What Medicare options do I have if I’m under 65 and disabled?
What Medicare benefits are available to individuals under 65 with disabilities?
If you’re under 65 and have a qualifying disability, you may be eligible for Medicare benefits before reaching the standard age of 65. Medicare provides the same coverage for individuals with disabilities as it does for those who qualify based on age, including hospital, medical, and prescription drug coverage. Here’s an overview of the Medicare benefits available to individuals under 65 with disabilities:
1. Eligibility for Medicare Based on Disability:
You may qualify for Medicare under 65 if you have a qualifying disability and have been receiving Social Security Disability Insurance (SSDI) or Railroad Retirement Board (RRB) disability benefits for at least 24 months.
You automatically get Medicare Part A (hospital insurance) and Part B (medical insurance) after 24 months of receiving SSDI or RRB disability benefits. There is no need to apply separately for Medicare if you qualify through disability benefits.
Exceptions to the 24-month waiting period:
If you have Amyotrophic Lateral Sclerosis (ALS), also known as Lou Gehrig’s disease, you qualify for Medicare as soon as your SSDI benefits begin, with no waiting period.
If you have End-Stage Renal Disease (ESRD) and need dialysis or a kidney transplant, you may also qualify for Medicare without the standard 24-month waiting period, though additional criteria apply.
2. Medicare Part A (Hospital Insurance):
Medicare Part A covers hospital services and other inpatient care, such as:
Inpatient hospital stays.
Skilled nursing facility care (following a hospital stay).
Home health care.
Hospice care.
Most individuals under 65 who qualify based on disability will receive premium-free Part A, as long as they or a spouse have worked and paid Medicare taxes for at least 10 years (40 quarters).
3. Medicare Part B (Medical Insurance):
Medicare Part B covers a range of outpatient services and medical care, including:
Doctor’s visits (primary care and specialists).
Outpatient services, such as lab tests, X-rays, and preventive services.
Durable medical equipment (e.g., wheelchairs, oxygen equipment).
Mental health services.
Physical, occupational, and speech therapy.
Part B requires a monthly premium, which is $174.70 in 2024 for most people, but the amount may vary based on your income.
4. Medicare Part D (Prescription Drug Coverage):
You can also enroll in a Medicare Part D plan to cover your prescription drug costs. Part D plans are offered by private insurance companies and help cover the cost of medications prescribed by your doctor.
You can enroll in Part D during your Initial Enrollment Period (IEP) for Medicare (which is based on when your disability benefits began) or during the Annual Enrollment Period (AEP) from October 15 to December 7 each year.
5. Medicare Advantage (Part C):
Instead of enrolling in Original Medicare (Parts A and B), individuals under 65 with disabilities can opt for a Medicare Advantage (Part C) plan. These plans are offered by private insurers and bundle Part A, Part B, and often Part D prescription drug coverage into one plan. Many Medicare Advantage plans also offer extra benefits like dental, vision, hearing, and wellness services.
Note: Medicare Advantage plans may have network restrictions, so you’ll need to choose healthcare providers within your plan’s network to avoid higher out-of-pocket costs.
6. Medigap (Medicare Supplement) Plans for Individuals Under 65:
Medigap plans are designed to help cover the out-of-pocket costs (like deductibles, copayments, and coinsurance) associated with Original Medicare. However, availability for individuals under 65 varies by state.
Federal law does not require insurance companies to sell Medigap policies to people under 65. Some states offer Medigap plans to people under 65 with disabilities, but premiums may be higher than for those over 65. Check your state’s rules and options for Medigap coverage.
7. Extra Help for Prescription Drug Costs:
If you have limited income and resources, you may qualify for Extra Help, a federal program that helps pay for Medicare Part D prescription drug costs. Extra Help can lower your monthly premiums, deductibles, and copayments for medications.
The program also eliminates the coverage gap (donut hole), so you won’t face higher out-of-pocket costs during that phase of your Part D coverage.
8. Medicaid and Dual Eligibility:
If you qualify for both Medicare and Medicaid, you are considered dual eligible. Medicaid can help pay for Medicare premiums, deductibles, copayments, and services not covered by Medicare, such as long-term care.
Medicare Savings Programs (MSPs) can also help pay Medicare premiums and out-of-pocket costs for individuals with limited income and resources.
9. How to Enroll in Medicare:
If you’ve been receiving SSDI or RRB benefits for 24 months, your Medicare enrollment is automatic, and you’ll receive your Medicare card in the mail. You don’t need to apply separately.
If you have ALS or ESRD, you’ll need to contact Social Security or the Railroad Retirement Board to initiate your Medicare benefits.
Key Takeaways:
If you’re under 65 and receive Social Security Disability Insurance (SSDI) or have certain conditions like ALS or ESRD, you can qualify for Medicare.
You receive the same Medicare Part A and Part B benefits as individuals who qualify based on age.
You can also enroll in Part D for prescription drug coverage and explore options like Medicare Advantage or Medigap plans, though availability for Medigap may vary by state.
For personalized help navigating your Medicare options as a person under 65 with disabilities, schedule an appointment with a Tsunami Advisor here: Schedule an Appointment.
