Medicare for People with Disabilities

• Does disability affect your Medicare coverage? Because millions of Americans are disabled before age 65, certain disability conditions can qualify individuals for Medicare coverage regardless of age.
• Do you qualify for Medicare early if you have a disability? This depends specifically on the type of disability and whether you have been receiving SSDI benefits for at least 24 months.
• Is Medicare free if you’re disabled? Typically, Medicare isn’t free for most people with disabilities, although financial assistance may be available to those with limited means through state Medicaid programs or a Low Income Subsidy (LIS, sometimes referred to as extra help). Examples of Medicare expenses might include monthly premiums, copays, deductibles, and coinsurance, and these costs may go up annually.
• Do disabilities impact what type of Medicare you can have? Generally, no. Those qualifying for Medicare as a result of a disability will have the same range of options as those qualifying based on age. However, some options, such as a private Medicare supplement policy, may be more expensive for those with disabilities.

Three months prior to the start of Medicare coverage, you should receive a packet in the mail from the Social Security Administration (SSA) containing your new Medicare card and an explanation of your Medicare benefits. You shouldn’t have to contact anyone to make this happen.

The information packet should also explain that your monthly Part B premium will be deducted from your monthly Social Security or railroad benefit check. You may choose to turn down Part B coverage if you have coverage through other means, such as a spouse’s employment plan, but be aware that if you turn down Part B and don’t have other coverage, you may incur a penalty if you enroll at a later date:

Medicare eligibility

Medicare is available for United States citizens or permanent residents age 65 and older, those under age 65 with a qualified disability receiving SSDI benefits for at least 24 months, and people diagnosed with ALS or ESRD.

SSDI eligibility

Social Security guidelines for disability eligibility are very strict. To be eligible for disability benefits, Social Security Act 223 states that a person must have:

• [An] inability to engage in any substantial gainful activity because of any medically determinable physical or mental impairment which can be expected to result in death or which has lasted or can be expected to last for a continuous period of not less than 12 months.
• In the case of an individual who has attained the age of 55 and is blind (within the meaning of “blindness” as defined in section 216(i)(1)), inability because of such blindness to engage in a substantial, gainful activity requiring skills or abilities comparable to those of any gainful activity in which he has previously engaged with some regularity and over a substantial period of time.

Additionally, you must have worked long enough and recently enough to have earned sufficient Social Security work credits depending on the age when you became disabled. Typically, you can earn up to four credits each year, but the amount needed changes from year to year.

Occasionally, there are special situations where these rules don’t apply, such as the following:

• If you’re a disabled child
• If you’re the survivor 
• If you’re a veteran
• If you’re blind or have low vision

As long as you’re considered incapable of substantial gainful activity, there’s no limit to the amount of assets, cash, or resources you can own to be eligible for SSDI.

Medicare is available to U.S citizens or permanent residents age 65 or older, those under age 65 with a qualified disability receiving SSDI benefits for at least 24 months, and people diagnosed with ALS or ESRD.

You may automatically be enrolled in Original Medicare when you turn 65 if you’re receiving Social Security, or after receiving disability benefits for 24 months. Otherwise, you must sign up during your IEP, GEP, or Special Enrollment Period (SEP):

• IEP: Most people get Medicare Part A (Hospital Insurance) and Part B (Medical Insurance). The enrollment period starts three months before you turn 65, includes the month of your birthday, and ends three months after you turn 65. If you’re not already collecting Social Security benefits before your IEP starts, you’ll need to sign up for Medicare online or contact the SSA.
• GEP: If you miss your IEP, you can sign up during Medicare’s GEP that runs from January 1 to March 31, and your coverage will start July 1.
• SEP: Once your IEP ends, you may have the chance to sign up for Medicare during a SEP. You can sign up for Part A and or Part B during a SEP if you have special circumstances.
• Open Enrollment Period (OEP): This period runs from October 15 to December 7. If you have already enrolled in a Medicare plan, you can use this time to enroll and change prescription drug plans or Medicare Advantage plans.
• Medicare Advantage Open Enrollment: This period runs from January 1 to March 15. If you’re enrolled in a Medicare Advantage Plan, this is when you can change to another type of Medicare Advantage Plan or disenroll and return to Original Medicare.

What are the Medicare enrollment periods for people with a disability?

Beneficiaries of Medicare are subject to certain costs. These include:

• Premium: The plan’s monthly payment
• Deductible: The amount you must pay on your own before insurance starts to cover the costs
• Copay: A flat fee you pay for covered services
• Coinsurance: The percentage of costs you pay after reaching your deductible

Knowing how these expenses work is essential to understanding Medicare costs.

If you have a disability and/or receive Medicaid benefits, you may qualify for a special type of Medicare Advantage Plan called Dual Eligible SNP (D-SNPs). These plans limit membership strictly to those who meet specific plan criteria, such as certain chronic or disabling health conditions, those who live in certain institutions like nursing homes or those who qualify for Medicaid benefits through their state.

These plans carefully tailor benefits, provider choices, and drug formularies to best meet the needs of the groups they serve. Generally, you can join an SNP at any time once you’re eligible for Medicare and Medicaid.

• Healthcare.gov Plan Finder: This government website is designed to help you find private health plans outside of the Health Insurance Marketplace. These plans may often be available in the Marketplace, but this offers additional options.
• Medicaid.gov: The official U.S. government site for Medicare | Medicaid: This is a government website designed to help find Medicaid and Children’s Health Insurance Program (CHIP) coverage information.
• USA.gov: Benefits and Insurance for People with Disabilities: Find information about health care coverage including Medicare and Medicaid. Also, learn about workplace disability insurance, compensation benefits for disabled veterans and Social Security benefits for people with disabilities.
• National Disability Institute: Financial Resilience Center: Offers resources and assistance to help those with disabilities and chronic health conditions navigate financially through hardships.
• Social Security Administration: Benefits for People with Disabilities: Information directly from the source regarding qualifying for SSDI and what services they offer.
• National Disability Navigator Resource Collaborative (NDNRC): The mission of the NDNRC is to provide cross-disability information and support to Navigators and other enrollment specialists thereby ensuring people with disabilities receive accurate information when selecting and enrolling in insurance through the Affordable Care Act (ACA) marketplaces.
• Medicaid and CHIP Payment and Access Commission: MACPAC serves as an independent source of information on Medicaid and CHIP, publishing issue briefs and data reports throughout the year to support policy analysis and program accountability.

• Dual Eligible Special Needs Plans (D-SNPs) | Last accessed December 2024
• Enrollment Period Summary | KFF | Last accessed December 2024
• Facts | The Faces and Facts of Disability | SSA | Last accessed December 2024
• Health coverage options for people with disabilities in the Health Insurance | Last accessed December 2024
• Medicare: What’s Medicare Supplement Insurance (Medigap)? | Last accessed December 2024
• Medicare and You Handbook 2022 | Last accessed December 2024
• Qualifying for Medicare When Receiving Disability Benefits | Last accessed December 2024
• Social Security Online – Medicare Information | Last accessed December 2024
• Who is eligible for Medicare? | Last accessed December 2024