Jane Dotson
Medicare is a health insurance program for people aged 65 and over, as well as some disabled people under 65 and people with permanent kidney failure. People under 65 who are deemed medically disabled can qualify for Medicare, but there is a two-year waiting period after the first month of receiving Social Security Disability Insurance (SSDI) benefits before coverage begins. This waiting period is waived for people with Amyotrophic Lateral Sclerosis (ALS), also known as Lou Gehrig's disease, who are enrolled in their first month of receiving SSDI benefits.
| Characteristics | Values |
|---|---|
| Who qualifies for Medicare | People 65 and older, some disabled people under 65, and people with end-Stage Renal Disease (permanent kidney failure treated with dialysis or a transplant) |
| Requirements for people under 65 | Must have received Social Security Disability benefits for 24 months or have End Stage Renal Disease (ESRD) or Amyotropic Lateral Sclerosis (ALS, also known as Lou Gehrig's disease) |
| Medicare coverage | Includes certain hospital, nursing home, home health, physician, and community-based services |
| Cost | Part A is free for most people, but Part B charges a monthly premium. Part A costs $278 or $506 each month in 2023, and $285 or $518 each month in 2025 |
| Losing coverage | Coverage can be retained if a person returns to work, but only for 8.5 years |
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What You'll Learn
Medicare qualifying period for those under 65
Medicare is a health insurance program for people aged 65 and over, but it is also available for certain people with disabilities who are under 65.
To qualify for Medicare under the age of 65, you must meet one of the following criteria:
- Receive Social Security Disability Insurance (SSDI) benefits for a minimum of 24 months. This includes a five-month waiting period after the beneficiary is deemed disabled.
- Have End-Stage Renal Disease (ESRD), which is permanent kidney failure requiring dialysis or a kidney transplant.
- Have Amyotrophic Lateral Sclerosis (ALS), also known as Lou Gehrig's disease.
It is important to note that there is no illness or underlying condition that disqualifies people from Medicare coverage. The health care services covered by Medicare do not have to be related to the individual's disability.
Once an individual is deemed eligible for Medicare under the age of 65, they will receive a Medicare card in the mail. They will be automatically enrolled in Medicare Part A (Hospital Insurance), which is free for most people, and Part B (Medical Insurance), for which most people pay a monthly premium.
If an individual with a disability returns to work, they may still retain their Medicare coverage. They can keep their coverage for at least 8.5 years after returning to work, including a nine-month trial work period. If the new employer has more than 100 employees and provides health insurance, then the employer insurance will become the primary payer, and Medicare will become secondary. However, if the employer has fewer than 100 employees, Medicare insurance will remain primary, and the individual will need to join Part B.
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Medicare coverage for specific disabilities
Medicare is a health insurance program for people aged 65 and above, some disabled people under 65, and people with end-stage renal disease (permanent kidney failure treated with dialysis or a transplant).
Medicare coverage is the same for people who qualify based on disability as for those who qualify based on age. There are no illnesses or underlying conditions that disqualify people from Medicare coverage. The health care services provided do not have to be related to the individual's disability to be covered. People with dementia, mental illness, and other long-term and chronic conditions can obtain coverage.
To qualify for Medicare based on disability, you must meet certain conditions. Firstly, you must be under 65 years of age. Secondly, you must have received Social Security Disability benefits for a minimum of 24 months, with a five-month waiting period after being deemed disabled. Alternatively, you must have End-Stage Renal Disease (ESRD) or Amyotrophic Lateral Sclerosis (ALS), also known as Lou Gehrig's disease.
If you are enrolled in Medicare and return to work, you may be able to retain your coverage as long as your disabling condition meets the Social Security Administration's criteria. This provision allows for at least 8.5 years of continued coverage after you return to work, including a nine-month trial work period. During this period, you will not be required to pay a premium for hospital insurance (Part A), although you will continue to pay for medical insurance (Part B).
If your new employer provides health insurance and has 100 or more employees, their insurance will become the primary payer, and your Medicare coverage will become secondary. If your employer has fewer than 100 employees, your Medicare insurance will remain the primary payer, and you will need to continue with Part B.
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Medicare costs and rules
Medicare is a health insurance program for people aged 65 and older. However, certain individuals under 65 with disabilities can also qualify for Medicare. This typically includes people who:
- Have received Social Security Disability Insurance (SSDI) benefits for 24 months.
- Have End-Stage Renal Disease (ESRD) or Amyotrophic Lateral Sclerosis (ALS), also known as Lou Gehrig's disease.
- Have received a disability determination from the Social Security Administration (SSA) and are eligible for SSDI benefits.
During the 24-month waiting period for Medicare coverage, individuals may be eligible for health insurance through a former employer. Additionally, those with low incomes and limited resources may qualify for state assistance with Medicare expenses.
