You probably know that Medicare coverage is available to people age 65 or older. You may also know that Medicare coverage is 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 decisions.
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 2-year waiting period that begins the first month you receive a Social Security benefit check. At the start of your 25th month of SSDI coverage, you’ll be automatically enrolled in Medicare.
Am I eligible for Medicare disability coverage if I am younger than age 65?
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.
There are two exceptions to the 2-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.
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 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.
Once 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 Medicare 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, also 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 monthly premium for Part B coverage.
You are allowed to keep your Medicare coverage for as long as a medical professional deems you medically disabled.
If you under age 65 and return to work, you won’t have to pay a premium for Part A for the next 8.5 years.
If you’re still younger than age 65 once that 8.5-year time period as passed, you’ll begin paying the Part A premium. In 2021, the standard Part A premium is $259.
Your Medicare costswill depend on your specific circumstances. It’s important to know that unlikestandard insurance plans, each Medicare part has its own costs and rules.
Part A costs
- Deductible: $1,484 for each benefit period
- Days 1–60: after the deductible has been met, inpatient stays will be completely covered until the 60th day the benefit period
- Days 61–90: $371 per day coinsurance
- Day 91 and above: $742 per day coinsurance until you exhaust your lifetime reserve days (60 days for a lifetime)
- After 60 lifetime reserve days: you pay all costs
Part B costs
The deductible for Medicare Part B in 2021 is $203. After you meet the deductible, some services are covered in full. You’ll pay 20 percent of the Medicare-approved amount for other services.
You might be eligible for assistance paying your premiums, deductibles, coinsurance, or copayments.
There are currently four Medicare savings programs 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.
- 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