Medicare For Disabled Individuals
Medicare is a government program primarily designed to help lower health care expenses for people age 65 and older. However, there are some provisions to help those under 65 years of age. There are certain conditions under which you can qualify for Medicare before age 65. This article will examine the basics of Medicare for disabled individuals, as well as some strategies to maximize the money-saving possibilities of this coverage.
Can I Get A Medicare Supplement Without Having To Pass Underwriting Requirements
If youâve gotten to this point and have realized you wouldnât be able to pass any underwriting, all is not lost!
There are 2 special circumstances where you donât have to answer any health questions at all. These are called open enrollment and Guaranteed Issue .
Open enrollment is when youâve signed up for Medicare Part B for the first time. In this situation, you donât have to answer any health questions.
Guaranteed Issue is a little bit more complicated, but here are a couple common examples:
- Youâre in a Medicare Advantage Plan, and you move out of the planâs service area.
- Your employerâs group health plan is ending.
So, if you qualify for open enrollment or Guaranteed Issue , you donât have to pass medical underwriting at all.
If youâre getting a bit of a headache and would rather have someone else figure this out for you, please contact us!
Our agents are experts and know the rules inside and out. With us, youâre never alone.
How Does Diabetes Affect My Medicare Supplement Eligibility
When you start filling out an application for a Medicare Supplement , youâll notice that thereâs a section about your health.
In this health section, there are lots of questions about certain diseases and conditions. In sum, if you have any of these conditions, youâre automatically declined.
For many carriers, diabetes is one of these concerns. However, simply having diabetes doesnât automatically decline you.
There is usually a set of specific questions that help the insurer decide how risky you are:
- How much insulin do you take?
- How many total medications do you take?
- Do you have any other conditions, such as high blood pressure?
- How much do you weigh?
All of these questions help the underwriter decide if youâre going to be too expensive to insure. If they find your diabetes to be too risky, theyâll decline you.
So, what are these specific qualifications, and how do you get around them?
Also Check: Does Medicare Cover Dementia Care Facilities
Medicare Supplement Plan Eligibility
Medicare supplemental insurance, often called Medigap because it fills in the out-of-pocket coverage gaps in Medicare Parts A and B, is purchased from private insurers.
Medigap helps cover copayments, coinsurance and deductibles from Medicare Part A and Part B.
To be eligible for Medigap coverage, you must meet one of these qualifications:
- You must be 65 or older.
- You have been diagnosed with Lou Gehrigs disease.
- You have been receiving Social Security or Railroad Board disability payments for 24 months.
- You must have been diagnosed with end-stage renal disease, requiring regular dialysis or a kidney transplant.
You cannot enroll in a Medicare Advantage plan and a Medigap plan at the same time. You have to choose one or the other.
Are Children Eligible For Medicare
If you want to qualify for Medicare, children must be disabled and checked through the Social Security Administration. They need to have been receiving social security for their benefits for two years before applying for Medicare. However, if your child has End Stage Renal Disease, which is a kidney condition that needs dialysis every day or a transplant for the affected kidney. Medicare pays for doctors visit and medical services that are provided for those disabilities and conditions that are allowed by Medicare.Quick Facts on Medicare for Kids
- Parents are still responsible for paying Medicare programs
- Some child healthcare programs are free through Medicare. For example, you may be eligible for CHIP or Childrens Health Program
- Even if you have other types of insurance, you can still receive Medicare
Read Also: Does Medicare Cover Family Counseling
The Parts Of Medicare
Social Security enrolls you in Original Medicare .
- Medicare Part A helps pay for inpatient care in a hospital or limited time at a skilled nursing facility . Part A also pays for some home health care and hospice care.
- Medicare Part B helps pay for services from doctors and other health care providers, outpatient care, home health care, durable medical equipment, and some preventive services.
Other parts of Medicare are run by private insurance companies that follow rules set by Medicare.
- Supplemental policies help pay Medicare out-of-pocket copayments, coinsurance, and deductible expenses.
- Medicare Advantage Plan includes all benefits and services covered under Part A and Part B prescription drugs and additional benefits such as vision, hearing, and dental bundled together in one plan.
- Medicare Part D helps cover the cost of prescription drugs.
Most people age 65 or older are eligible for free Medical hospital insurance if they have worked and paid Medicare taxes long enough. You can enroll in Medicare medical insurance by paying a monthly premium. Some beneficiaries with higher incomes will pay a higher monthly Part B premium. To learn more, read .
Sign Up: Within 8 Months After Your Family Member Stops Working
- If you have Medicare due to a disability or ALS , youll already have Part A .
- Youll pay a monthly premium for Part B , so you may want to wait to sign up for Part B.
