Legislative History Of Medicare Eligibility For Ssdi Beneficiaries
The Social Security Amendments of 1972, P.L. 92-603, extended Medicare to persons with disabilities who had been entitled to Social Security Disability Insurance benefits for at least 24 consecutive months. The provision required the waiting period to begin with the first month of SSDI entitlement, which is five months after the onset of the disability.
Is It Mandatory To Sign Up For Medicare After Age 65
No, it isnt mandatory to join Medicare. People can opt to sign up, or not.
If you don’t qualify for Social Security retirement benefits yet, you may need to manually enroll in Medicare at your local Social Security office, online or over the phone when you turn 65. You can also apply online for your Medicare coverage at www.medicare.gov.
Enrolling in Medicare as soon as youre eligible ensures you get the subsidized health care you deserve without waiting periods or financial penalties.
If you continue to work for a company employing 20 or more people after you turn 65, you could delay your Medicare enrollment. Your employee group plan provides enough medical coverage while youre working, meaning you may be able to wait to sign up for Medicare once you retire without incurring any late penalties.
Services Equipment & Access
People younger than age 65 who have Medicare due to a disability occasionally have difficulty obtaining specialized Medicare-covered services, equipment and supplies. While some younger people are relatively healthy despite their disabilities, others have serious physical and mental conditions that require coordinated care from highly trained specialists. Some people also need unusual or customized equipment. In addition, certain specialized equipment and supplies may not be covered by Medicare. Getting the necessary services, equipment and supplies you need may depend on your ability to advocate for it. This may involve a great deal of persistence.
You have the right to assistance or equipment that provides you with the same access as others to services and facilities. For example, if you have a hearing, speech or language disability, you have the right to an interpreter or some other method or equipment for communicating with medical providers. You have the right to accessible equipment, such as examination tables and mammography equipment that can accommodate wheelchair users. However, it must be reasonable for a medical provider to supply these accommodations, and doing so cannot create an undue burden on the financial resources of the provider. The U.S. Department of Justice, Civil Rights Division oversees these issues.
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Whats The Difference Between Medicare Vs Medicaid
Its easy to confuse the Medicare vs Medicaid programs because their names are so similar, although theyre really quite different. Each government programs designed to provide healthcare coverage for elderly and poor Americans. And taxpayer dollars fund both programs but when youre comparing Medicare vs Medicaid coverage, the similarities end there.
How Long Do Medicare Benefits Last For People With Disabilities
As long as youre receiving Social Security disability benefits, your Medicare coverage will continue. In some cases, your Medicare coverage can extend beyond your disability payments.
For example, if you return to work and become ineligible for SSDI, you could stay on Medicare for another eight and a half years93 monthsas long as your disability persists. However, you have to opt in to your employers health plan if they offer one.
In this case, your employer’s health plan would become the primary payer, and Medicare would pay secondary . Unfortunately, if your employer offers only an HSA plan, you wont be able to use Medicare since HSAs and Medicare dont mix.
When Does Medicare Advantage Coverage Start
The date your Medicare Advantage plan starts depends on the enrollment period and your eligibility. Those turning 65 and enrolling in Medicare, can select an advantage plan 3-month before the effective date.
When you pre-enroll in your plan, you save yourself from scrambling. Medicare is one thing you dont want to procrastinate on. Many people change plans during the Annual Enrollment Period if you make a change during this period, your policy will begin on January 1st of the following year.
Does Social Security Automatically Enroll You In Medicare
If you are receiving Social Security benefits, you may also wonder about medical coverage. Do you have to sign up or are you already enrolled in Medicare?
It is important to know the distinction between Medicare Part A and Medicare Part B. In addition, you probably want to know the different circumstances that will enroll you and when you will have to sign up.
If you are receiving Social Security benefits at least 4 months before you turn 65, then you will automatically be enrolled in Medicare Part A and B. If you do not receive Social Security benefits at least 4 months before you turn 65, you will need to sign up.
