In general, those who qualify for Medicare are 65 and older. The program was created to help older Americans get health insurance coverage. However, there are some people who are able to get Medicare if they are under 65.
Often, these people are disabled or have specific health conditions. This guide will help you understand what disabilities allow you to qualify for Medicare early and how to enroll in coverage if you are eligible.
In order to get Medicare for a disability, you have to have received Social Security Disability Income (SSDI) payments or railroad disability annuity checks for at least 24 months. At that point, you will automatically be enrolled in both Medicare Part A and B.
That means that the disabilities that qualify you for Medicare under age 65 are the same ones that qualify you for SSDI. According to Social Security, you must earn under $1,310 per month and have a condition that significantly limits your ability to do basic activities of work for at least 12 months. Also, your condition must be listed by Social Security as severe or considered as severe as one on the list. If it’s not on the list or comparable, there must be little to no other work available to you due to your condition.
Examples of disabilities that qualify for early Medicare eligibility include:
You can also get Medicare if you have Lou Gehrig’s disease (ALS), pancreatic cancer, or acute leukemia. There are additional conditions that may allow you to qualify before 65, visit the Social Security website for more information.
If you qualify for Medicare due to disability, you still pay the monthly premiums the way other Medicare enrollees do. That means that Part A will only be premium-free if you worked for at least 40 quarters in a job paying Medicare taxes. Otherwise, you’ll pay a monthly premium.
However, if you have a lower income and asset level, you may qualify for a Medicare Savings Program that can help you pay for your premiums and out-of-pocket costs. You might also qualify for Medicaid as well as Medicare, meaning you will be dual-eligible and pay less.
All Medicare enrollees pay a monthly premium for Medicare Part B. If you are disabled, the amount will be deducted from your SSDI check or railroad disability payment.
Just like with Medicare Part A, if you have a low income and assets, you may qualify for additional help with your premiums and out-of-pocket costs. Being dual-eligible for Medicare and Medicaid can also reduce your costs.
Americans with disabilities get all of the same benefits from Medicare that other Medicare beneficiaries receive. That means they can choose between Original Medicare and Medicare Advantage, shop for prescription drug plans (Part D), and more.
It’s important to ensure that you choose a plan that provides the coverage you need. For example, if you choose a Medicare Advantage (Part C) plan, you’ll want your doctors to be part of the insurer’s network so that you can get coverage. If you stay with Original Medicare, you might consider a Medigap plan when you are first eligible to help you with your coinsurance.
It can be difficult for those who are disabled and under 65 to find health insurance outside of Medicare. If you are able to work, you can likely get health insurance coverage from your employer. If you are not working, you might qualify for Medicaid.
However, if you are able to qualify for Medicare, that can give you an important option that will give you broader coverage than Medicaid alone. Medicare is a great option for those who are disabled and cannot work.
You can get Medicare if you are under 65 for a variety of disabilities and medical conditions. These health conditions are the same ones that qualify you to receive Social Security Disability Income (SSDI) payments.
You need to receive SSDI for 24 months before you qualify for Medicare. That waiting period may be waived for certain health conditions, such as Lou Gehrig’s disease (ALS).
If you’re disabled and qualify for Medicare, it’s important to take advantage of this coverage so you can get the care you need. That means having the right Medicare plan and assistance programs in place.
If you’re interested in learning more about Medicare plans, we can help. Contact us today to talk to a licensed insurance agent and compare plans.