Avoid the penalty & gap in coverageIf you miss this 8-month Special Enrollment Period, youll have to wait to sign up and go months without coverage. You might also pay a monthly penalty until you turn 65. The penalty goes up the longer you wait to sign up. How much is the Part B late enrollment penalty?
Recommended Reading: Are All Medicare Plan F The Same
How Do I Qualify For The Giveback
You may qualify for a premium reduction if you:
- Are enrolled in Part A and Part B
- Do not rely on government or other assistance for your Part B premium
- Live in the zip code service area of a plan that offers this program
- Enroll in an MA plan that provides a giveback benefit
Because not all plans offer this benefit, it’s important to do your research and compare plans, benefits, and costs to ensure you’re making the best decision for you.
Contact Social Security To Sign Up For Medicare
You can either:
Know when to sign up for Part BYou can only sign up for Part B at certain times. If you dont sign up for Part B when you turn 65, you might have to wait to sign up and pay a monthly late enrollment penalty. Find out when you can sign up. How much is the Part B late enrollment penalty?
Also Check: Can You Sign Up For Medicare Part A Only
Youre Enrolled In Original Medicare And Are Looking For Additional Coverage
If youre enrolled in Original Medicare, Part A and Part B, and youre interested in other types of Medicare coverage, your eligibility will depend on the part of Medicare.
Medicare Advantage plans are another way to receive your Medicare benefits, delivered through Medicare-contracted private insurance companies. These plans offer, at minimum, the same benefits as Original Medicare, but may include additional coverage, such as routine vision and dental, prescription drug benefits, or wellness programs. You must continue paying your Part B premium, in addition to any premium the Medicare Advantage plan charges. To be eligible to enroll in a Medicare Advantage plan, you must:
- Have Medicare Part A and Part B.
- Not have end-stage renal disease .
- Live in the service area of the Medicare Advantage plan youre considering.
Medicare Part D is prescription drug coverage. This is optional coverage that doesnt come with Original Medicare and must be obtained through a Medicare-approved private insurance company. You can get this coverage through a stand-alone Medicare Prescription Drug Plan or a Medicare Advantage plan that comes with prescription drug benefits . To be eligible for Medicare Part D, you must:
- Have Medicare Part A and/or Part B.
- Live in the service area of the plan youre considering.
- Not have end-stage renal disease, with some exceptions .
To learn about Medicare plans you may be eligible for, you can:
Medicare Advantage And Medicaid Better Together
When youre disabled to the extent that you qualify for Medicare early, your income is often very limited. This means that you might qualify for Medicaid. This is especially true if you are single, or if your disability payments are the sole source of your household income. If you think that you have any chance of qualifying for Medicaid, you should definitely apply through your State. If you qualify for full Medicaid benefits, you become eligible for some significant cost savings.
When youre eligible for both programs youre known as dual-eligible. There are special Medicare Advantage plans known as Dual Special Needs Plans that are designed to provide maximum coverage for dual eligible people. Some of the great benefits of these plans include:
- Extremely low prescription drug costs
- Zero out of pocket costs for medical services
- Help paying for your Part B premium
In addition, Dual Special Needs Medicare Advantage plans tend to come with even richer extra benefits. This usually takes the form of more money available to pay for dental expenses, routine eyewear, and hearing aids. Besides these, D-SNPs frequently come with monthly allowances to purchase healthy and fresh foods. In short, it is worth the time and effort to apply for Medicaid it can really help you lower costs, which is critical when youre on a fixed disability income.
Read Also: Is Tresiba Covered By Medicare
How To Opt Out Of Medicare Part B
So, if you dont want to be enrolled, you may be able to opt out. Follow the instructions in your Welcome to Medicare packet, which Medicare sends you during the three months before youre eligible, in most cases.
Were always happy to answer your questions. Call one of our eHealth licensed insurance agents at 1-888-296-0117 . Representatives are available from 8 AM to 8 PM Monday through Friday, and from 10 AM to 7 PM Saturdays, Eastern time.
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!
How To Get Medicare Part A And Part B Coverage
- If you receive SSDI for 24 months, you will automatically be enrolled in Medicare Parts A and B at the beginning of the 25th month.
- If you have ALS, you will automatically be enrolled in Medicare Parts A and B as soon as you receive the first month of SSDI benefits.
- If you have ESRD, you must apply for Medicare benefits. Medicare eligibility depends on a variety of factors, including whether or not you are receiving dialysis, have had a kidney transplant, and/or have paid Medicare taxes sufficiently.
Recommended Reading: When Does Medicare Part D Start
Who Qualifies For Medicare Part A Thats Premium
Most people dont have to pay a premium for Medicare Part A if they or their spouse paid Medicare taxes while working for at least 10 years . If youre not eligible for premium-free Part A, you will have to pay a monthly premium of up to $471 in 2021.
In addition, you must also pay the Part B premium each month. The standard premium is $148.50 in 2021.
