Paul Sanchez
Medicare is a health insurance program for older adults and people with certain conditions. If you have a disability, you may qualify for Medicare disability coverage. Generally, you can be enrolled in Medicare before the age of 65 if you have been approved for SSDI benefits based on certain disabilities. Medicare eligibility for working people with disabilities falls into three distinct time frames: the trial work period, the seven-and-three-quarter years after the trial work period, and the indefinite period following those 93 months.
| Characteristics | Values |
|---|---|
| Eligibility | Individuals under 65 with certain disabilities may be eligible for Medicare. These include Amyotrophic Lateral Sclerosis (ALS) and End-Stage Renal Disease (ESRD). |
| Enrollment | Individuals must have received Social Security Disability Insurance (SSDI) benefits for 24 months and undergo a five-month waiting period before enrolling in Medicare. |
| Costs | Part A is generally premium-free, while Part B typically requires a monthly premium. Individuals may be responsible for out-of-pocket costs, deductibles, and coinsurance for both parts. |
| Work and Disability | Medicare coverage can be retained while working if the individual remains medically disabled. A trial work period of 9 months is provided, followed by extended coverage for 8.5 years, after which premiums may apply. |
| Supplemental Insurance | Medicare can be retained as supplemental insurance if an individual enrolls in a Marketplace plan before Medicare. Medicaid eligibility may continue even after enrolling in Medicare. |
| Employer Insurance | If an individual's employer provides health insurance, it may become the primary payer, with Medicare as secondary coverage. |
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What You'll Learn
Medicare eligibility for working people with disabilities
Medicare is a health insurance program for people aged 65 and above and some disabled people under 65. Medicare eligibility for working people with disabilities falls into three distinct time frames.
Firstly, there is a trial work period, which extends for 9 months after a disabled individual obtains a job. During this time, the ability to perform such work will not disqualify the individual from being considered disabled and receiving Social Security and Medicare benefits. However, if there is independent evidence that the individual is no longer disabled, their benefits may be terminated.
Secondly, there is a period of seven and three-quarter years (93 months) after the end of the trial work period. During this time, a beneficiary may receive hospital and medical insurance (Part A and Part B) for free as long as they still have a disabling impairment. This provision allows health insurance to continue when a beneficiary goes to work and engages in substantial gainful activity. Although cash benefits may cease, the beneficiary has the assurance of continued health insurance.
Finally, there is an indefinite period following those 93 months. During this time, working individuals with disabilities can continue to receive benefits as long as the individual remains medically disabled and under the age of 65. However, they will have to pay the premium for Part A as well as the premium for Part B. The amount of the Part A premium will depend on the number of quarters of work in which the individual or their spouse has paid into Social Security. Individuals with low incomes and limited resources may be eligible for state assistance with these expenses.
It is important to note 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. Additionally, there is a five-month waiting period after a beneficiary is determined to be disabled before they begin to collect Social Security Disability benefits. People with End-Stage Renal Disease (ESRD) or Amyotropic Lateral Sclerosis (ALS) do not have to collect benefits for 24 months to be eligible for Medicare.
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Medicare disability coverage costs
Medicare is available for certain people with disabilities who are under 65. To qualify, individuals must have received Social Security Disability Insurance (SSDI) benefits for 24 months, except in the case of Amyotrophic Lateral Sclerosis (ALS) or End-Stage Renal Disease (ESRD), which require no waiting period.
There is no age requirement for Medicare disability coverage, and the health care services covered do not have to be related to the individual's disability.
Medicare eligibility for working people with disabilities falls into three time frames:
- A 9-month trial work period after a disabled individual obtains a job. During this time, the individual will continue to receive Medicare coverage and Social Security income.
- The 93 months (7 and three-quarter years) after the end of the trial work period.
- An indefinite period following those 93 months.
During the first two periods, an individual can keep their Medicare coverage as long as they continue to meet the medical standard for being considered disabled under Social Security rules.
Individuals with disabilities who are working do not have to pay a premium for Part A (hospital insurance) for 8.5 years after returning to work. After this period, they will have to pay the premium for Part A as well as Part B (medical insurance). The amount of the Part A premium will depend on the number of quarters of work in which the individual or their spouse has paid into Social Security.
Low-income individuals with resources under $4,000 ($6,000 for a couple) may be eligible for state assistance with these premiums under a Qualified Disabled and Working Individuals program. There are also Medicare savings programs available to help cover costs for people with incomes below preset levels.
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Medicare and SSDI
Medicare is available for certain people with disabilities who are under 65. These individuals must have received Social Security Disability Insurance (SSDI) benefits for 24 months or have End-Stage Renal Disease (ESRD) or Amyotrophic Lateral Sclerosis (ALS), also known as Lou Gehrig's disease.
