Medicare is generally thought of as health insurance exclusively for seniors 65 and older. Most people aren’t aware that people under 65 may qualify for Medicare if they have a disability. We’ll explore the circumstances under which a person with a disability qualifies for Medicare, when they should apply, how they can get Medicare Part D drug coverage, and more.
When Can a Disabled Person Get Medicare Coverage?
If you are disabled and have received disability benefits from Social Security or disability benefits from the Railroad Retirement Board (RRB) for 24 months, you automatically qualify for Medicare Parts A (hospital insurance) and Part B (medical insurance).
If you have ALS (Amyotrophic Lateral Sclerosis, also called Lou Gehrig’s disease) you’ll automatically get Parts A and B the month your disability benefits begin.
If you have end-stage renal disease (ESRD) you can get Medicare Parts A and B, regardless of your age, as long as one of the following applies to you:
- You’ve met the work credit requirements under Social Security, the RRB, or as a government employee
- You’re already getting or are eligible for Social Security or railroad retirement benefits
- You’re the spouse or dependent child of someone who has adequate works credits under Social Security, the RRB, or as a government employee, or who is already getting or is eligible for Social Security or RRB benefits.
Deciding Whether to Enroll in Part B (medical insurance)
Because there is a premium for Part B of $104.90/month (for most people), some disabled people elect not to enroll in Part B if they can instead get medical coverage through a spouse or family member’s group health insurance plan.
Be aware that if you delay enrollment in Part B and, instead, elect to join your spouse’s or family member’s group plan, you may pay a penalty when you later need to enroll in Part B (if your spouse or family member retires, for example), and you may also have to wait for Medicare open enrollment.
Whether the penalty and open enrollment stipulation applies to you depends on the number of employees at your spouse/family member’s company. Talk to a Medicare professional to learn whether these rules may apply to you.
What about Drug Coverage?
If you’re newly eligible for Medicare because you have a disability, you can sign up for a Medicare Advantage Plan or a Medicare Prescription Drug Plan. You are eligible to sign up during the 7-month period that begins three months before your 25th month of getting Social Security or RRB disability benefits, and which ends three months after the 25th month.
How Medicare Works with Other Insurance
As mentioned earlier, it is possible to have both Medicare and another insurance plan, such as coverage through a spouse’s employer group health plan or through Medicaid. Each type of coverage is referred to as a “payer.”
Medicare’s coordination of benefits rule determines which plan is the primary payer and which is the secondary payer. The primary payer pays first, up to the coverage limits, and then sends a bill for the remainder to the secondary payer. In some instances there may also be a third payer.
We’ve touched on some of the rules and stipulations surrounding Medicare for those with a disability. To find out whether you qualify, consult with the experts at CA Medicare today.