include Part D coverage. They usually have $0 premiums and $0 deductibles, and include extra benefits such as dental, vision, and care coordination to help you manage your condition. Benefits are specifically tailored to help keep costs low.

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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.

Don’t Forget The Initial Enrollment Period

Even if you’re automatically enrolled in Part A and Part B, you’ll want to be sure you know when your Initial Enrollment Period is. During your IEP, you can join, switch, or drop a Medicare health plan, a Medicare Advantage plan , or a Medicare Part D prescription drug plan.

Your IEP happens when you first become eligible for Medicare.

• If you’re eligible for Medicare because you have a disability and you’re not yet 65, your IEP is the 7-month period surrounding your eligibility. This starts the 3 months before your 25th month of receiving disability benefits, which is when you’ll receive your Medicare card. It also includes the 25th month and the 3 months after.
• If you’re eligible for Medicare because of a disability but you turn 65, your IEP is the 3 months before you turn 65, the month of your birthday, and the 3 months after.

While enrolling in a Part C Medicare Advantage plan is optional, you must enroll in Part D or have other creditable drug coverage. This means your drug plan compares to Medicare in terms of both coverage and cost. Otherwise, you may have to pay a late enrollment penalty.

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You May Qualify For Legal Assistance

Figuring out which healthcare plan will cover you can be confusing especially if you havent yet filed your disability claim. A local disability advocate can walk you through Medicare vs Medicaid coverage available in your state. Its almost impossible to tell whether youre eligible for healthcare assistance programs without first knowing your individual circumstances and location.

Ready to see if you may qualify? Click the button below to start your free online benefits evaluation now!

Medicare For Disabled People Under : How To Get Coverage

Find Cheap Medicare Plans in Your Area

Although Medicare is well known as a federal program that provides health care to seniors 65 and older, it also covers more than 8 million people with disabilities under the age of 65.

Qualifying for Medicare when you are under the age of 65 is a process that begins by applying for Social Security disability benefits. After several steps are completed, there’s usually a two-year waiting period before Medicare’s health insurance benefits begin.

• Get help paying for Medicare

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Your Health Care Rights

The Americans with Disabilities Act of 1990 , federal legislation and California state law all prohibit discrimination on the basis of a disability. However, these laws are limited in a number of ways, and they dont require insurance companies to sell you policies.

Medical providers cannot refuse to treat you because you have a disability. But they can refuse to accept you as a new patient if they are refusing other Medicare patients, or if they dont treat anyone with Medicare. Medical providers are also permitted to refer you to another provider if the care you need is not within the scope of their practice.

If you think a physician or health care plan is denying your disability rights, file a complaint with your medical group, your plan and the U.S. Department of Justice . If you need help, contact your local Health Insurance Counseling & Advocacy Program office for free counseling and information.

Unitedhealthcare Dual Complete Plans

Plans are insured through UnitedHealthcare Insurance Company or one of its affiliated companies, a Medicare Advantage organization with a Medicare contract and a contract with the State Medicaid Program. Enrollment in the plan depends on the plans contract renewal with Medicare. This plan is available to anyone who has both Medical Assistance from the State and Medicare. This information is not a complete description of benefits. Call TTY 711, or use your preferred relay service for more information. Limitations, co-payments, and restrictions may apply. Benefits, premiums and/or co-payments/co-insurance may change on January 1 of each year.

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Apply For Benefits Online

You should apply for disability benefits as soon as you develop a disability. Follow these easy steps to apply online for disability:

• To start your application, go to our Apply for Benefits page, and read and agree to the Terms of Service. Click Next.
• On that page, review the Getting Ready section to make sure you have the information you need to apply.
• Select Start A New Application.
• We will ask a few questions about who is filling out the application.
• You will then sign in to your personal mySocial Security account, or you will be prompted to create one.
• Complete the application.

You can use the online application to apply for disability benefits if you:

• Are age 18 or older.
• Are not currently receiving benefits on your own Social Security record.
• Are unable to work because of a medical condition that is expected to last at least 12 months or result in death.
• Have not been denied for disability in the last 60 days.

Note: If your application was recently denied, our application is a starting point to request a review of the determination we made.

You may be able to file online for SSI at the same time that you file for SSDI benefits. Once you complete the online process described above, a Social Security representative will contact you if we need additional information.

You Automatically Get Medicare

• You should already have Part A and Part B , because you have ALS and youre already getting disability benefits.
• We mailed you a welcome package with your Medicare card.

Sign up for Part B if you live in Puerto Rico or outside the U.S.

• Well mail you a welcome package with your Medicare card 3 months before your Medicare coverage starts.

Sign up for Part B if you live in Puerto Rico or outside the U.S.You get Part A automatically. If you want Part B, you need to sign up for it. If you dont sign up for Part B within 3 months after your Part A starts, you might have to wait to sign up and pay a monthly late enrollment penalty.

• Well mail you a welcome package with your Medicare card 3 months before your Medicare coverage starts.

