You probably know that Medicare coverage is available to individuals 65 or older. You might know that there is also Medicare coverage available for people with disabilities.
If you qualify for disability benefits from the Social Security Administration, you can get Medicare coverage. Knowing when your Medicare coverage will start, what it will cover, and much it will cost can help you make important plans.
You can qualify for Medicare if you have a disability and have been approved for Social Security Disability Insurance (SSDI). In most cases, you’ll need to wait 24 months before your Medicare coverage begins. There is a two-year waiting period that starts the first month you receive a Social Security benefit check. At the start of your 25th month of SSDI coverage, you’ll automatically be enrolled in Medicare.
There are two exceptions to the two-year waiting period. If you have amyotrophic lateral sclerosis (ALS), also known as Lou Gehrig’s Disease, you’ll be enrolled in coverage in the first month you receive SSDI. If you have end stage renal disease (ESRD), your Medicare coverage normally begins the first day of the fourth month of your dialysis treatment.
Medicare disability coverage doesn’t have an age requirement. You can get Medicare coverage as long as you have a disability and have been approved for SSDI.
Yes, as long as you’ve been approved for SSDI. You’ll be automatically enrolled at the start of your 25th month of receiving benefits. You’ll receive your card in the mail during your 22nd month of SSDI benefits. Once you’re eligible, you’ll have coverage from Medicare parts A and B. Parts A and B are known as original Medicare.
- Medicare Part A (hospital insurance). Part A is used to pay for hospital stays and other types of short-term patient care, such as skilled nursing facilities. People generally don’t pay a premium for Part A coverage.
- Medicare Part B (medical insurance). Part B is used to pay for a wide range of medical services, including doctor and specialist appointments, emergency room visits, ambulance services, medical equipment, preventive care, and some medications. You’ll normally pay a premium for Part B coverage.
The first step to getting Medicare coverage if you have a disability is to apply for Social Security Disability benefits. Your disability will need to meet the standards set by the Social Security Administration in order to qualify for coverage. Generally, this means you are unable to work and that your condition is expected to last for at least a year.
Medicare doesn’t determine who is eligible for disability coverage. You don’t need to take any further steps if the Social Security Administration has approved your disability application. You’ll just need to wait the required 24 months, and you will be automatically enrolled in Medicare.
Your Medicare costs will depend on your specific circumstances. It’s important to know that unlike standard insurance plans, each Medicare part has its own costs and rules.
Medicare Part A costs
You won’t typically pay a premium for Medicare Part A. While there are some circumstances when people do need to purchase Part A coverage, people who receive Social Security benefits or benefits from the Railroad Retirement Board are able to get free coverage. This means you won’t pay for Medicare Part A as long as you’ve been receiving SSDI benefits for 24 months.
Hospitalization costs with Medicare Part A include:
- Deductible: $1,408 for inpatient hospital stays during each coverage period.
- Days 1-60: No fee. After the deductible is met, inpatient stays will be completely covered until the 60th day in each period.
- Days 61-90: $352 per day coinsurance.
- Days 91+: $704 per day coinsurance until you reach your lifetime reserve limit (60 days for a lifetime).
- After 60 reserve days: You pay all costs.
Medicare Part B Costs
Your Medicare Part B premium will be deducted from your SSDI check. According to the U.S. Centers for Medicare & Medicaid Services (CMS), the standard Part B premium for 2020 is $144.60.
The deductible for Medicare Part B in 2020 is $198. After you meet the deductible, some services are covered in full. You’ll pay 20 percent of the Medicare-approved amount for other services.
Some people choose to decline Medicare Part B coverage. Often this is because they can get more affordable coverage from another source, such as their spouse’s job. You can choose to not take your Medicare Part B coverage if you have other coverage options.
There will be instructions to decline Part B coverage included with your Medicare card when it arrives in the mail. However, you might have to pay a late enrollment penalty if you don’t take Part B coverage when you become eligible but decide to take it later.
You might be eligible for assistance paying your premiums, deductibles, coinsurance, or copayments.
There are currently four Medicare savings plans available to help cover these costs:
- Qualified Medicare Beneficiary (QMB) Program
- Specified Low-Income Medicare Beneficiary (SLMB) Program
- Qualifying Individual (QI) Program
- Qualified Disabled and Working Individuals (QDWI) Program
These plans are designed to help people who fall under preset income levels pay for their Medicare coverage. You’ll need to meet income requirements to qualify.
If you can’t qualify for a Medicare assistance plan, you might want to consider a Medigap plan. Medigap plans are sold by private insurance companies approved by Medicare to help you cover the costs of coinsurances, copays, and other expenses Medicare doesn’t pay.
Medicare supplement plans
Once you’re eligible for Medicare parts A and B, you’ll have the option to purchase Medicare supplement plans. The two supplemental Medicare parts are:
- Medicare Part C (Medicare Advantage plans). Advantage plans, also known as Part C plans, offer more coverage options than original Medicare. This coverage is offered by private companies that have contracts with Medicare. You’ll need to be enrolled in parts A and B and pay a premium to get an Advantage plan.
- Medicare Part D (Prescription Drug plans). Part D is a prescription drug plan. You can use this plan to help offset the cost of your medications. Premiums for Part D depend on your income. A program called Extra Help can help cover Medicare Part D and your prescription drugs costs if you have limited resources.
Medicare doesn’t pay for:
- dental services
- vision services
- hearing aids
- cosmetic surgeries
- long-term care
You can purchase a Medicare Advantage plan that covers dental, vision, and other non-covered services.
You might also want to consider purchasing a long-term care insurance plan if you think you might need long-term care now or in the future; however, Medicare does not offer this type of coverage.
Medicare coverage is available for people with a disability who receive SSDI. You’ll automatically be enrolled in parts A and B after your 24th month of SSDI benefits. You can choose to decline Medicare Part B coverage if you have other options that work better for your budget.
You’ll generally pay premiums for only Part B, but there are deductibles and coinsurance costs for both parts. You can get help paying your premiums and other costs with Medicare assistance plans and Medigap plans.