Wednesday, May 22, 2024

When Can A Disabled Patient Enroll In Medicare Part D

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Do I Have To Sign Up For Medicare Part D

Medicare Open Enrollment

Its not required for you to have Part D coverage. That said, if you currently need or anticipate needing to spend a significant amount of money on drugs in the future, you should really consider enrolling. The Medicare prescription drug benefit may be a good decision for you. Think about your current drug coverage, your income and how much you currently spend on prescription drugs before you choose a drug prescription plan.

Some states have a pharmaceutical assistance program that helps with the costs of Part D coverage as well. However, you will already have to be enrolled in Part D coverage to get this help. If your income is falls within the eligibility guidelines, then you can enroll in Medicare Part D and get a plan that is nearly free. The government pays for most of the drug costs if you qualify for Extra Help based on your income. Also, if you sign up for a prescription drug plan and qualify for Extra Help, then you dont have to pay a premium penalty for late enrollment.

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.

Special Circumstances: Medicare With Als Or End

Medicare eligibility rules for people with ALS or end-stage renal disease are different. Individuals who qualify for Medicare with ALS or ESRD do not have to wait for your 25th month of disability to be eligible for Medicare.

If you qualify with ALS: You will automatically get Medicare Part A and Part B the month your disability benefits begin. 7

If you qualify with ESRD:8

  • For most people, Medicare coverage will start on the 1st day of the 4th month of dialysis treatment.
  • If you have an employer group health plan, Medicare will begin on the fourth month of dialysis.
  • Treatments if you have employer coverage.
  • If you participate in an at-home dialysis training program, your coverage may begin the first month of a regular course of dialysis provided the following are true:
  • You participated in training from a Medicare-approved training facility for the first three months of your regular dialysis
  • Your doctor expects you to finish training and be able to do your dialysis treatments yourself

Note, according to Medicare in order to qualify with ESRD all of the below must apply:9

For further information related to ALS and Medicare, visit

For further information related to ESRD and Medicare, visit

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How Long Do People On Disability Have To Wait To Become Eligible For Medicare

Once you have collected SSDI payments for two years, you will become eligible for Medicare. You wont even have to sign upMedicare will automatically enroll you in Part A and Part B and mail your Medicare card to you shortly before your coverage begins.

Thankfully, your 24-month waiting period doesnt have to be all at once. For example, if you qualify for SSDI, lose eligibility, then re-qualify for SSDI, each month you collect checks counts toward the total 24-month waiting period.

Similarly, if you apply for SSDI and are denied disability benefits, you can appeal the decision. If you appeal and the decision is reversed, your 24-month waiting period will be backdated to when your disability benefits should have started. The result: your wait for Medicare will be shorter than two years.

Do I Qualify For Social Security Disability And Medicare Benefits

How to Enroll in Medicare

Medicare and disabilitybenefits from Social Security help people who are unable to work due to injuryor disease. You may qualify for Social Security Disability Insurance if youreat least 18 years old, and cant work for 12 months or longer. You can learnmore about the requirements on the Social Security Administrations website, and even apply online.

Youll be eligible and automatically enrolled in Medicare Part A and Medicare Part B once youve been receiving Social Security Disability benefits, or disability benefits from the Railroad Retirement Board, for 24 months. Youll receive your Medicare card in the mail up to three months before your coverage starts. If you want to verify your start date, or havent received your Medicare card, you can contact Social Security directly.

Read Also: What Is Retirement Age For Medicare

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.

Speeding Up An Ssdi Application

Your application for SSDI is likely to move more quickly if you select one healthcare provider 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.

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What Is The Medicare Part D Late Enrollment Penalty

Its a good idea to sign up for a Part D plan when you become eligible, even if youre not taking any prescription medications. Why? Medicare adds on a permanent 1 percent late enrollment penalty to your premiuif you dont enroll within 63 days of your initial eligibility period.

The penalty rate is calculated based on the national premium rate for the current year multiplied by the number of months you didnt enroll when you were eligible. So, if you wait, your extra penalty payment will be based on how long you didnt have PartD coverage. This can add up.

The base premium changes year to year. If the premium goes up or down, your penalty changes, too.

If you have a Medicare Advantage plan, when you turn 65, you still need to have Part D coverage.