Sign up for Part B if you live in Puerto Rico or outside the U.S.You get Part A automatically. If you want Part B, you need to sign up for it. If you dont sign up for Part B within 3 months of turning 65, you might have to wait to sign up and pay a monthly late enrollment penalty.

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What Is The Waiting Time For Medicare Benefits To Begin

With most diseases and conditions, Medicare coverage becomes effective 24 months after you start receiving Social Security Disability Insurance payments.

Steps to qualify for Medicare under the age of 65

Medicare Benefits For People With Disabilities

Whether you qualify for Medicare based on age or a disability, Medicare Part A and Part B coverage stays the same. Medicare beneficiaries have the same benefits and can access the same services. The same coinsurance and copayments also apply to Medicare beneficiaries under 65. Heres a brief rundown of what each covers:

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Is Medicare Mandatory If You’re On Disability

Social Security will start to automatically enroll most SSDI recipients in both Medicare Parts A and B before their 25th month of SSDI benefits. Three months before your coverage starts, the SSA will send you your new Medicare card, with your name, your Medicare number, and the dates your Part A and Part B coverage will start. The SSA will automatically deduct your monthly premiums from your Social Security check at the start of your 25th month of benefits unless you send back your Medicare card . Then your coverage begins.

For practical purposes, you can’t decline Medicare Part A, which covers hospitalization and skilled nursing stays. So Medicare Part A is mandatory if you’re on disability, but Social Security doesn’t usually take any money out for Part A premiums anyway.

You can decline Medicare Part B, which covers doctors’ visits, x-rays, lab fees, surgery, and the like. Social Security will take money out of your SSDI check for Part B premiums, so people who are covered under their spouse’s employer-based health care insurance sometimes want to decline it .

If you don’t want Part B, send the card back to Medicare . If you keep the card, you will have Part B coverage and Social Security will take the Part B premium out of your SSDI benefits.

Why Do You Have To Wait 2 Years For Medicare

Medicare was originally intended for those over 65, and when Medicare was expanded to include persons with disabilities, a very expensive expansion, the two-year waiting period was added as a cost-saving measure. About a third of disability recipients receive Medicaid coverage during the waiting period.

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Medicare For Children With Disabilities

Having health insurance for children with disabilities or special health care needs is essential. And, as our children become adults, they have new options for getting that health insurance. If your child has been receiving Social Security Disability Insurance benefits for 24 months, Medicare might be an option to help pay for medically necessary services, care, and equipment. You can learn more about these benefits on our Social Security Disability Insurance page.

Medicare Part B Medical Insurance

Medicare Part B helps cover medically necessary doctors services, outpatient care, home health services, durable medical equipment, mental health services, and other medical services. Part B also covers many preventive services. More information can be found at Medicare Part B.

Medicare Part B Eligibility

A person is eligible for Medicare Part B if they are entitled to premium-free Medicare Part A or are age 65 or older, a U.S. citizen or person lawfully present in the U.S. Non- citizens lawfully admitted for permanent residence, who have resided in the U.S. for five continuous years immediately prior to the month of enrollment, are also eligible.

There is a monthly premium for Medicare Part B. The amount of the premium usually changes each January at the time of the Social Security Cost of Living Adjustment. In some cases, an individuals premium amount may be higher if the individual did not choose to enroll in Part B when they first became eligible.

How to Determine and Identify Part D Enrollment

To find out about a persons enrollment, the following information is required:

• The persons Medicare Beneficiary Identifier
• The persons last name
• The persons date of birth
• The effective date of the persons Medicare Part A or Part B coverage

The persons zip code or the persons representative payees zip code

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Do I Have To Take Part B

You are not required to take Part B, and some people choose to delay. Deciding to opt out of Part B at this time is a personal choice and depends on your unique situation. about whether or not you should take Part B when you qualify for Medicare with a disability. Some people who qualify for Medicare under age 65 due to disability but are covered under an employers plan or a spouses employer plan, may opt to delay.2

Getting Medicare Enrollment Assistance

If you have questions about or need help with Medicare eligibility or enrollment due to disability, you will want to talk with Social Security office. You can also go to your local State Health Insurance Assistance Program office for Medicare counseling.

If you get approved for disability benefits but arent yet eligible for Medicare yet , you can reach out your local state human services agency to see if Medicaid may be an option for you.11

Footnotes

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Answer A Few Questions To Check Your Eligibility

When Social Security approves you for Social Security disability insurance benefits, that means you’ll eventually get access to Medicare benefits too. You’ll be eligible for Medicare two years after your entitlement date for SSDI benefits. .

But getting approved for SSDI only gets you access to Medicare. The fact that you were approved for SSDI makes you eligible for Medicare earlier than you otherwise would be , but it doesn’t pay your premiums. Medicare is not free for disability recipients. The program has premiums, deductibles, and copays, and the costs go up every year .

Anyone with low income and assets, however, including individuals who receive SSDI and aren’t eligible for SSI disability, can receive help from their states in paying for Medicare premiums if they have low income and assets.

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

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