Qualifying for Medicare with a Disability
Anyone under age 65 who has received Social Security disability insurance for at least 24 months should be eligible for Medicare. When this required amount of time has passed, you will receive a letter in the mail informing you of your next options.
When you are enrolled, you cannot be denied coverage based on the type of care you need, even for conditions such as:
- Alzheimer’s Disease
- Mental Illness
- Multiple Sclerosis
- Parkinson’s Disease
Eligible benefits are determined on a case-by-case basis—so, you will never be turned down because of the condition you have. Rather, specific care coverage will be determined as you need it. You will never be denied if you need care for an extended amount of time, or because they are considered “maintenance only” issues.
You are also automatically eligible for Medicare regardless of age if you have ALS (Amyotrophic Lateral Sclerosis) or End-Stage Renal Disease (ESRD).
People with disabilities who are eligible for Medicare receive all of the same coverage as regular Medicare beneficiaries. Under Part A, this includes:
- Hospital Inpatient Care (Up to 60 Days)
- Nursing Facility Care (Up to 60 Days)
- Nursing Home Care (Upon Approval)
- Hospice Care (Upon Approval)
- Home Health Services (Upon Approval)
Generally, then, Part A includes hospitalization coverage. Part B, on the other hand, covers general medical services and supplies—anything that is eligible for coverage that is deemed “medically necessary” by your doctor. This can include things like:
- Clinical research
- Ambulance services
- Durable medical equipment (DME)
- Mental health services
- Partial hospitalization
- Preventative services (flu shots, vaccines, etc.)
Enrolling in Medicare with a Disability
You will more than likely be automatically enrolled into Parts A and B when you reach the required 24 months. You can, however, choose to also enroll in a Part D plan, or a separate Part C plan instead.
Most Part C plans include Part D coverage but, if not, you can add one. Or, you can not get Part C, and simply add a Part D plan to Original Medicare.
Continued Coverage and Eligibility
You can receive continued, long-term Medicare based on your disability until you turn 65. At that time, you will simply no longer be covered as a disability, but as a regular beneficiary, but your benefits will not change.
However, many people with a disability choose to return to work at some point. With regards to your Medicare coverage, there are 3 different ways in which your coverage will end/continue:
- Trial Work Period (TWP): You have 9 months (non-consecutive) to work as usual. If you are deemed no longer disabled, your Medicare will end.
- Extended Period of Eligibility (EPE): If your disability extends beyond the TWP, you now fall under the EPE, which can last up to 93 months.
- Indefinite Access to Medicare: After both the TWP and EPE (8 and a half years), you can continue to receive Medicare so long as you remain disabled.