Jane Dotson
Medicare is a health insurance program for people aged 65 and older, some disabled people under 65, and people with end-Stage Renal Disease. To apply for Medicare disability insurance, you must first apply for disability benefits at Social Security. Once you start receiving Social Security disability benefits, you will be eligible for Medicare after a 24-month qualifying period. During this waiting period, you may be eligible for health insurance through a former employer. After this qualifying period, you will automatically get Medicare Part A (hospital insurance) and Part B (medical insurance). If you are still working, you can continue to receive Medicare benefits as long as you remain medically disabled, but you will have to pay premiums for Part A and Part B.
| Characteristics | Values |
|---|---|
| Who is eligible for Medicare disability insurance? | People with disabilities under 65 years of age, people with end-Stage Renal Disease, and people with Amyotropic Lateral Sclerosis. |
| What are the requirements to apply for Medicare disability insurance? | The individual must have received Social Security Disability benefits for 24 months. There is also a five-month waiting period after a beneficiary is determined to be disabled. |
| How long does Medicare coverage last? | Individuals will receive at least 7-9 years of continued Medicare coverage as long as their disabling condition meets the rules. |
| What are the costs associated with Medicare disability insurance? | Most people do not have to pay for Part A (hospital insurance). For Part B (medical insurance), most people pay a monthly premium. The cost depends on the number of quarters worked and the individual's income. |
| How to apply for Medicare disability insurance? | Individuals can apply for disability benefits at Social Security. They can also contact their state Medicaid agency or apply for a Marketplace plan. |
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What You'll Learn
Eligibility requirements
Medicare is a health insurance program for people aged 65 and older, some disabled people under 65, and people with end-stage renal disease or amyotrophic lateral sclerosis (ALS, or Lou Gehrig's disease).
To be eligible for Medicare disability insurance, you must meet the following requirements:
- You must be under the age of 65.
- You must have received Social Security Disability Insurance (SSDI) benefits for at least 24 months. This is known as the waiting period for Medicare coverage.
- You must continue to meet the medical standard for being considered disabled under Social Security rules. This is reviewed periodically, and coverage may be discontinued if your condition improves and no longer meets the criteria.
- If you are working, you must be enrolled in the Trial Work Period program, which extends for 9 months after obtaining a job. This period is meant to test your ability to return to work while still receiving benefits.
- After the Trial Work Period, you are eligible for an additional 93 months (7 years and 9 months) of coverage.
- If you have a low income and limited resources, you may be eligible for help with payment under a state-run program for Qualified Disabled and Working Individuals.
It is important to note that even if you meet these criteria, there may be additional factors that determine your eligibility for Medicare disability insurance. These requirements may vary based on your specific circumstances and the state you reside in.
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Medicare parts and costs
Medicare is a health insurance program for people aged 65 and older, some disabled people under 65, and people with end-stage renal disease. It 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. During the 8.5-year period of extended Medicare coverage, working individuals with disabilities who are under 65 will not have to pay a premium for Part A. After this period, they will have to pay the premium for Part A, which in 2025 will be either $285 or $518 each month, depending on how long they or their spouse have worked and paid Medicare taxes.
Part B: Medical Insurance
Most people pay a monthly premium for Part B. The beneficiary can buy Premium Supplemental Medical Insurance (Part B) at the same monthly cost which uninsured eligible retired beneficiaries pay ($135.50 per month for 2019). There are also deductibles and coinsurance costs for Part B. If a beneficiary with a disability returns to work, they or a third party will continue to pay for Part B. If their Social Security Disability Insurance cash benefits stop due to their work, they will be billed every 3 months for their medical insurance premiums.
Supplemental Coverage
There is no yearly limit on out-of-pocket costs unless you have supplemental coverage, like a Medicare Supplement Insurance (Medigap) policy or a Medicare Advantage Plan. If you have limited income and resources, your state may help pay your premiums and other costs.
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Applying for disability benefits
Medicare is a health insurance program for people aged 65 and older, some disabled people under 65, and people with end-Stage Renal Disease or Amyotropic Lateral Sclerosis (ALS). To apply for Medicare disability benefits, there are a few important steps and considerations to keep in mind.
First, it's important to understand the eligibility criteria. For individuals under 65, Medicare coverage is available for those who have received Social Security Disability benefits for at least 24 months or have specific medical conditions, such as end-stage renal disease or ALS. There is also a five-month waiting period after being deemed disabled before receiving Social Security Disability benefits.