You can avoid the penalty if you have Medicare from another plan. This means you have drug coverage thats at least equal to the basic Medicare Part D coverage from another source, like an employer.

Since the penalty can add to your premium cost, it makes sense to buy a Part D plan at low cost when you become eligible. You can change plans during each open enrollment time if you need different coverage.

Debunking Myths Of Medicare Part D

Dollars and Sense | How Medicare beneficiaries can save on prescription drugs

Since the enactment of the Affordable Care Act, there have been rumors surrounding Medicare. You may have heard that Medicare isnt available or that you have to buy extra coverage to meet the new laws health insurance mandate. These statements arent true. Some of the worst myths surround prescription drug coverage.

Studies also show that many Americans dont know what Medicare does or how it works. Per enrollment numbers reported by the CMS, there are about 61.4 million Medicare beneficiaries as of 2018, a number that includes senior citizens and people with certain disabilities. Of those enrollees, over a third have Medicare Advantage plans. The changes to Medicare have given these beneficiaries more preventive care services, annual wellness checkups and tests for cancer in addition to prescription drug coverage for specialty medications. Many people think that Medicare is Obamacare, but its actually a healthcare program that started in 1965.

Debunking these myths about Medicare and prescription drug coverage is important, as it helps get people the coverage that they need. Misinformation and political posturing does nothing but hurt the people for whom Medicare was created.

The following myths and facts about Medicare Part D and the ACA should provide you with a better understanding of the program.

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Applying For Medicare Part D With Medicares Plan Finder

Before going to Medicares site, be sure youve finished all the prep work described in Enrolling in Medicare Part D: What youll need .

  • Go to the Medicare Plan Finder page: Create an account if you’ll want to save your search and come back to it later. Otherwise, click “Continue without logging in.”
  • Enter your information: Select “Drug Plan . Then enter your zip code and answer any other questions that pop up. Click “Next,” and confirm you’d like to see drug costs when comparing plans. Answer any additional questions as they pop up.
  • Enter all your drugs, dosages, and frequencies just as you listed them: Sometimes, you have the option to use a generic version of your medication, which is less expensive. When you’re done, click “Done Adding Drugs.”
  • Select up to two pharmacies*: Proceed to the next page.
  • *A note about selecting pharmacies: Unfortunately, without looking at the plans, its difficult to know which pharmacy is best for your needs. Since each plan has different pharmacies in its network, its hard to know which one to pick now, before you even have a list of plans to choose from. But alas, this is the way the plan finder works until Medicare revamps their site.
  • Browse Part D plans: A list of drug plans that may work for you will populate. If you receive a lot of results, use the filters and sorting tools to make the list more manageable.
  • Enroll. Once youve narrowed the many options, you can enroll via your selected plans Enroll button.
  • Automatic Medicare Part A And Part B Enrollment

    Under some circumstances, you may be automatically enrolled in Medicare Parts A and B:

    • Youve been receiving SSDI benefits for 24 months.
    • Youve been receiving RRB disability benefits for 24 months and dont have a disability freeze.
    • You have ALS and youve received one SSDI payment or one RRB disability payment.

    Some people choose to delay Medicare Part B enrollment because they have some other type of health coverage. If you have ESRD and take Medicare Part A while delaying your Medicare Part B enrollment, youll lose the right to sign up at any time during the 30-month ESRD coordination period. As a result, you may end up with a costly gap in coverage.

    Read Also: Does Medicare Help Pay For Incontinence Supplies

    When Will My Medicare Begin

    In most situations you can receive Medicare disability benefits once you receive Social Security disability income benefits for 24 months. Medicare disability coverage begins the 25th month. The 24-month period begins the month you are entitled to receive Social Security disability benefits. In some cases this could be earlier than the month you receive your first disability benefit check. A person who has ALS and is under age 65 can get Medicare benefits the first month he or she is entitled to SSDI or railroad retirement disability benefits. If you have ESRD , you are eligible for Medicare benefits:

    • the first month you start to administer a regular course of dialysis treatment after receiving selfcare training, or
    • the fourth month you receive treatment at a dialysis center , or
    • the month the transplant is done or the month of hospitalization as an inpatient up to two months before the transplant, if pre-transplant testing has begun.

    What Are The Medicare Prescription Drug Coverage Options

    Getting Ready for Open Enrollment  Medicare Part D ...

