Medicare Journey

I Am On Disability

And Under 65

Oh YES it's True..... 

Medicare is available for certain people with disabilities who are under age 65! 

It seems a bit complicated but below is some basic information that will help you get started on this journey if you are under 65 and disabled. 

If you become eligible for Medicare because of a disability and have been receiving Social Security Disability Insurance (SSDI) or railroad disability annuity checks for 24 months, you should automatically be enrolled in both Medicare Parts A and B at the start of your 25th month. 

You can also qualify for Medicare if you have End Stage Renal Disease (ESRD) or Amyotropic Lateral Sclerosis (ALS, also known as Lou Gehrig’s disease). There is a 5-month waiting period after a beneficiary is determined to be disabled before they can collect Social Security Disability benefits. You do not have to wait and collect benefits for 24 months in order to be Medicare eligible, if you have ESRD or ALS.

These are the requirements for Medicare eligibility for people with ESRD and ALS:     

  • ESRD – Generally 3 months after a course of regular dialysis begins or after a kidney transplant 
  • ALS – Immediately upon collecting Social Security Disability benefits.
You should not have to contact anyone. You should receive a package via “snail” mailwithin 3 months before your coverage starts with your new Medicare card. There will also be a letter explaining how Medicare works and that you were automatically enrolled in both Parts A and B.



If you get Social Security retirement benefits, your package and card will come from the Social Security Administration (SSA). If you get railroad disability annuity checks, your package and card will come from the Railroad Retirement Board (RRB) and your Medicare card will be slightly different from the standard Social Security Medicare card.

The letter also explains that your monthly Part B premium will be automatically deducted from your Social Security check or railroad disability annuity check beginning the month your coverage begins.

Typically, you should not turn down Part B unless you have insurance based on your or your spouse’s current work (job-based insurance). If you do not have job-based insurance and you turn down Part B, you may incur a PENALTY if you need to sign up for Medicare coverage in the future. Also, if your job-based insurance will pay secondary after you become eligible for Medicare, you should consider enrolling in Medicare in order to have primary coverage and pay less for your care.

If you were not automatically enrolled or have other enrollment questions, contact your local Social Security office or Railroad Retirement Board field office.


Frequently Asked Questions


HOW DO PEOPLE WITH DISABILITIES ENROLL IN MEDICARE?


People who qualify for Social Security Disability benefits should receive a Medicare card in the mail when the required time period has passed. You should contact the local Social Security office if this does not happen or if any other questions arise.


WHAT MEDICARE PLANS CAN I ENROLL IN OR QUALITY FOR?

If you do not have job-based insurance (or spousal job-based insurance), you can choose to enroll in either:

  • Medicare (Disability) Supplement Plan - These premiums typically are cost prohibitive but offer the most flexibility.
  • Medicare Advantage Plan - Many of these plans include Part D and other benefits plus they offer a low or $0 premium. There are PPO and HMO plans with networks and these plans will typically have more restrictions than a Supplement plan.

WHAT MEDICARE BENEFITS ARE AVAILABLE FOR PEOPLE WITH DISABILITIES?

Medicare coverage is the same for people who qualify based on disability as for those who qualify based on age. For those who are eligible, the full assortment of Medicare benefits are available. Coverage includes hospital, nursing home, home health, physician, community-based services and other misc. benefits. The health care services do not have to be related to the individual’s disability in order to be covered.


CAN I GET MEDICARE COVERAGE IF I'M STILL WORKING WITH A DISABILITY?

This is a really great question as many people today have disabilities and still work. Medicare eligibility for working people with disabilities falls into three distinct time frames. The first is the trial work period (TWP), which extends for 9 months after a disabled individual obtains a job. The second is the Extended Period of Eligibility (EPE), which is 7 ¾ years (93 months) after the end of the trial work period. Finally, there is an indefinite period following those 93 months which is called Indefinite Access to Medicare (IAM). Keep in mind that Medicare eligibility during each of these periods applies only while the individual continues to meet the medical standard for being considered disabled under Social Security rules.


CAN PEOPLE WITH DEMENTIA, MENTAL ILLNESS, AND OTHER LONG-TERM AND CHRONIC CONDITIONS OBTAIN COVERAGE?

Yes absolutely! There are no illnesses or underlying conditions that disqualify people for Medicare coverage. Beneficiaries are entitled to an individualized assessment of whether they meet coverage criteria. Although there are criteria that must be met to obtain coverage for particular kinds of care, Medicare should not be denied based on the person’s underlying condition, diagnosis, etc. For example: not being denied Medicare coverage simply because they will need health care for a long time or because their underlying condition(s) will not improve.Physical therapy and other services can be covered even if they are only expected to maintain or slow deterioration of the person’s condition, not to improve it. People with certain conditions are at particular risk for being unfairly denied access to Medicare coverage for necessary health care.People with these and other long-term conditions are entitled to coverage if the care ordered by their doctors meets Medicare criteria:

  • Alzheimer’s Disease
  • Mental Illness
  • Multiple Sclerosis
  • Parkinson’s Disease
If it seems that Medicare enrollment or coverage has been unfairly denied, ask the individual’s doctor to help. 


Have Questions?

Fill out the form to the right and we will get back to you with some straight answers.