Jeffrey Wade
If you are disabled and under 65, you may be eligible for Medicare, a health insurance program that is usually available to people 65 and older. To qualify for Medicare under 65, you must 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. During the 24-month waiting period for Medicare coverage, you may be eligible for health insurance through a former employer or Medicaid. If you are already enrolled in a Marketplace plan, you can keep it as supplemental insurance when you enroll in Medicare, although you will lose any premium tax credits and savings associated with your Marketplace plan.
| Characteristics | Values |
|---|---|
| Medicare eligibility | People aged 65 and older, some disabled people under 65, people with end-Stage Renal Disease (permanent kidney failure treated with dialysis or a transplant), people with Amyotropic Lateral Sclerosis (ALS, also known as Lou Gehrig's disease) |
| Social Security Disability Insurance (SSDI) eligibility | People with disabilities who have received Social Security Disability benefits for 24 months |
| Medicare enrollment | Automatic when an individual starts receiving Social Security benefits; during the initial enrollment period (the month an individual is notified about the end of premium-free health insurance and the following seven months); during the annual general enrollment period (January 1 to March 31 each year); during a special enrollment period if covered under an employer group health plan |
| Medicare parts | Part A (hospital insurance) and Part B (medical insurance). Part A is premium-free, while Part B requires monthly payments |
| Supplemental insurance | Individuals may keep their Marketplace plan as supplemental insurance when they enroll in Medicare, but they will lose any premium tax credits and savings for their Marketplace plan |
| Medicaid | Individuals may apply for Medicaid coverage while waiting for Medicare enrollment |
| Job-based insurance | Individuals with job-based insurance can delay Medicare enrollment, but enrollment in Medicare Part B is required within eight months of losing job-based coverage |
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What You'll Learn
Medicare eligibility for those under 65
Medicare is typically a health insurance program for people aged 65 and over. However, it is also available for certain people with disabilities who are under 65.
To be eligible for Medicare under 65, an individual must meet one of the following criteria:
- They must have received Social Security Disability Insurance (SSDI) benefits for a 24-month qualifying period. The first 24 months of disability benefit entitlement is the waiting period for Medicare coverage.
- They have End-Stage Renal Disease (ESRD), also known as permanent kidney failure, which is treated with dialysis or a transplant.
- They have Amyotrophic Lateral Sclerosis (ALS), also known as Lou Gehrig's disease. In this case, they will receive Medicare coverage as soon as they start receiving disability benefits.
During the 24-month qualifying period for Medicare, beneficiaries may be eligible for health insurance through a former employer. Additionally, individuals with low incomes and limited resources may be eligible for state assistance with Medicare expenses.
Once an individual under 65 is eligible for Medicare, they will have access to the full range of Medicare benefits, including hospital, nursing home, home health, physician, and community-based services. The health care services do not need to be related to the individual's disability to be covered. There are no illnesses or underlying conditions that disqualify people for Medicare coverage, and beneficiaries are entitled to an individualized assessment of whether they meet the coverage criteria.
For individuals under 65 who are working, there is a trial work period of nine months after obtaining a job. During this time, they can continue to receive Medicare and Social Security benefits as long as they still meet the medical standard for being considered disabled. After the trial work period, individuals can continue to receive Medicare coverage for at least 8.5 years (including the trial work period), as long as their disabling condition still meets the relevant rules.
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Job-based insurance and Medicare
Job-based insurance is insurance offered by an employer or union to current employees and their family members. This insurance can be used to delay Medicare enrollment. However, it is important to understand whether your job-based insurance is the primary payer or secondary payer for your medical bills. If your job-based insurance is the primary payer, you may want to delay Part B of Medicare, as this part requires additional monthly premiums.
If your employer has more than 20 employees, your job-based insurance is likely the primary payer, and Medicare is secondary. In this case, some people choose not to enrol in Part B of Medicare due to the additional costs. Conversely, if your employer has fewer than 20 employees, your job-based insurance is secondary, and Medicare is primary. If you delay Medicare enrolment in this case, your job-based insurance may provide little to no coverage. Therefore, it is recommended to enrol in Part B to avoid high costs for your care.
If you are eligible for Medicare due to age (65+) and are covered by your or your spouse's job-based insurance, you have a Special Enrollment Period (SEP). This allows you to enrol in Medicare without penalty after your job-based insurance ends. The Part B SEP specifically starts when you have coverage from current work and are in your first month of eligibility for Part B. It ends eight months after you lose coverage from current employment.
It is important to note that you should not have more than eight consecutive months without coverage from either Medicare or insurance from current work to be eligible for the Part B SEP. Additionally, you must have been continuously covered by job-based insurance or Medicare Part B since becoming eligible for Medicare, including the first month of eligibility. To avoid gaps in coverage, it is generally recommended to enrol in Medicare before losing job-based insurance.
If you are considering delaying Part B enrolment due to job-based insurance, ensure you understand whether your coverage will be primary or secondary. You can do this by contacting your or your spouse's human resources department.
