How To Qualify For Medicare Disability

How Does Having A Disability Affect Insurance Options

Whether you’re already age 65 or exploring Medicare options as a disabled adult, it’s important to know that the number of insurance options increases once you qualify for Medicare. You may choose to stay with traditional Medicare, purchase a supplement policy or enroll in a Medicare Advantage plan. Depending on your financial need, you may qualify for Medicare and Medicaid, which is commonly called dual eligible. Medicare Advantage plans are available in a variety of plan types for people who are dual-eligible, in long-term care facilities or have chronic special needs.

Talk To A Disability Lawyer

Need a lawyer? Start here.

Self-help services may not be permitted in all states. The information provided on this site is not legal advice, does not constitute a lawyer referral service, and no attorney-client or confidential relationship is or will be formed by use of the site. The attorney listings on this site are paid attorney advertising. In some states, the information on this website may be considered a lawyer referral service. Please reference the Terms of Use and the Supplemental Terms for specific information related to your state. Your use of this website constitutes acceptance of the Terms of Use, Supplemental Terms, Privacy Policy and Cookie Policy. Do Not Sell My Personal Information

What Happens After Submitting The Application

After you are finished with the application and all applicable forms, you will submit it to Social Security.

If you create an account at the my Social Security website, you can track your application online as well.

The process of getting approved for disability benefits can take three to five months. Applying online helps to expedites the process.

After the applying, you can expect the following to occur:

• Confirmation of the application
• Application and medical information are assessed
• Contact will be made if more information or documentation is needed
• If any other family members are eligible for benefits, information will be sent to applicant

Now that you know what to expect when you fill out an application, you are ready to start the process.

If you have any questions or concerns, we have tons of helpful articles and blogs available.

Enter your zip code below to compare private Medicare plans and ensure your disability and medical needs are always covered.

Recommended Reading: Does Medicare Cover Prolia Injections

If You Live Outside Of The Continental Usa Hawaii Or Alaska

If you live in a U.S. territory, automatic enrollment will be limited to Medicare Part AMedicare Part A is hospital coverage for Medicare beneficiaries. It covers inpatient care in hospitals and skilled nursing facilities. It also covers limited home healthcare services and hospice care…. for qualified beneficiaries. Enrollment in Medicare Parts B and D is manual via telephone or a local SSA office.

You Automatically Get Medicare When You Turn 65

• 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.

Recommended Reading: Can I Enroll In Medicare Online

Social Security And Medical Benefits

SSI beneficiaries automatically receive Medicaid benefits.

Be aware however that there are many special Medicaid and Medicaid waiver programs in Florida that do not require a person to be eligible for SSI. For more information, see the Florida Medicaid Summary of Services.

SSDI beneficiaries qualify for Medicare benefits following a two year waiting period after first receiving SSDI. There are limited circumstances under which SSDI beneficiaries may qualify for Medicare without the two year waiting period.

Some individuals may be dually eligible for SSI and SSDI, and therefore for Medicaid and Medicare. Some individuals who receive SSDI only, may nevertheless be eligible to have Medicaid pay their Medicare premiums, and in some cases, their copays.

Some individuals, who received SSI benefits as a minor, become SSDI beneficiaries based on the work record of a parent or grandparent who is deceased, disabled or retired. As long as the persons SSDI benefits are based on the work record of the parent or grandparent, and not on their own work record, the individual should maintain their eligibility for Medicaid. This is called Protected Medicaid.

Speeding Up An Ssdi Application

Your application for SSDI is likely to move more quickly if you select one doctor as the lead contact for your case. It’s best to go with one who:

• Has experience with disability cases
• Responds promptly to requests for information
• Is familiar with your overall health situation

It’s also a good idea to keep a detailed log of your everyday activities and experiences.

For example, document any difficulties you have with mobility or side-effects you are experiencing from medications. This will help when you have your interview with a Social Security representative. The interview may take place on the phone or in person at your local Social Security office.

The SSA website provides an easy-to-use Disability Starter Kit that includes FAQs, a checklist, and a worksheet to help you get ready for your interview. You can save time during your interview if you fill out the needed applications online before your appointment.

According to the SSA, most applications are processed within three to five months.