If you've been approved for SSDI benefits based on certain disabilities, you can enrol in Medicare before turning 65. After drawing SSDI for 24 months, you are automatically enrolled in both Medicare Part A and Part B (original Medicare) starting at the 25th month and will receive a Medicare card. Part A is typically free, while Part B charges a monthly premium.
Medicare eligibility for working people with disabilities falls into three distinct time frames. The first is the trial work period, which extends for 9 months after a disabled individual obtains a job. The second is the 93 months (7 and three-quarter years) after the trial work period. Finally, there is an indefinite period following those 93 months. It's important to note that Medicare eligibility during these periods is contingent on the individual continuing to meet the medical standard for being considered disabled under Social Security rules.
Even after the 8-and-a-half-year period of extended Medicare coverage has ended, working individuals with disabilities can continue to receive benefits as long as they remain medically disabled and under 65. At this point, they will have to pay the premium for Part A and Part B. Individuals with low incomes and limited resources may be eligible for state assistance with these expenses.
Additionally, it's worth noting that if you enrolled in a Marketplace plan before getting Medicare, you can keep your Marketplace plan as supplemental insurance when enrolling in Medicare. However, you may lose premium tax credits and other savings associated with your Marketplace plan.
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Medicare and employer insurance
Medicare is available for certain people with disabilities who are under the age of 65. These individuals must have received Social Security Disability Insurance (SSDI) benefits for 24 months or have End Stage Renal Disease (ESRD) or Amyotropic Lateral Sclerosis (ALS).
If you are still working and receiving health insurance through your employer, you are still eligible for Medicare once you turn 65. Depending on your company's size, you may choose to enroll in Medicare immediately or delay enrollment. If your employer has 20 or more employees, you can delay signing up without incurring any late enrollment penalties.
If you have Medicare and other health insurance, each type of coverage is called a "payer". The "primary payer" pays up to the limits of its coverage, and then the remaining balance goes to the "secondary payer". If your group health plan or retiree coverage is the secondary payer, you may need to sign up for Medicare Part B before they pay. This order of payment is called "coordination of benefits".
If you have a disability and are working, you may receive at least 93 months of hospital and medical insurance after the trial work period, as long as you still have a disabling impairment. This provision allows health insurance to continue when a beneficiary goes to work. After premium-free Medicare coverage ends due to work, beneficiaries can purchase Medicare hospital and medical insurance if they continue to have a disability at the end of the 93-month period.
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Medicare enrollment
Medicare is available for certain people with disabilities who are under the age of 65. These individuals 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.
There are several ways to enroll in Medicare, whether you plan to retire or keep working. If you begin receiving Social Security retirement benefits between the age of 62 and up to 4 months before turning 65, you will be automatically enrolled in Medicare Part A and Part B when you turn 65. If you apply for Social Security 3 months before you turn 65 or later, you can sign up for Medicare when you apply for Social Security.
The Initial Enrollment Period to sign up for Medicare begins 3 months before you turn 65 and ends 3 months after the month you turn 65—a total of 7 months. You may have to pay a penalty if you miss your Initial Enrollment Period. If you are not ready to receive Social Security benefits at 65 because you are still working, you can apply online for Medicare only. If you don't sign up for Part B within 3 months of turning 65, you might have to wait to sign up and pay a monthly late enrollment penalty.
If you are receiving Social Security disability benefits, you will automatically begin receiving Medicare Parts A and B after 24 months. If you have Lou Gehrig's disease (ALS), you will receive Medicare Parts A and B immediately when you enrol in Social Security disability benefits.
If you have ESRD, you can call 800-772-1213 and tell the representative that you want to apply for Medicare because you have ESRD.
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Frequently asked questions
Yes, Medicare provides disability insurance for certain people with disabilities who are under 65.
To get disability insurance from Medicare, you must have received Social Security Disability Insurance (SSDI) benefits for 24 months or have End-Stage Renal Disease (ESRD) or Amyotrophic Lateral Sclerosis (ALS), also known as Lou Gehrig's disease.
Yes, you may be able to return to work and keep your Medicare coverage if your disability responds to treatment. However, if your new employer provides health insurance and has more than 100 employees, your Medicare coverage may become secondary.
Part A of Medicare disability insurance is typically free, but Part B usually charges a monthly premium. You may be responsible for some out-of-pocket costs unless you have employer insurance or supplemental coverage.
To enroll in Medicare disability insurance, you should first ensure that you meet the eligibility requirements mentioned above. Then, you can apply for Medicare coverage through the Social Security Administration.