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Medicare Parts A and B
Medicare is a federal health insurance program for people aged 65 and older and some people under 65 with certain disabilities or conditions. It has two parts: Part A and Part B.
Medicare Part A
Medicare Part A is hospital insurance. It helps cover inpatient care in hospitals, skilled nursing facility care, hospice care, and home health care. Most people do not have to pay a premium for Part A. To be eligible for premium-free Part A, an individual must be entitled to receive Medicare based on their own earnings or those of a spouse, parent, or child. The worker must have a specified number of quarters of coverage (QCs) and file an application for Social Security or Railroad Retirement Board (RRB) benefits. The exact number of QCs required depends on whether the person is filing for Part A based on age, disability, or End-Stage Renal Disease (ESRD). Individuals receiving monthly Social Security or RRB benefits at least four months before turning 65 will get Part A automatically at age 65. Those not receiving monthly Social Security or RRB benefits must file an application for Medicare by contacting the Social Security Administration.
Medicare Part B
Medicare Part B is medical insurance. Most people pay a monthly premium for Part B. If you did not sign up for Part B when it was first offered, you can sign up for it during a general enrollment period (January 1st through March 31st of each year) or a special enrollment period. If your Social Security Disability Insurance cash benefits stop due to your work, you or a third party will be billed every 3 months for your medical insurance premiums. If you are receiving cash benefits, your medical insurance premiums will be deducted from your check.
Medicare Advantage
Medicare Advantage (Part C) is an alternative to Parts A and B that bundles several coverage types, including Parts A, B, and usually Part D (prescription drug coverage). These "bundled" plans are offered by Medicare-approved private companies and may offer some extra benefits that Original Medicare doesn't. You must sign up for Part A or Part B before enrolling in a Medicare Advantage plan.
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Applying for disability benefits
If you are applying for disability benefits, there are a few options available to you. Firstly, you can apply for Social Security Disability Insurance (SSDI) benefits, which are available for people with disabilities. To apply, you can use the online application process, or you can apply by phone or mail. The Social Security Administration (SSA) also provides Disability Starter Kits to help guide you through the application process and outline the specific documents and information you will need to provide.
If you are a veteran, you can file a claim for disability compensation through the Department of Veterans Affairs (VA). You can file a VA disability claim online, by mail, in person, or with the help of a professional such as an accredited attorney or claims agent. It is important to gather any supporting documents, such as medical records and evidence of your disability, to submit alongside your claim to ensure a quick process.
Additionally, if you are currently employed, your employer should be able to provide information about health insurance coverage options. If your employer has more than 100 employees, they are required to offer health insurance to individuals and spouses with disabilities.
Medicare is also an option for certain individuals with disabilities who are under 65. To be eligible, you must have received SSDI benefits for 24 months or have specific medical conditions. During the 24-month waiting period for Medicare coverage, you may be eligible for health insurance through a former employer.
Finally, you may be able to obtain Medicaid coverage while waiting for Medicare or if you require additional insurance. You can apply through your state Medicaid agency or create an account and complete an application online.
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Supplemental insurance options
If you have job-based insurance from your employer, spouse, or family member, you may be able to delay your Medicare Part B enrollment and retain your job-based insurance as the primary payer, with Medicare as the secondary payer. If your employer has more than 100 employees, they are required to offer you health insurance, and Medicare will be the secondary payer. If you have job-based insurance and are eligible for Medicare due to a disability, you have a Special Enrollment Period (SEP) to enroll in Part B up to eight months after your job-based insurance coverage ends.
If you are enrolled in a Marketplace plan before getting Medicare, you can keep your Marketplace plan as supplemental insurance when you enroll in Medicare. However, you will lose any premium tax credits and savings for your Marketplace plan.
Medicare Part A (Hospital Insurance) is premium-free for most people. If you don't qualify for premium-free Part A, you may be able to buy it. In 2023, the premium is either $278 or $506 each month, depending on how long you or your spouse worked and paid Medicare taxes.
Medicare Part B (Medical Insurance) is paid for monthly by most people. If you are receiving Social Security Disability Insurance cash benefits, your medical insurance premiums will be deducted from your check. If you are not receiving cash benefits, you or a third party will be billed every three months for your medical insurance premiums.
You can also add coverage by buying a Medigap policy or choosing to join a Medicare drug (Part D) plan to add prescription coverage.
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Frequently asked questions
Yes, if you have certain disabilities and have received Social Security Disability Insurance (SSDI) benefits for 24 months, or have End-Stage Renal Disease (ESRD) or Amyotrophic Lateral Sclerosis (ALS).
You should enrol when you're first eligible to avoid delays and penalties. You can apply for disability benefits at Social Security and follow the process for getting benefits before turning 65.
Yes, you can delay Medicare enrolment if you have job-based insurance. However, you may want to enrol in Medicare depending on whether your job-based insurance pays primary or secondary.
Part A is hospital insurance and is premium-free. Part B is medical insurance and requires monthly payments.
Yes, you can keep your Medicare coverage for at least 8.5 years after returning to work, as long as your disabling condition still meets the requirements.