Recommended Reading: Will Medicare Pay For Handicap Bathroom

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
• Information about your work
• How much you earned last year and this year
• Name and address of your employer
• Beginning and end dates of any active military duty
• Jobs you’ve had in the past 15 years
• Information about workers’ compensation or other benefits you filed

A Disability And A Long Wait Are Required For Early Medicare Enrollment

Lisa Sullivan, MS, is a nutritionist and a corporate health and wellness educator with nearly 20 years of experience in the healthcare industry.

• ESRD Coverage

Medicare isn’t available to most people until age 65, but if you have a long-term disability or have been diagnosed with certain diseases, Medicare is available at any age.

According to Kaiser Family Foundation data, 14% of all Medicare beneficiaries are under age 65. As of April 2021, 63.3 million Americans were enrolled in Medicare. So roughly 9 million of those beneficiaries are under age 65 and eligible for Medicare because of a disability as opposed to age.

Recommended Reading: Who Do You Call To Sign Up For Medicare

If You Were Overpaid By Ssa

If the Social Security Administration says that you have been overpaid, you are entitled to written notice explaining why the overpayment occurred and how much you have been overpaid. If you are still receiving benefits, SSA can withhold some or all of your benefits to repay the overpayment.

Some reasons for overpayments include:

• Your income is more than what you reported to SSA
• Your living situation changed
• Your marital status changed
• You have or received more resources than allowed or
• You are no longer disabled but continued to receive benefits this includes receiving benefits while an appeal of a reduction or termination is pending.

How To Enroll In Medicare With A Disability

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.

Read Also: Is Xolair Covered By Medicare Part B

Living Outside The Us Is Trickier

If you plan to live outside the U.S., you must decide whether or not to keep your Medicare Part A and Part B benefits. Since most Medicare beneficiaries qualify for premium-free Part A, there’s no extra cost for you to stay enrolled .

But if you disenroll in Part A, you must pay back any Part A benefits you’ve received up until that point. Depending on your specific situation, that could be quite expensive.

If you decide to stay enrolled in Part B, you will still need to pay for your monthly Part B premium , even though your care won’t be covered.

If you travel back to the U.S. occasionally, it might be worth it to keep your Part B benefits since you can schedule care in the U.S. If you are not planning to return to the U.S. often or at all you’ll have to decide whether the cost of Part B is worth it.

If Im Eligible For Social Security Disability Benefits When Does Medicare Kick In

You will typically be automatically enrolled in Original Medicare, Part A and B, after youve received Social Security disability benefits for two straight years. Your Medicare coverage will start 24 months from the month you qualified for disability benefits. In some cases, this could be earlier than the month when you received your first check. You must be either a U.S. citizen or legal permanent resident of at least five continuous years to be eligible for Medicare.

Note that certain conditions may qualify you for Medicare under age 65, but have different enrollment details than those described above.

• If you have Lou Gehrigs disease , youre enrolled in Medicare automatically the first month you receive disability benefits from Social Security or the Railroad Retirement Board. The life expectancy of someone with ALS averages two to five years from the time of diagnosis, according the ALS Association. If you have ALS, you may not have time to wait two years on Social Security disability.
• If you have end-stage renal disease , you might qualify for Medicare, but youre not automatically enrolled. End-stage renal disease means kidneys are functioning at 10 to 15 percent of their normal capacity according to the Cleveland Clinic. At that point, the choices are dialysis or a kidney transplant. If youre on dialysis or youve had a kidney transplant, contact Social Security .

Recommended Reading: What Age Do You Draw Medicare

Medicare Enrollment For Ssdi Recipients

To become eligible for Medicare based on disability, you must first qualify for Social Security Disability Insurance. SSDI pays monthly benefits to people with disabilities who might be limited in their ability to work. If you are injured or have a medical condition that limits your ability to work, you may be eligible for SSDI.

Call a Licensed Agent:

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

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 ssa.gov.
• In person at your local Social Security office.

You May Like: How Much Medicare Is Taken Out Of Social Security Check

File For Disability In Ohio

There are three ways to initially apply for Social Security Disability benefits. You can apply online, over the telephone, or in-person.

• Online: You can apply online at ssa.gov.
• Telephone: You can apply over the telephone by calling the SSAs toll-free customer service line at 1-800-772-1213
• In-person: You can apply in-person at your local Social Security field office. Find your local office here.

The following information is about Social Security Disability in Ohio.

