Getting Medicare Early When Disabled: Who Qualifies?

If you’re disabled, you may qualify for various benefits, with Social Security Disability Insurance (SSDI) being the most common. SSDI is a monthly benefit to replace lost wages resulting from an extended disability. To qualify, you must have worked at a Social Security-qualified job and paid Social Security taxes. Medicare may also be available early for those under age 65 who are receiving SSDI. This article explains SSDI, whether you can get Medicare early if you are disabled and what steps you should follow.

Key takeaways:

Can I apply for Medicare if I am disabled and under 65?

Medicare covers more than eight million disabled individuals under age 65. The process typically begins when you apply for SSDI. Once it's determined you meet the disability criteria, you’ll receive insurance payments five months later. Medicare benefits begin 24 months after you've started receiving SSDI payments for medical expenses. Most people are able to start Medicare coverage, but some recipients decline it to prevent Social Security from taking premiums out of their monthly benefits.

Besides working in a Social Security-qualified job, your medical condition must meet certain criteria. Your disability must inhibit you from performing the basic functions of your job and prevent you from finding a different job. If you don’t follow your doctor’s recommended treatment plan for your condition, you may be disqualified from receiving SSDI benefits.

Disabilities that qualify for Medicare under 65

A disability is defined as a condition expected to last at least a year and inhibits your ability to work and perform everyday functions. Here is a short list of disabilities that may qualify for early Medicare coverage:

  • Parkinson’s disease
  • Heart disease
  • Lupus
  • Multiple sclerosis
  • Cystic fibrosis
  • Amyotrophic lateral sclerosis (ALS)
  • Mental illnesses such as schizophrenia, dementia, and others

If you have a disability that meets the criteria for SSDI, you may be eligible for Medicare coverage. Disabled Medicare beneficiaries usually receive the same benefits as the program’s 65-year-old beneficiaries.

Medicare on Social Security Disability

If you've received SSDI for 24 months, you’ll be automatically enrolled in Medicare Parts A and B at the beginning of the following month. This doesn’t apply to those diagnosed with end-stage renal disease (ESRD).

Various Medicare plans work well for those who qualify. Medicare Advantage plans, or Medicare Part C, allow anyone disabled under 65 to receive Part C, which includes basic Medicare benefits such as hospitalization, medical expenses, blood work, and hospice.

When do you get Medicare on disability?

You may automatically enroll in Medicare Parts A and B when collecting SSDI for 24 months. An exception to this rule is if you’re diagnosed with ESRD or ALS. In this case, you’ll begin receiving Medicare coverage when you receive SSDI payments. You'll be automatically enrolled in Medicare Part A or hospital insurance. In addition to Part A, you may also obtain Medicare Part B if you live within the 50 states of America or in the District of Columbia. However, you do have the option to decline Part B if you already have medical insurance.

Do you have to pay for Medicare when on SSDI?

Medicare carries its own set of costs, such as premiums, deductibles, and co-pays, depending on what you choose. However, state programs are available to help pay premiums for low-income individuals. The Qualified Medicare Beneficiary (QMB) has low-income assistance for those meeting income qualifications to help pay out-of-pocket expenses. To be eligible for the QMB program, your income must be no more than slightly above the Federal Poverty Guidelines (FPG).

Is Medicare mandatory if on disability?

Medicare Part A is mandatory if you’re on disability. However, you can decline Part B, which covers doctors’ visits, x-rays, lab fees, and surgeries. You may face penalties if you don't enroll. Check with your local Social Security office to see if any penalties will apply.

Social Security doesn’t automatically enroll you in Parts C and D. You can choose to enroll provided you're enrolled in Parts A and B. Medicare Part D, which covers prescription drugs, is not mandated.

How do people with disabilities enroll in Medicare?

You must apply for SSDI through the Social Security Administration at www.ssa.gov, by phone, or by visiting your local Social Security office. Your eligibility will be determined, and once accepted, you may enroll in Medicare after 24 months. You'll enroll in SSDI following these listed steps:

  1. Go to the official SSA website.
  2. Click on “Apply for benefits”.
  3. Fill out the “Apply for Social Security Benefits form”.
  4. Be sure to click on the “Disability” box under the “What do you want to apply for” section.
  5. Click on the “Supplemental Security Income for Disability” box under the Supplemental Security Income section.
  6. Click on the “Learn how to apply” button.

If you've become disabled, it's possible to qualify for Medicare benefits before you hit the age of 65. You'll just have to apply for SSDI through the Social Security Administration website first. It's a process that does seem easy if you follow the directions carefully. Once you follow through on the outline steps, you'll likely be on your way to enrolling in a Medicare plan.

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