To apply for disability benefits, you must first apply through Social Security. You can do this by creating an account and completing an application, indicating that you have a disability. Your application will then be forwarded to your state Medicaid agency for processing. During the 24-month waiting period for Medicare coverage, you may be eligible for health insurance through a former employer or Medicaid.
Once you start receiving disability benefits, you will be eligible for Medicare. You will automatically receive Medicare Part A (Hospital Insurance), which is typically premium-free, and Part B (Medical Insurance), for which most people pay a monthly premium. You will receive a welcome package with your Medicare card three months before your coverage starts.
It's important to promptly report any changes in your work activity, as your Medicare coverage may continue even after you return to work, as long as your disabling condition meets certain rules. Additionally, there are programs that can help with the cost of premiums for low-income individuals.
By following these steps and understanding the eligibility criteria, individuals can successfully apply for Medicare disability benefits and ensure they receive the coverage they need.
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Coverage timelines
If you are under 65 and receiving disability benefits from Social Security, you will be eligible for Medicare after receiving disability benefits for 24 months. You will be mailed a welcome package with your Medicare card 3 months before your Medicare coverage starts.
If you have End-Stage Renal Disease (ESRD), Amyotropic Lateral Sclerosis (ALS, also known as Lou Gehrig's disease), or are over the age of 65, you will be eligible for Medicare automatically.
If you are under 65 and working, there are three distinct time frames for Medicare eligibility:
- The trial work period, which extends for 9 months after a disabled individual obtains a job. During this time, the beneficiary may be eligible for health insurance through a former employer.
- 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 93-month period, a beneficiary will receive hospital and medical insurance. After this period, beneficiaries can purchase Medicare hospital and medical insurance if they continue to have a disability.
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Supplemental insurance options
Medicare is a health insurance program for people aged 65 and older, some disabled people under 65, and people with end-stage renal disease. It has two parts: Part A (hospital insurance) and Part B (medical insurance). Most people do not have to pay for Part A, but most people pay monthly for Part B.
If you receive Social Security Disability Insurance (SSDI) benefits, you are eligible for Medicare after a 24-month qualifying period. During the first 24 months of receiving disability benefits, you are in the waiting period for Medicare coverage. During this time, you may be eligible for health insurance through a former employer.
If you are under 65 and disabled, you must have received SSDI benefits for 24 months or have End-Stage Renal Disease (ESRD) or Amyotrophic Lateral Sclerosis (ALS) to be eligible for Medicare. There is also a five-month waiting period after being declared disabled before you can start receiving SSDI benefits.
If you receive SSDI benefits, you are considered covered under the healthcare law and do not have to pay a penalty for not having insurance. You cannot enroll in a Marketplace plan to replace or supplement your Medicare coverage unless you enrolled in the Marketplace plan before getting Medicare. If you do decide to keep your Marketplace plan as supplemental insurance, you will lose any premium tax credits and other savings associated with the plan.
If you have low income and limited resources (less than $4,000 for an individual and $6,000 for a couple), you may be eligible for state assistance with your Medicare premiums through a buy-in program for Qualified Disabled and Working Individuals. You can contact your local Social Services or medical assistance office to find out more about this program.
If you are disabled and working, you can also consider a Medigap policy, which allows you to enjoy the benefits of your employer's insurance without giving up your Medigap coverage. Your Medigap insurance company cannot refuse to cover care for any pre-existing conditions.
If you receive Supplemental Security Income (SSI) Disability, you may automatically get Medicaid coverage or may need to apply, depending on your state. In many states, SSI recipients automatically qualify for Medicaid, while in others, SSI guarantees Medicaid eligibility but requires signing up.
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Frequently asked questions
To apply for Medicare disability insurance, you must first apply for disability benefits at Social Security. Once you start receiving Social Security disability benefits, you will automatically get Medicare after a 24-month waiting period.
Medicare disability insurance is available for people under 65 with certain disabilities. To be eligible, you must have received Social Security Disability Insurance (SSDI) benefits for 24 months, or have End Stage Renal Disease (ESRD) or Amyotropic Lateral Sclerosis (ALS).
Most people do not have to pay for Medicare Part A (hospital insurance). For Part B (medical insurance), most people pay a monthly premium. The cost of Part A premiums depends on the number of quarters worked and contributions made to Social Security.
Yes, you can keep your Medicare coverage for at least 8.5 years after returning to work, as long as your disabling condition meets the relevant rules.
If your Medicare enrollment application is denied, you can ask your doctor for help and guidance on what to do next.
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