Medicare is available to people under 65 if they have end stage renal disease, Lou Gehrig’s disease, or have received Social Security Disability Insurance for 24 months.
For people in these groups, enrollment in Original Medicare is automatic once they meet the time frame requirement. Original Medicare comprises Part A, which is for hospitalization insurance, and Part B, which is for preventive and medically necessary insurance.
The healthcare coverage for a person with a disability with parts A and B is identical to the coverage people get when they enroll in the program at age 65.
This article explains how people with a disability may qualify for Medicare programs and the costs involved.
Three groups of people under the age of 65 are eligible for Medicare. The table below shows the groups that qualify and when they become eligible.
| Groups who qualify for Medicare under 65 | When they become eligible |
|---|---|
| people receiving Social Security Disability Insurance (SSDI) | after 24 months of receiving benefits |
| people with end stage renal disease | typically 3 months after a kidney transplant or 3 months after regular dialysis begins |
| people with amyotrophic lateral sclerosis (ALS) or Lou Gehrig’s disease | immediately after starting to receive Social Security disability benefits |
Enrollment in Medicare parts A and B should happen automatically once a person who qualifies meets the time frame requirement. A Medicare card should arrive in the mail. If it does not, an individual may wish to contact their local Social Security office.
If a person’s condition improves to the point that they no longer qualify for SSDI, they will also no longer be eligible for Medicare. Should this happen, they must wait until they reach the age of 65 before they can reenroll.
Glossary of Medicare terms
We may use a few terms in this article that can be helpful to understand when selecting the best insurance plan:
- Out-of-pocket costs: An out-of-pocket cost is the amount a person must pay for medical care when Medicare does not pay the total cost or offer coverage. These costs can include deductibles, coinsurance, copayments, and premiums.
- Deductible: This is an annual amount a person must spend out of pocket within a certain period before an insurer starts to fund their treatments.
- Coinsurance: This is the percentage of treatment costs that a person must self-fund. For Medicare Part B, this is 20%.
- Copayment: This is a fixed dollar amount a person with insurance pays when receiving certain treatments. For Medicare, this usually applies to prescription drugs.
Out-of-pocket costs for Medicare are the amount a person pays for medical care that Medicare does not cover or after Medicare pays its share. These costs can include deductibles, coinsurance, copayments, and premiums.
Part A costs
Part A covers hospital or skilled nursing facility stays, home healthcare, and hospice care.
Most people do not pay a monthly premium for Part A but pay a $1,632 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 does not relate to the calendar year. It begins the day a person enters the hospital or skilled nursing facility and ends when they have not received in-patient care for 60 consecutive days.
Part B costs
Part B covers a range of services, such as diagnostic tests, treatments, doctor visits, health screenings, medical equipment, and rehabilitation therapies.
People with Part B coverage pay a monthly premium of $174.70. An annual deductible of $240 is also payable, along with 20% of Medicare-approved doctor services costs.
Part D costs
Parts A and B do not cover prescription drug costs, while Medicare Part D covers prescribed medication.
A person can include Part D in their plan or may wish to explore alternative plans through Medicare Advantage.
The cost of premiums can vary depending on the extent or level of coverage a person needs and their geographical location.
Projections estimate the average cost of Part D will be around $55.50 per month in 2024.
The maximum annual deductible in 2024 is $545.
People may also need to pay a copayment or coinsurance during the initial coverage period and 25% of the cost of drugs after this period.
Part C or Medicare Advantage costs
An alternative to Medicare parts A, B, and D is Medicare Advantage.
Also known as Medicare Part C, Medicare Advantage plans include the benefits of parts A, B, and D.
Most Medicare Advantage plans include prescription drug coverage, and the average monthly premium is $18.50. Premiums vary greatly depending on a person’s income, insurer, and level of coverage.
A person with Medicare Advantage must also pay the Part B monthly premium of $174.70.
A person with a disability who wishes to enroll in either Medicare Part D or an Advantage plan must apply directly with the plan provider during the Initial Enrollment Period (IEP). If they enroll outside this time, they may need to pay a penalty fee.
The IEP spans 7 months and includes:
- the 3 months before qualifying for Medicare
- the month a person qualifies for Medicare
- the 3 months after qualifying for Medicare
Some people with a disability who are under 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 returns to work, they do not have to pay Part A premiums for the first 9 months, which is a “trial work period.”
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 and any deductibles, coinsurances, and copayments.
To be eligible for QMB, a person must not have a monthly income exceeding $1,275, while a married couple’s monthly income must not exceed $1,724.
In addition to income, QMB eligibility requirements include resources such as stocks, bonds, and savings accounts. The resource limit for an individual is $9,430, and for a married couple, it is $14,130.
A person can determine whether they qualify for Medicare with several online websites and tools, including:
- Medicare’s tool for estimating eligibility and likely premium
- Disability Benefits Center online disability evaluation tool
- the Medicare phone number 1-800-MEDICARE (1-800-633-4227) or TTY/TDD: 1-877-486-2048 for those with hearing or speech issues
- Medicare & You 2024 handbook
More resources are available at the end of this article in the sources section.
Medicare automatically enrolls people in parts A and B after they have been receiving Social Security disability benefits for 24 months.
Exceptions to this are people with amyotrophic lateral sclerosis (ALS) and end stage renal disease who are entitled to Medicare sooner.
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.