Tuesday, May 14, 2024

Who Qualifies For Medicare Under 65

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People Under 65 Who Qualify For Medicare

Medicare for Individuals Under 65

One of the most visible Medicare populations is people 65 and older. However, that doesnt mean younger people dont qualify for Medicare. Two groups younger than 65 that qualify for Medicare are people with End Stage Renal Disease and people with disabilities. Read more below to learn about the Medicare requirements for these groups.

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.

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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 Does Medicare Cover

Medicare helps pay for certain health care services and durable medical equipment. To have full Medicare coverage, Medicare beneficiaries must have Part A and Part B .

The following is a partial list of Medicare-covered services. The covered services listed below may require payment of deductibles and Co-Payments.

If you have questions about covered services, call Medicare at 1-800-633-4227.

Is My Spouse Eligible For Medicare When I Turn 65

Medicares Role for People Under Age 65 with Disabilities

If you are about to turn 65 and plan on enrolling in Medicare, you might be wondering if your younger spouse will also be eligible for Medicare or will be covered under your plan. This article will explain what happens in this situation.

Medicare Eligibility

You are eligible for Medicare if you meet these conditions:

  • You are at least 65 years old.
  • You are a permanent legal resident of the US for at least five years or are a U.S. Citizen.
  • You are eligible for benefits from Social Security or the Railroad Retirement Board or
  • You are a government employee or retiree who has paid Medicare payroll taxes.

There are a few exceptions that will allow you to enroll in Medicare before you turn 65 such as having a disability for 24 consecutive months, End Stage Renal Disease, or ALS.

Can my spouse receive Medicare coverage when I turn 65?

Unfortunately, Medicare is designed to cover individuals so your spouse will not be covered under your plan. Therefore, if your spouse does not independently qualify for Medicare, they will not receive Medicare coverage.

Employer insurance often provides group insurance that covers you, your spouse, and dependents, but since Medicare only provides individual insurance, it will not cover anyone other than you.

Health Insurance Options

For more information on Medicare and your options when you become eligible, contact a licensed Medicare agent.

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Medicare Eligibility If You Are Under 65

People younger than 65 may qualify for Medicare if they have certain costly medical conditions or disabilities.

If you are under 65, you can qualify for full Medicare benefits if:

  • You have been receiving Social Security disability benefits for at least 24 months. These do not need to be consecutive months.
  • You have end-stage renal disease requiring dialysis or a kidney transplant. You qualify if you or your spouse has paid Social Security taxes for a specified period of time, based on your age.
  • You have amyotrophic lateral sclerosis, also known as Lou Gehrigs disease. You qualify for Medicare immediately upon diagnosis.
  • You receive a disability pension from the Railroad Retirement Board and meet certain other criteria.

How To Enroll In Coverage Beyond Original Medicare

Health costs can quickly add up. Its great that Original Medicare is available with qualifying disabilities to people under 65, but what about coverage beyond Original Medicare? Medicare Advantage, Medicare Supplements, and Part D plans can add additional benefits and help you save on out-of-pocket costs. However, different states have different laws and some plans may not be at the best possible rate. A licensed agent is your best bet to compare your different options and enroll in the coverage you need at the price you want. Call us today at 833-438-3676 or fill out this form to get in contact with a licensed agent.

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Medicare Eligibility For People Under 62

There are a few exceptions for Medicare age limits that can allow people younger than 65 and under age 62 to enroll in Medicare.

  • If you have ALS , you are immediately eligible for Medicare regardless of your age as soon as your Social Security or Railroad Retirement Board disability benefits begin.
  • You may also qualify for Medicare if you have kidney failure that requires dialysis or a kidney transplant, which is known as end-stage renal disease .
  • You may also qualify for Medicare at age 62 or any age before 65 if you receive disability benefits from either Social Security or the Railroad Retirement Board for at least 24 months.

If you qualify for Medicare under the age of 65 because of a disability, you might also qualify for a Medicare Advantage Special Needs Plan.

Social Security Disability And Medicare

Medicare Disability Benefits – Options [Under Age 65]

A person may have a disability that restricts their ability to work. People with these disabilities may often qualify for Social Security or Railroad Retirement Board benefits.

Once a person has received these benefits for 24 months, they can start a Medicare plan, even though they are under 65 years of age.

A person with a disability may otherwise have difficulty getting health insurance, as a private insurer may charge them higher premiums due to pre-existing medical conditions.

As a result, Medicare provides a more cost-effective coverage option for people who have disabilities.

Examples of disabilities that may qualify a person for Social Security or RRB benefits include:

  • back injuries and other musculoskeletal issues
  • bleeding disorders
  • heart conditions, including congestive heart failure
  • mental health disorders, such as depression
  • sensory issues, such as vision loss
  • speech disorders
  • severe respiratory illnesses, such as COPD

Medicare has specific criteria for children under the age of 18 years who wish to claim disability benefits or enroll in Medicare.

The SSA does not pay disability benefits to a young person until they reach 18 years of age. Therefore, a person with a disability does not qualify for Medicare until they are 20 years of age.

An exception to this rule applies to people who are 18 years of age and have ALS. They qualify for Medicare benefits once they reach this age.

Those with ESRD can qualify for Medicare if they meet the following criteria:

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Do I Have To Take Part B

You are not required to take Part B, and some people choose to delay. Deciding to opt out of Part B at this time is a personal choice and depends on your unique situation. about whether or not you should take Part B when you qualify for Medicare with a disability. Some people who qualify for Medicare under age 65 due to disability but are covered under an employers plan or a spouses employer plan, may opt to delay.2

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

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

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.

