Sunday, February 25, 2024

Does A Person On Disability Qualify For Medicare

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How Do Beneficiaries Out

Medicare Disability Benefits – Options [Under Age 65]

Out-of-pocket spending

Although total Medicare per capita spending is higher for Medicare beneficiaries under age 65 with disabilities than for older beneficiaries, younger beneficiaries in traditional Medicare spend significantly less out of pocket, on average. This is likely due to the fact that a greater share of younger beneficiaries with disabilities than older beneficiaries have Medicaid coverage , as well as Part D Low-Income Subsidies , that help cover their premiums and cost sharing. Overall, out-of-pocket spending by younger beneficiaries with disabilities is 40% less than that of older beneficiaries . Younger beneficiaries have lower average out-of-pocket spending than older beneficiaries for insurance premiums and for medical and long-term care services combined .

On average, in 2012 beneficiaries in traditional Medicare with disabilities spent the largest share of their total non-premium out-of-pocket costs on medical providers , followed by prescription drugs and long-term care facility costs . These services also were the top three in terms of out-of-pocket costs for older beneficiaries, but in a different order: older beneficiaries spent the largest share of their out-of-pocket costs on facility costs , followed by medical providers and prescription drugs .

Access to care and cost-related problems

Figure 6: Selected Measures of Access to Health Care for Medicare Beneficiaries Under Age 65 Compared to Those Age 65 or Older

Should I Sign Up For Medical Insurance

With our online application, you can sign up for Medicare Part A and Part B . Because you must pay a premium for Part B coverage, you can turn it down.

If youre eligible at age 65, your initial enrollment period begins three months before your 65th birthday, includes the month you turn age 65, and ends three months after that birthday.

If you choose not to enroll in Medicare Part B and then decide to do so later, your coverage could be delayed and you may have to pay a higher monthly premium for as long as you have Part B. Your monthly premium will go up 10 percent for each 12-month period you were eligible for Part B, but didnt sign up for it, unless you qualify for a .

If you dont enroll in Medicare Part B during your initial enrollment period, you have another chance each year to sign up during a general enrollment period from January 1 through March 31. Your coverage begins on July 1 of the year you enroll. Read our publication for more information.

Is Your Condition Severe

Your condition must significantly limit your ability to do basic work-related activities, such as lifting, standing, walking, sitting, or remembering for at least 12 months. If it does not, we will find that you do not have a qualifying disability.

If your condition does interfere with basic work-related activities, we go to Step 3.

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How Do People Under Age 65 With Disabilities Qualify For Medicare

People under age 65 become eligible for Medicare if they have received SSDI payments for 24 months. Because people are required to wait five months before receiving disability benefits, SSDI recipients must wait a total of 29 months before their Medicare coverage begins. People under age 65 who are diagnosed with end-stage renal disease or amyotrophic lateral sclerosis automatically qualify for Medicare upon diagnosis without a waiting period.5 Of those who were receiving SSDI in 2014, 34% qualified due to mental disorders, 28% due to diseases of the musculoskeletal system and connective tissue, 4% due to injuries, 3% due to cancer, and 30% due to other diseases and conditions.6

Returning To Work With Medicare Disability Enrollment

Medicare Disability Coverage and Plans for the Disabled

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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I’m Under 65 And Have A Disability I’d Like To Go Back To Work Can I Keep My Medicare Coverage

Yes. You can keep your Medicare coverage for as long as youre medically disabled. If you return to work, you won’t have to pay your Part A premium for the first 8 1/2 years. After that, you might be able to buy Part A coverage and pay a monthly premium.

If you can’t afford the Part A premium, you may be able to get help from your state. Get help with Part A and Part B costs.

What Are The Eligibility Requirements For Medicaid

The chief qualification for Medicare coverage is ones age the current eligibility age for Medicare is 65 years old. However, there are some provisions that qualify a person with disabilities for Medicare coverage, even if they are not 65.

If a person wishes to seek Medicare coverage, and they have a disability, there is a 24-month waiting period from the date a person is deemed disabled under SSDI, unless a person suffers from end-stage renal failure or ALS.

