Some people with a disability do not need to wait until the age of 65 to become eligible for Medicare.
Those who have collected Social Security disability benefits for 24 months receive automatic enrollment into traditional Medicare, which comprises parts A and B.
This article will examine the eligibility of people with a disability for Medicare programs, as well as the costs involved. It will also look at keeping Medicare after returning to work and the help available for paying Medicare costs.
There are three groups of people eligible for Medicare if they are under the age of 65. The time frame in which each group becomes eligible differs as follows:
|Those who receive Social Security disability benefits||After 24 months|
|Those with end stage renal disease||Generally, 3 months after a kidney transplant |
3 months after regular dialysis begins
|Those with amyotrophic lateral sclerosis, or Lou Gehrig’s disease||Immediately after starting to receive Social Security disability benefits|
Enrollment in Medicare parts A and B is usually automatic for someone in any of these three groups. As long as a person receives Social Security disability benefits, they will be eligible for Medicare.
Once a person with Social Security disability benefits meets the time frame requirement, they should receive their Medicare card in the mail. If they do not, they may wish to contact their local Social Security office.
If a person’s condition improves to the point that they no longer qualify for Social Security disability benefits, they will also no longer be eligible for Medicare coverage. Should this happen, they must wait until they reach the age of 65 before they can reenroll with Medicare.
We may use a few terms in this piece that can be helpful to understand when selecting the best insurance plan:
- Deductible: This is an annual amount that a person must spend out of pocket within a certain time period before an insurer starts to fund their treatments.
- Coinsurance: This is a percentage of a treatment cost that a person will need to self-fund. For Medicare Part B, this comes to 20%.
- Copayment: This is a fixed dollar amount that an insured person pays when receiving certain treatments. For Medicare, this usually applies to prescription drugs.
Traditional Medicare costs include those for Part A, which is for hospitalization insurance, and those for Part B, which is for preventive and medically necessary insurance.
Through Medicare, healthcare coverage for a person with a disability is identical to the coverage for an individual who qualifies because of their age.
Areas of coverage include certain hospital and nursing home stays, along with doctor visits and community-based services.
Part A costs
Most people do not pay a monthly premium for Part A, but they pay a $1,600 deductible for each benefit period. They also pay coinsurance that varies with the length of their hospital stay within the benefit period.
A benefit period is not related to the calendar year. It begins the day a person enters a hospital or skilled nursing facility, and it ends when they have not received in-patient care for 60 consecutive days.
Part B costs
The coverage from parts A and B does not include prescription drug costs. Coverage for prescribed medication is known as Medicare Part D.
A person may wish to include Part D as part of their plan, or they may decide to explore available options through Medicare Advantage.
Enrollment in one of these plans is possible, but it must be within a certain time frame.
The cost of premiums can vary depending on the extent or level of cover required and the person’s geographical location.
The average cost of Part D was $42 per month in 2020.
An annual deductible usually applies to Part D, and the amount can vary. However, the maximum amount in 2021 is $445.
An alternative to Medicare parts A, B, and D is Medicare Advantage.
Sometimes known as Medicare Part C, Medicare Advantage plans include the benefits of Medicare parts A, B, and D.
The average premium for a Medicare Advantage plan that includes prescription drug coverage is $36 per month in 2020. A person with an Advantage plan must also pay the Part B monthly premium of $164.90.
- the 7-month period that begins 3 months before the 25th month of Social Security disability benefits
- the 7-month period that includes the 25th month of disability benefits
- the 7-month period that stops after the 25th month of disability benefits
Some people with a disability who are under the age of 65 are able to return to work. When this happens, they may keep their Medicare benefits for as long as they have a disability.
Once an individual goes back to work, they do not have to pay Part A premiums for the first 8 years and 6 months. After this time, however, they must pay the Part A premiums.
A person who cannot afford Medicare costs may be eligible for the Qualified Medicare Beneficiary (QMB) Program. This is one of the Medicare Savings Programs for people with low incomes. It helps pay the Part A and Part B premiums, along with any deductibles, coinsurances, and copayments.
To be eligible for QMB, a person cannot have a monthly income that exceeds $1,153. A married couple’s monthly income cannot exceed $1,546.
In addition to income, QMB eligibility requirements include resources, such as stocks, bonds, and savings accounts. The resource limit for an individual is $8,400, and it is $12,600 for a married couple.
Medicare automatically enrolls people in parts A and B after they have been receiving Social Security disability benefits for 24 months.
The healthcare coverage for a person with a disability with parts A and B is identical to the coverage that people get when they enroll in the program at age 65.
If a person with a disability wishes to add prescription drug coverage, Part D, to their Medicare parts A and B, they may do so. They may instead opt to enroll in Medicare Advantage, which would take the place of Medicare parts A, B, and D.
Because a person must enroll in either Part D or Medicare Advantage within a specified time frame, they may wish to seek information on these programs in advance.