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End Stage Renal Disease Requirements

ESRD is the last stage of kidney failure. These patients need extensive medical care, including dialysis and possible kidney transplant. People with ESRD are eligible for Medicare if they meet the following criteria:

  • Applicant must be a U.S. citizen or permanent legal resident who has lived in the U.S. for at least 5 years
  • Applicants must have permanent kidney failure requiring regular dialysis or a kidney transplant.
  • Applicant or spouse have paid social security taxes for a certain length of time depending on your age.

Additionally, your ESRD must be confirmed and documented by a doctor.

Disability & Medicare Eligibility And Enrollment What You Need To Know In 2022

Medicares Role for People Under Age 65 with Disabilities

Some people can qualify for Medicare due to disability. In this case, if you have a qualifying disability, you are eligible for Medicare even if you are not yet age 65. To find out if your disability qualifies for disability benefits or for Medicare, youll need to speak with Social Security directly, but in general, you become eligible the 25th month of receiving Social Security Disability Insurance benefits .

If you have a qualifying disability, you must first file for disability benefits through Social Security before you can even be considered eligible for Medicare due to disability. Approval of the request by Social Security is an important first step. It is also important to note that these benefits are different from Supplemental Security Income benefits, and that SSI benefits do not qualify you for Medicare.

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Medicare Under 65 For Those With Disabilities

Are you under 65 years old, disabled, and have been receiving disability benefits from the Social Security Administration , or specific Railroad Retirement Board disability benefits, for at least two years? If so, may be eligible to enroll for Medicare under age 65 benefits.

To qualify for benefits, you must fit Social Securitys definition of having a disability and have been employed long enough under SSA-covered employment. In most cases, Social Security defines a disability to be something that causes you to be incapable of doing the work you previously could, due to a condition that will last at least a year or end in your death. You must also be unable to do any other type of work, even with assistance.

The Social Security Administration determines if you qualify for disability payments and then if you are eligible for Medicare.

How Do Beneficiaries Out

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

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Who Is Eligible For Medicare

Generally, Medicare is available for people age 65 or older, younger people with disabilities and people with End Stage Renal Disease . Medicare has two parts, Part A and Part B . You are eligible for premium-free Part A if you are age 65 or older and you or your spouse worked and paid Medicare taxes for at least 10 years. You can get Part A at age 65 without having to pay premiums if:

  • You are receiving retirement benefits from Social Security or the Railroad Retirement Board.
  • You are eligible to receive Social Security or Railroad benefits but you have not yet filed for them.
  • You or your spouse had Medicare-covered government employment.

To find out if you are eligible and your expected premium, go the Medicare.gov eligibility tool.

If you did not pay Medicare taxes while you worked, and you are age 65 or older and a citizen or permanent resident of the United States, you may be able to buy Part A. If you are under age 65, you can get Part A without having to pay premiums if:

  • You have been entitled to Social Security or Railroad Retirement Board disability benefits for 24 months.
  • You are a kidney dialysis or kidney transplant patient.

While most people do not have to pay a premium for Part A, everyone must pay for Part B if they want it. This monthly premium is deducted from your Social Security, Railroad Retirement, or Civil Service Retirement check. If you do not get any of these payments, Medicare sends you a bill for your Part B premium every 3 months.

How Much Does Medicare Cost At Age 65

Medicare Explained: What Disabilities Qualify for Medicare under 65?

The standard premium for Part B modestly increases year over year. Part A costs also can increase, including the annual deductible and other coinsurance. Known as hospital insurance, Part A doesnt require a monthly premium as long as you have paid Medicare taxes through employment for at least 10 years.

Part B, known as medical insurance, typically pays 80% of the covered cost while you pay the deductible and then 20%.

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Eligibility For People With Als

People with ALS, or Lou Gehrigs disease, can qualify for Medicare when they are under 65 years of age.

ALS is a progressive, neurodegenerative disorder that disrupts a persons ability to speak, move, eat, and ultimately breathe. The condition has no cure and is eventually fatal.

According to the ALS Association, an estimated 16,000 people in the United States have the disorder. A doctor usually diagnoses ALS between the ages of 4070 years.

Unlike ESRD, those with ALS can receive Medicare Part A benefits in their first month of receiving Social Security or RRB benefits.

The SSA automatically enrolls a person with ALS in a Medicare plan when they start paying Social Security benefits.

According to a 2017 review in Amyotrophic Lateral Sclerosis and Frontotemporal Degeneration, a persons monthly costs with ALS under Medicare can total $10,398 during the month of their diagnosis.

ALS often progresses rapidly and leads to high healthcare costs. This is why a persons Medicare benefits will usually begin as soon as possible.

Is Medigap Coverage Expensive For People Under 65

Medigap rates typically increase each year. Additionally, you may have to answer questions about your health that could increase the cost of your coverage.

Original Medicare costs the same for beneficiaries, regardless of age. However, the cost of a Medigap policy can be much greater for disabled beneficiaries. In most cases, a Medicare Advantage plan is the best option for beneficiaries who are under 65 and disabled.

Its important to note that when you reach 65, you will be eligible to enroll during the Medicare Supplement Open Enrollment Period. At that time, you can purchase a policy without answering health-related questions.

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Get Started With Medicare

Medicare is health insurance for people 65 or older. Youre first eligible to sign up for Medicare 3 months before you turn 65. You may be eligible to get Medicare earlier if you have a disability, End-Stage Renal Disease , or ALS .

Follow these steps to learn about Medicare, how to sign up, and your coverage options. Learn about it at your own pace.

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Find Cheap Medicare Plans in Your Area

Although Medicare is well known as a federal program that provides health care to seniors 65 and older, it also covers more than 8 million people with disabilities under the age of 65.

Qualifying for Medicare when you are under the age of 65 is a process that begins by applying for Social Security disability benefits. After several steps are completed, there’s usually a two-year waiting period before Medicare’s health insurance benefits begin.

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