The information in this article comes from SSA.gov and Medicare.gov. Deciding to receive both Medicare Part A and Part B is an important financial decision so even though the information in this article is accurate, you should always consult with your financial advisor before making the decision.
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Who Is Eligible For Ssdi
The rules are different when youre applying for SSDI. Youll need 40 work credits if youre applying at age 62 or older.
To qualify for SSDI, you must:
- be unable to work because of a medical condition that will last at least 12 months, or is terminal
- not currently have a partial or short-term disability
- meet SSAs definition of a disability
- be younger than full retirement age
You must be able to prove you meet these criteria, and this process can be difficult. Once you qualify for SSDI, the amount of disability youll receive may be based on your age and the amount of time youve worked and paid into Social Security.
This table explains what benefits are offered based on your age and number of years worked:
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, thisisn’t true in all states. Medicaid is operated by the states,and the states are allowed to set eligibility criteria that are different thanSSI’s criteria. As a result, whether getting approved for SSI gets you Medicaiddepends on your state, as we’ll discuss below.
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If Youve Been Collecting Social Security Disability Benefits For 24 Months
You will be automatically enrolled in Medicare Parts A and B at the beginning of the 25th month after you first received your Social Security disability benefits. Exceptions include those who do not live in any of the 50 United States or the District of Columbia or if you have end-stage renal disease .
You can apply separately for a Medicare prescription drug plan through a private insurance carrier if you want prescription drug insurance. Enroll in a Medicare prescription drug plan as early as three months before the 25th month of your Social Security disability benefits.
To enroll in a Medicare Prescription Drug Plan, you can use the eHealth plan comparison tools on this page.
Enrolling In Medicare With A Disability
Just like when you become eligible for Medicare at age 65, when you are eligible with disability, you have an Initial Enrollment Period of 7 months.
Your Initial Enrollment Period will begin after you have received either disability benefits from Social Security for 24 months or certain disability benefits from the Rail Road Retirement Board for 24 months.1 In other words, your IEP starts on the 25th month of disability benefits.
You will be automatically enrolled in Medicare Part A and Part B, but if you decide you want to get a Medicare Advantage or Part D prescription drug plan, you will need to enroll yourself directly with the private plan provider. You will need to enroll during your IEP to avoid late enrollment penalties.
NOTE: If you become eligible for Medicare because of ALS or ESRD, your situation is different. See the below special sections for eligibility and enrollment for ALS and ESRD.
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What If Iwas Approved For Ssi But Denied Medicaid
If you receive SSI but were denied Medicaid benefits in a 209state or any state for that matter, you should appeal the decision to yourstate’s Medicaid agency. Your state has to follow certain federal Medicaidrules in notifying you of the denial and holding a hearing. To learn more, readNolo’s article on appealinga Medicaid denial.
Medicare Vs Medicaid: How Medicaid Works
Medicaid is a need-based joint federal and state insurance program that covers low-income individuals and families. That said, Medicaid coverage can vary significantly from state to state. Thats because the federal government covers up to 50% of each states Medicaid program costs. This means all remaining Medicaid program costs must be paid for at the state level.
Unlike Medicare, Medicaid isnt available to everyone and it has very strict eligibility requirements. To qualify for Medicaid coverage, you must either already be receiving SSI benefits or fit within a mandatory eligibility group. If your financial resources arent limited enough to qualify for SSI, you may still qualify for state-based Medicaid assistance programs. For more information about the updated Medicaid eligibility requirements under the Affordable Care Act , visit the Medicaid.gov website.
While each states coverage varies , the federal government requires that there is coverage for the following services as long as theyre deemed medically necessary.
- Preventive care for children under 21
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Getting Help With Medicare Costs
You might be able to get help paying for your Medicare coverage if your income and resources are below a specified limit. You could qualify for Medicaid, a government program for low-income individuals.
If your income is too high to qualify for Medicaid, try a Medicare Savings Program , which generally has higher limits for income. As a bonus, if you qualify for an MSP, you automatically qualify for Extra Help, which subsidizes your Part D costs.