The main qualifications for Medicare are:

  • Enrollees must be 65 years old, unless they are disabled and receive SSDI benefits
  • Applicants must be legal residents of the United States for five years

Enrollees can have Part A premiums waived if:

  • They have been legal residents of the United States for five years
  • They have paid Medicare taxes for at least 10 years
  • They are less than 65 years old and are receiving SSDI payments

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

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

Can Ssi Recipients Receive Medicare

Already on Medicare Disability, Turning 65 Soon

People who receive disability benefits through the Supplemental Security Income program don’t qualify for Medicare insurance coverageâat least until they reach the age of 65 years old. Upon turning 65, SSI recipients can receive Medicare based on age. Learn more about the Medicare and Medicaid that comes with disability benefits.

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What Are Dual Health Plans

Dual health plans are designed just for people who have both Medicaid and Medicare. Theyre a special type of Medicare Part C plan. Dual health plans combine hospital, medical and prescription drug coverage. Youll keep all your Medicaid benefits. Plus, you could get more benefits than with Original Medicare. And you could get it all with as low as a $0 plan premium.

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If You Get Ssdi Benefits And Are In A 24

  • You may be able to get Medicaid coverage while you wait. You can apply 2 ways:
  • Create an account or log in to complete an application. Answer yes when asked if you have a disability. Well forward your application to your state Medicaid agency.
  • Apply directly to your state Medicaid agency. Select your state from the menu on this Medicaid page for contact information.
  • If youre eligible for Medicaid, your Medicaid eligibility may continue even after you enroll in Medicare.
  • If youre turned down for Medicaid, you may be able to enroll in a private health plan through the Marketplace while waiting for your Medicare coverage to start. You may qualify for lower costs on Marketplace coverage based on your income and household size.
  • When asked about your income on your Marketplace application, be sure to include your SSDI income.

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    Exceptions And More Information

    An exception to Medicare due to disability applies if you have been diagnosed with Amyotrophic Lateral Sclerosis also known as Lou Gehrigs disease. If you have ALS, Medicare begins the first month you are entitled to Social Security disability benefits.

    Generally, enrollment in Medicare Part A and Part B is automatic. If you are receiving disability benefits, you will receive a Medicare card showing the date your Medicare benefits begin.

    Click the link below to view and download our factsheet, or call SHIIPSMP at to have a copy sent to you.

    How To Enroll In Medicare With A Disability

    Medicare Advantage Plan Eligibility

    The first step to getting Medicare coverage if you have a disability is to apply for Social Security Disability benefits. Your disability will need to meet the standards set by the Social Security Administration to qualify for coverage. Generally, this means you are unable to work and that your condition is expected to last for at least a year.

    Medicare doesnt determine who is eligible for disability coverage. You dont need to take any further steps if the Social Security Administration has approved your disability application. Youll just need to wait the required 24 months, and you will be automatically enrolled in Medicare.

    Once youve been approved for SSDI, youll be automatically enrolled at the start of your 25th month of receiving benefits. Youll receive your Medicare card in the mail during your 22nd month of SSDI benefits. Once youre eligible, youll have coverage from Medicare parts A and B, also known as original Medicare.

    • Medicare Part A . Part A is used to pay for hospital stays and other types of short-term patient care, such as skilled nursing facilities. People generally dont pay a premium for Part A coverage.
    • Medicare Part B .Part B is used to pay for a wide range of medical services, including doctor and specialist appointments, emergency room visits, ambulance services, medical equipment, preventive care, and some medications. Youll normally pay a monthly premium for Part B coverage.

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    What Are The Characteristics Of Medicare Beneficiaries Under Age 65 With Disabilities Compared To Beneficiaries Age 65 Or Older

    Medicare beneficiaries under age 65 with disabilities differ from beneficiaries age 65 or older in several ways, including their demographic, socioeconomic, and health status profiles.

    Income: In 2012, a much larger share of beneficiaries under age 65 with disabilities than older beneficiaries had low annual incomes . Nearly one quarter of younger beneficiaries with disabilities had incomes less than $10,000 per year and two-thirds had incomes less than $20,000 per year, compared to 13% and 39%, respectively, of older beneficiaries.7

    Figure 1: Selected Characteristics of Medicare Beneficiaries Under Age 65 Compared to Those Age 65 or Older

    Race/ethnicity and gender: A larger share of beneficiaries under age 65 than older beneficiaries are black and Hispanic , and a larger share are male .