Medicare For Ssi Recipients

Do you get Medicare coverage if you were approved for SSI? Claimants who are approved for SSI only typically receive Medicaid coverage in most states. And like SSI, Medicaid is subject to income and asset limitations. Medicaid is a needs-based, state- and county-administered program that provides for a number of doctor visits and prescriptions each month, as well as nursing home care under certain conditions.Can you ever get Medicare if you get SSI? Medicare coverage for SSI recipients does not occur until an individual reaches the age of 65 if they were only entitled to receive monthly SSI disability benefits. At the age of 65, these individuals are able to file an “uninsured Medicare claim,” which saves the state they reside in the cost of Medicaid coverage. Basically, the state pays the medical premiums for an uninsured individual to be in Medicare so that their costs in health coverage provided through Medicaid goes down.

For people with limited income and assets, Medicare offers “Extra Help” for prescription drug costs. This Extra Help covers the costs of a Medicare prescription drug plan — including monthly premiums and prescription co-pays. The application is online at www.socialsecurity.gov/prescriptionhelp. For more information, see Nolo’s article on the Extra Help subsidy.

Don’t Miss: How Much Does Medicare Pay For Physical Therapy In 2020

Request A Change In Overpayment Recovery Rate

If you agree that you have been overpaid but are unable to repay the overpayment at the SSA has asked you to, you can work out a payment plan. https://www.ssa.gov/forms/ssa-632.html.

Keep a copy of any documents you file with the Social Security Administration and get the names of any Social Security representatives you speak with concerning your case.

• Report wages for SSI or SSDI
• Update your direct deposit information
• Get replacement forms for tax purposes
• Get online notifications about your account and
• Access multiple planning tools, such as the Retirement Calculator.

You can create your own account here:

Medicare If You Have A Disability And Are Under 65

If you are under 65 and have a disability you may qualify for Medicare. You will usually need to receive Social Security Disability Income for 24 months before becoming eligible for Medicare. Exceptions are made for those with end stage renal disease or Amyotrophic Lateral Sclerosis , also known as Lou Gehrig’s Disease. To qualify for SSDI you must meet the standards for disability set by the Social Security Administration and you or your spouse must have paid Social Security taxes while employed.

Social Security Protection If You Become Disabled from the Social Security Administration can help you determine whether or not you are eligible for Social Security Disability Income .

If you qualify for Medicare our Medicare information page may be of interest to you.

Recommended Reading: Where Do You Apply For Medicare

Survivors Benefits For Children

Unmarried children can be eligible to receive Survivors Benefits generally 75 percent of the workers benefit amount as long as they are:

• Under 18 years old
• 19 or under and attending an elementary or secondary school full time or
• Disabled before age 22 and remain disabled.

Stepchildren, grandchildren, step grandchildren or adopted children may also receive benefits under certain circumstances.

Also Check: How Much Does Disability Pay In California

Disability Benefits Statistics For Ohio

A 2019 report by the Office of Disability Adjudication and Review found that the average wait time for a disability hearing in Ohio was 15.4 months. That is slightly longer than the national average of 14.9 months. Incidentally, the percentage of cases approved in Ohio was lower than the national average, at around 39%.

While most of Ohios average hearing statistics are close to national averages, there are four regional offices with much longer wait times. The Cincinnati, Columbus, and Dayton offices all have waiting times longer than 17 months.

Read Also: How To Get New Medicare Card Without Social Security Number

How To Enroll In Medicare Disability

If you are eligible for Medicare disability, you may or may not need to take extra steps to enroll:

If you’ve been collecting SSDI benefits:

• You’ll be automatically enrolled in Medicare Parts A and B at the beginning of your 25th month.

• You should receive your Medicare card in the mail approximately three months prior to your coverage start date.

• Your Part B premium (and Part A premium, if you owe one, will be deducted from your Social Security check.

If you’ve been diagnosed with ALS:

• You’ll be automatically enrolled in Medicare the first month you start collecting SSDI benefits. The 24-month waiting period does not apply to those with ALS diagnosis.

• If you’ve been collecting SSDI for another disability, and then are diagnosed with ALS within the 24-month waiting period, you can enroll in Medicare immediately.

If you have ESRD, the eligibility process is a little different:

• You can choose whether or not to enroll in Medicare you are not automatically enrolled.

• If you want to sign up, you can do so through your local social security office.

Medicare coverage is available to many people under the age of 65 with disabilities. Don’t let fear of a complicated eligibility process keep you from getting Medicare benefits.

Andrea Bonner is a healthcare writer with more than 10 years of experience covering senior health. She is from the Raleigh-Durham area in North Carolina.