Contact your states Medicaid office for more information.
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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Medicare Eligibility Under Ssdi
- This image courtesy of Pixabay
Medicare is not only a health insurance program for people 65 and older, it is also health insurance for some disabled individuals. If awarded Social Security Disability Insurance benefits, you are eligible for Medicare after a 24-month waiting period, which begins the date you first become eligible to receive social security disability benefits.
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.
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Medicare Part C With Ssdi
Part C plans, also known as Medicare Advantage, combine the benefits of parts A and B. Private insurance companies offer Advantage plans, which may also include benefits such as vision, dental, fitness, and Part D prescription drug coverage.
A Special Needs plan, or SNP, is an Advantage plan tailored to meet the needs of people with certain chronic conditions, including ALS and ESRD.
Costs of Advantage plans vary. The average Advantage plan monthly premium in 2019 was $29, according to the Kaiser Family Foundation. On top of this, a person may have to pay copays and deductibles. However, there may be an annual limit for out-of-pocket costs, which may be lower for people with Advantage plans than those with original Medicare.
A person may be eligible to receive extra support, based on their income.
If You Get Medicare For Disability And Then Return To Work
If you get Medicare due to disability and then decide to go back to work, you can keep your Medicare coverage for as long as youre medically disabled.3 And, if you do go back to work, you wont have to pay the Part A premium for the first 8.5 years.
Part A is premium-free for those with a disability and under 65 only if you get Social Security or Railroad Retirement Board benefits for 24 months or have ESRD and meet certain requirements.4
If youre 65 or older, Part A is premium-free if you or your spouse worked and paid Medicare taxes for at least 10 years, you already get retirement benefits from Social Security or the Railroad Retirement Board, or youre eligible for these benefits but havent filed for them yet.5
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Medicare Supplement Plans For Disabled Under 65
Medicare pays a large portion of the cost, but not all of it. Medigap can help cover what Medicare doesnt cover. But if youre under 65, it can be hard to find an affordable Medigap plan.
While some states require companies to offer at least one Medigap plan to people under age 65, others do not. In some states, Medigap plans are only available to certain types of beneficiaries, such as people with end-stage renal disease.
In several states, you cant buy a Medigap plan at all if youre under 65. And rates tend to go up from one year to the next. So, Medigap can be both hard to get and expensive if youre under 65. Often, the best solution is an Advantage plan.
When you turn 65, youll qualify for the Medicare Supplement Open Enrollment Period. Then, you can get a policy without having to answer any questions about your health.
What Happens To My Medicare Disability When I Turn 65
If you receive SSDI for 24 months and enroll in Medicare before turning 65, not much happens when you turn 65. You can remain on Medicare, but your eligibility technically is based on your age rather than your disability. You get the same Initial Enrollment Period surrounding your 65th birthday that everyone else gets, meaning you do have a chance to make changes to your coverage as you approach 65.
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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 Part D For Disabled Under 65
If you choose Medicare, youll need a Part D drug plan. Youll pay a premium, and a copay or coinsurance. Many people on Social Security Disability qualify for Extra Help with Part D costs. Eligibility for Extra Help is based on income and assets. If youre on Medicaid, you automatically qualify for Extra Help.
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Changes To The Waiting Period Criteria
The Social Security Disability Amendments of 1980, P.L. 96-265, permitted an individual becoming re-entitled to SSDI benefits to count the months of the earlier spell of disability in satisfying the 24-month waiting period if the spell occurred within the previous five years or seven years for disabled widows and those who were disabled since childhood. The amendments also provided that if an individual was in a trial work period after the termination of the SSDI benefits, and had not completed the 24-month waiting period, the months of the trial work period could count toward satisfying the required waiting period for Medicare eligibility.
Effective October 1, 2000, the Ticket to Work and Work Incentives Improvement Act of 1999, P.L. 106-170, extended Medicare Part A coverage to certain working former SSDI beneficiaries for a total of 8.5 years.