    Health status: Nearly two-thirds of all younger Medicare beneficiaries had a cognitive or mental impairment in 2012, compared to 29% of older beneficiaries . This includes memory loss that interferes with daily activity, difficulty making decisions, trouble concentrating, and loss of interest within the past year.8 Nearly 6 in 10 reported their health status as fair or poor and almost the same share reported having one or more limitations in their activities of daily living, compared to 20% and 34% of beneficiaries age 65 or older, respectively. But roughly the same share of both younger beneficiaries with disabilities and older beneficiaries report having five or more chronic conditions .

    Adults With A Disability That Began Before Age 22

    An adult who has a disability that began before age 22 may be eligible for benefits if their parent is deceased or starts receiving retirement or disability benefits. We consider this a “child’s” benefit because it is paid on a parent’s Social Security earnings record.

    The Disabled Adult Child who may be an adopted child, or, in some cases, a stepchild, grandchild, or step grandchild must be unmarried, age 18 or older, have a qualified disability that started before age 22, and meet the definition of disability for adults.


    It is not necessary that the DAC ever worked. Benefits are paid based on the parent’s earnings record.

    • A DAC must not have substantial earnings. The amount of earnings we consider substantial increases each year. In 2022, this means working and earning more than $1,350 a month.

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    If Your Income Is Low And Your State Hasnt Expanded Medicaid

    If your state hasnt expanded Medicaid, your income is below the federal poverty level, and you dont qualify for Medicaid under your states current rules, you wont qualify for either health insurance savings program: Medicaid coverage or savings on a private health plan bought through the Marketplace.

    Find out why
    • When the health care law was passed, it required states to provide Medicaid coverage for all adults 18 to 65 with incomes up to 133% of the federal poverty level, regardless of their age, family status, or health.
    • The law also provides premium tax credits for people with incomes between 100% and 400% of the federal poverty level to buy private insurance plans in the Health Insurance Marketplace®.
    • The U.S. Supreme Court later ruled that the Medicaid expansion is voluntary with states. As a result, some states havent expanded their Medicaid programs.
    • Adults in those states with incomes below 100% of the federal poverty level, and who dont qualify for Medicaid based on disability, age, or other factors, fall into a gap.
    • Their incomes are too high to qualify for Medicaid in their states.
    • Their incomes are below the range the law set for savings on a Marketplace insurance plan.

    States are continuing to make coverage decisions. They could expand Medicaid in the future.

    I Have A Disability Or Chronic Condition

    How Medicare Works with Social Security Disability

    You might be able to join a type of Medicare Advantage Plan, called a Special Needs Plan. These plans tailor their benefits for people:

    • With both Medicare and Medicaid
    • That have a specific disease or condition
    • That live in an institution or require nursing care at home

    You can compare these plans with others in your area to find one that meets your needs.

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    Medicare Coverage For Working People With Disabilities

    If you have a disability and are working, your Medicare coverage can fall into one of three plans.

  • Trial Work Period : You will be entitled to continue receiving Medicare and Social Security disability benefits for a maximum 9-month trial work period during any rolling 5 year period. The nine months of trial work do not have to be consecutive but you must meet the set guidelines for gross income or work more than 80 hours per month.
  • Extended Period of Eligibility :In some cases, your gross income may meet the substantial gainful activity level but you are still disabled. In this case, you may continue to receive Medicare coverage after completing the trial work period. You may remain eligible for Medicare coverage for up to eight and a half years under EPE. Even if the SSDI cash benefits cease during this period you will still be eligible for Medicare coverage.
  • Indefinite Access to Medicare:Working Medicare recipients under 65 years with disabilities may continue to receive Medicare coverage as long as they remain disabled. However, the individual may need to pay premiums for both Part A and B of Medicare based on their income. If you fall in this category, you may get assistance with premiums from a state-run buy-in program that caters to qualified working persons who are disabled.
  • Are Ssdi Recipients Automatically Eligible For Medicare

    Yes, Social Security disability recipients receive Medicare as an extra benefit. SSDI recipients are eligible to receive Medicare benefits two years after their “date of entitlement,” or DOE . Most people don’t receive Medicare until 24-29 months after becoming disabled. For more information on how the date of entitlement is calculated, see our article on how long it takes to receive Medicare benefits.

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    Do I Have To Pay For Medicare On Ssdi

    Medicare isnt free for most people on Social Security Disability Insurance. Unless you qualify for another form of income-based help, youll most likely need to pay the Medicare Part B premium, which for most people in 2022 is }. Its unlikely that youll have to pay for Part A. In addition to the Part B premium, you may be responsible for other costs, as outlined below.

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