Also, keep in mind that individuals with a higher income may have to pay more for their Part B premium. Be aware that if you dont sign up for Medicare Part B when you first become eligible, you may have to pay a 10% penalty for each full 12-month period you could have had it but didnt sign up .
You Have Lou Gehrigs Disease
If you have amyotrophic lateral sclerosis , youll be eligible for Medicare and automatically enrolled in Medicare Part A and Part B on the first day of the month that you start receiving disability benefits. Unlike other disabilities, you dont have to wait 24 months to be eligible for Medicare benefits.
Read Also: Is It Mandatory To Take Medicare At 65
What To Do Next When You Become Eligible For Medicare
If you currently have a health plan through Covered California:
If you dont currently have a health plan through Covered California:
If youre currently enrolled in Medicare Part A, or eligible for premium-free Medicare Part A, you cant enroll in new coverage through Covered California. This is because Medicare Part A is considered minimum essential coverage under the Affordable Care Act. But depending on your income and assets, you may be eligible for additional coverage through Medi-Cal. Once youre enrolled in Medicare, you can contact your local county office or complete the Covered California application to see if you also qualify for Medi-Cal.
Biden Announces Free Tests And Defends The White House Response As Covid Cases Surge
During Monday’s White House news briefing, press secretary Jen Psaki told reporters that the administration will start to have free coronavirus tests “out the door in the coming weeks.”
“The contracts are structured in a way to require that significant amounts are delivered on an aggressive timeline, the first of which should be arriving early next week,” Psaki said.
“We also expect to have details on the website as well as a hotline later this week,” Psaki added.
Today, my administration announced that health insurers will be required to cover the cost of at-home COVID testing kits starting January 15th.
The Biden Administration says it is “incentivizing” insurers and group health plans to set up programs that will allow Americans to get the over-the-counter tests directly through preferred pharmacies, retailers or other entities with no out-of-pocket costs.
Medicare Part D Premiums
Your Part D Premium will depend on the plan you choose. Just like with your Part B coverage, youll pay an increased cost if you make more than the preset income level.
In 2022, if your income is more than $91,000 per year, youll pay an IRMAA of $12.40 each month on top of the cost of your Part D premium. IRMAA amounts go up from there at higher levels of income.
This means that if you make $95,000 per year, and you select a Part D plan with a monthly premium of $36, your total monthly cost will actually be $48.40.
What Medicare Plan Is Right For My Child
If you are eligible for Medicare, then the best plan is sold through a private health insurance company in the form of Medicare Advantage plans. These are plans that were created by private health insurance companies, but they offer more services. There are many advantages to using Medicare Part instead of CHIP or other private health insurance policies. For one, you can see doctors at any Medicare-approved facility, and you can also get coverage for your childs doctors visits and so much more, which brings the costs down a lot.If you dont qualify for other childrens healthcare programs, Medicare may be the right answer. One thing to remember is that you have to receive social security benefits for a disabled person for 2 years before you can get on a Medicare plan even if for your child. For other questions concerning Medicare or family health insurance plans, just go through our blog. Its updated each week with lots of different tutorials and tips specifically related to Medicare health coverage and Medicare Part C.
MedicarePartC.com, a website owned by Health Network Group, LLC, markets products underwritten by National Health Insurance Company, Integon National Insurance Company and Integon Indemnity Corporation. Health Network Group National Health Insurance Company, Integon National Insurance Company and Integon Indemnity Corporation are all related companies under National General Holdings Corp.
Medicare Enrollment Questions? Speak with an Agent
Recommended Reading: What Are The Four Different Parts Of Medicare
Am I Eligible For Medicare Part A
Generally, youre eligible for Medicare Part A if youre 65 years old and have been a legal resident of the U.S. for at least five years. In fact, the government will automatically enroll you in Medicare Part A at no cost when you reach 65 as long as youre already collecting Social Security or Railroad Retirement benefits.
If youre already receiving Social Security or Railroad Retirement benefits, all you need to do is check your mail for your Medicare card, which should automatically arrive in the mail about three months prior to your 65th birthday . The card will arrive with the option to opt-out of Part B , but opting out of Part B is only a good idea if youre still working and have employer-sponsored coverage that provides the same or better coverage, or if your spouse is still working and you have coverage under their plan.
If youre not already receiving Social Security or Railroad Retirement benefits, youll need to enroll in Medicare during a seven-month open enrollment window that includes the three months before the month you turn 65, the month you turn 65, and the three following months. If you enroll before the month you turn 65, your benefits will start the month you turn 65 . If you enroll in the three months after you turn 65, your coverage could have a delayed effective date.
In addition to turning 65, people can become eligible for Medicare due to a disability , or due to end-stage renal disease or amyotrophic lateral sclerosis .