    All Part D and prescription drug plans are offered through private insurance. Availability varies by state.

    The right plan for you depends on your budget, medication costs, and what you want to pay for premiums and deductibles. Medicare has a tool to help you compare plans in your area looking ahead to 2020.

    • Part D. These plans cover prescription medications for outpatient services. All plans have to offer some basic level of drug coverage based on Medicare rules. Specific plan coverage is based on the plans formulary, or drug list. If your doctor wants a drug covered thats not part of that plans list, theyll need to write a letter of appeal. Each nonformulary medication coverage decision is individual.
    • Part C . This type of plan can take care of all your medical needs , including dental and vision coverage. Premiums might be higher and you might have to go to network doctors and pharmacies.
    • Medicare supplement .Medigap plans help pay for some or all out-of-pocket costs like deductibles and copays. There are 10 plans available. You can compare the rates and coverage with your original Medicare coverage gap and premiums. Choose the best option to give you maximum benefits at the lowest rates.

    New Medigap plans dont cover prescription drug copays or deductibles. Also, you cant buy Medigap insurance if you have a Medicare Advantage plan.

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    Tips For Choosing A Medicare Part D Plan

    Remember, the plan you choose isnt set in stone. If your needs change year to year, you can switch to another plan in the next open enrollment period. Youll have to stay in the plan an entire year, so choose carefully.

    When using the Medicare plan finder to choose a Part D plan, enter your medications and doses, then select your pharmacy options. Of the available drug plans, youll see the lowest monthly premium plan displayed first. Keep in mind, the lowest premium plan may not fit your needs.

    Theres a drop-down selection to the right of the screen listing three options: lowest monthly premium, lowest yearly drug deductible, and lowest drug plus premium cost. Click through all the options and look at your choices before making a final decision.

    If Youre On Medicare For Disability What Happens When You Turn 65

    When you turn 65, youll no longer qualify for Medicare based on your disability. Instead, youll qualify based on your age. Youll be able to continue your Original Medicare coverage or sign up for a Medicare Advantage Plan, just as you would if youd never had Medicare coverage before. If you decided to delay your Part B enrollment when you were under the age of 65, youll be automatically enrolled in Part B and will need to decide if you want to keep Original Medicare or switch to Medicare Advantage. Youll also have the opportunity to enroll in a Medicare Part D plan.

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    Coverage For Esrd Or Als

    If a person has ESRD or ALS, they do not have to wait 2 years before qualifying for Medicare.

    Medicare enrolls anyone with ALS in the first month that they receive SSDI benefits. A person with ESRD is eligible for Medicare from the first day of the 4th month of their dialysis treatment.

    After a person meets the criteria for SSDI, they qualify for auto-enrollment in Medicare parts A and B, which are collectively called original Medicare. Below, learn about the coverage and costs of each part:

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

    Get Prepared for Medicare Annual Enrollment

    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 eHealths Medicare related content is compliant with CMS regulations, you can rest assured youre getting accurate information so you can make the right decisions for your coverage. Read more to learn about our Compliance Program.

    Find Plans in your area instantly!

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    Enrolling In Original Medicare

    When it comes to Original Medicare, enrollment could be a piece of cake. If youre already receiving Social Security or Railroad Retirement Board benefits and youre a U.S. resident, the government automatically enrolls you in both Medicare Part A and Medicare Part B at age 65. Three months prior to your 65th birthday, your Medicare card will arrive in the mail with instructions.

    At this point, youll have the option to turn down Medicare Part B . But you probably wont want to do that unless you have coverage from your own or your spouses current employer, and the employer has at least 20 employees. Thats a valid reason for delaying your enrollment in Medicare Part B.

    If you decide to not enroll in Part B, but plan to enroll at a later date, know that you could end up having to pay a higher premium 10% higher for each year you could have enrolled, but didnt. The penalty doesnt apply, however, if the reason you didnt initially enroll in Part B coverage was that you had employer-sponsored health insurance from your current employer, including TRICARE from current military employment.

    If you havent yet enrolled in Social Security but are eligible and want to begin receiving benefits, you can enroll online, or at a local Social Security office. Be sure you understand how your benefits depend on the age at which you start receiving them, and theres no right or wrong answer in terms of when you should activate your benefits.

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