Medicare has two parts, each with its own costs and rules:
Part A (Hospital Insurance)
Most people do not have to pay a premium for Part A. However, those who do pay a premium can expect to pay $278 or $506 each month in 2023, with the amount depending on their work history and the amount of Medicare taxes paid. Individuals who are required to pay a premium for Part A must also enroll in Part B and pay the premium for both parts to maintain coverage.
Part B (Medical Insurance)
Most people pay a monthly premium for Part B. Individuals with employer insurance with more than 100 employees can choose to disenroll from Part B if they prefer to have their employer insurance as the primary payer.
Part D (Medicare Prescription Drug Plans)
Medicare Part D offers various ways to pay for prescriptions, and beneficiaries should ensure that their medications are covered under their plan.
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Medicare and employer insurance
Medicare is a health insurance program for people aged 65 and over, some disabled people under 65, and people with end-stage renal disease. People under 65 who are approved for Social Security Disability Insurance (SSDI) benefits based on certain disabilities may be enrolled in Medicare automatically. These disabilities include Amyotrophic Lateral Sclerosis (ALS) and End-stage Renal Disease (ESRD).
If you are under 65 and have a disability, you are not required to sign up for Medicare until you turn 65. However, if you are still receiving group health insurance coverage at that time, you may need to enrol in Medicare to avoid a monthly Part B late enrolment penalty. If your employer has 20 or more employees, you can delay signing up without incurring late enrolment penalties. If your employer has fewer than 20 employees, Medicare is the primary payer, and you must enrol in Part B. If your employer has 20 or more employees, Medicare is the secondary payer, and your group health plan is the primary payer.
If you are enrolled in Medicare and have employer insurance, Medicare may be the primary or secondary payer, depending on the number of employees in the company. If your company has fewer than 20 employees, Medicare is the primary payer, and your employer insurance is the secondary payer. If your company has 20 or more employees, your employer insurance is the primary payer, and Medicare is the secondary payer. This means that Medicare will only pay out for costs that your employer insurance does not cover.
If you are enrolled in Medicare and are returning to work, you can keep your Medicare coverage as long as your disabling condition still meets the rules. You can keep your Medicare coverage for at least 8.5 years after you return to work, including a 9-month trial work period. If your new employer provides health insurance and has more than 100 employees, the employer insurance will become the primary payer, and your Medicare will become secondary. If your new employer has fewer than 100 employees, you will need to join Medicare Part B, and your Medicare insurance will be the primary payer.
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Applying for Medicare
Medicare is a health insurance program for people aged 65 and above, some disabled people under 65, and people with end-stage renal disease. Here is a step-by-step guide to applying for Medicare:
Step 1: Check Eligibility
Before applying for Medicare, it is important to determine your eligibility. Individuals under 65 may be eligible for Medicare if they have received Social Security Disability benefits for 24 months or have certain qualifying disabilities, such as End-Stage Renal Disease (ESRD) or Amyotrophic Lateral Sclerosis (ALS).
Step 2: Understand the Different Parts of Medicare
Medicare has four different parts: Part A, Part B, Part C, and Part D. Part A is hospital insurance, which is free for most people. Part B is medical insurance, for which most people pay a monthly premium. Part C, also known as Medicare Advantage, is an alternative to Original Medicare (Parts A and B) and is offered by private insurance companies. Part D covers prescription drugs, and you may need to sign up for this separately.
Step 3: Gather Required Information and Documents
When applying for Medicare, you will need to provide personal information such as your name, date of birth, Social Security number, and contact information. You may also need to provide information about your current health insurance coverage, income, and resources. Additionally, you may require specific forms, such as the CMS-18-F-5 form for enrolling in Part A and/or Part B.
Step 4: Choose Your Coverage and Complete the Application
You can apply for Medicare online, by phone, or in person. During the application process, you will need to choose the coverage that best suits your needs. If you are eligible for premium-free Part A, you can simply sign up for it without having to purchase it. If you want to enroll in Part B, you may need to pay a monthly premium.
Step 5: Await Your Medicare Card
Once your application is processed, you will receive your Medicare card in the mail. This typically happens within a few weeks of enrolling. If you are under 65 and qualify based on disability, you should receive your card after the required time period has passed.
It is important to note that individuals with disabilities who are working or returning to work may still be eligible for Medicare. There is a trial work period, and individuals can continue to receive benefits as long as they remain medically disabled and meet certain income criteria.
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Frequently asked questions
Medicare is a health insurance program for people aged 65 and older, as well as some disabled people under 65 years of age.
You can qualify for Medicare if you have a disability and have been approved for Social Security Disability Insurance (SSDI). There is a 24-month waiting period after receiving SSDI benefits before you are eligible for Medicare.
Yes, if you have Amyotrophic Lateral Sclerosis (ALS), also known as Lou Gehrig's Disease, or End-Stage Renal Disease (ESRD), you will be enrolled in coverage in the first month you receive SSDI benefits.
Yes, you can keep your Medicare coverage if you still have a disabling impairment. If you are under 65, you won't have to pay a premium for Part A for 8.5 years after returning to work.
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