Qualified for Disability? Explore Your Medicare Coverage Options

According to data from the U.S. Social Security Administration, almost 9 million people received disability benefits in 2022. Social Security Disability Insurance (SSDI) supports individuals who are unable to work in what the agency considers substantial gainful activity, defined in 2024 as earning less than $1,550 a month for non-blind people or $2,590 a month for people who are legally blind. 

If you’ve applied or qualified for Social Security disability benefits, you should understand how this affects your Medicare eligibility and enrollment. In this article, you’ll learn about the coverage that’s available to you and how you can make changes to meet your needs. 

Medicare Eligibility Before 65 

Medicare was established in 1965 to offer public health insurance for older people. Most U.S. citizens and legal residents become eligible during their Initial Enrollment Period, a window of seven months around the time of their 65th birthday.  

Over the decades, changes in the law have extended coverage to younger people with disabilities. After receiving SSDI benefits for two years, you should be enrolled automatically in both parts of Original Medicare: Medicare Part A (hospital insurance) and Part B (medical insurance). If you’re currently going through that 24-month qualifying period, you can expect to receive your Medicare card in the 21st month, three months before your new coverage is scheduled to start.  

On the other hand, if you’re receiving SSDI payments and have end-stage renal disease (ESRD) or amyotrophic lateral sclerosis (ALS) — commonly known as Lou Gehrig’s Disease — you don’t have to wait as long: 

• People with ESRD are automatically enrolled after undergoing three months of dialysis or being admitted to a Medicare-certified hospital for a kidney transplant. 
• People with ALS are automatically enrolled the same month that they start receiving their SSDI payments. 

Paying Medicare Costs 

Medicare is not free. While Part A usually doesn’t require a monthly premium, Part B does ($174.70 a month for most people in 2024). Plus, beneficiaries generally need their medical or hospitalization costs to exceed a deductible before the insurance starts paying its share, and they are charged coinsurance for certain services.  

Part B does not pay for most medications. To get coverage for prescription drugs, you will need to enroll in a Medicare Part D plan from a private insurer. The monthly premiums and coinsurance costs vary by plan. 

As an alternative, you may choose a Medicare Advantage plan. Offered by private insurance carriers, these plans substitute for Original Medicare and generally include Part D prescription drug coverage. They can also include supplemental benefits like hearing, vision, and dental care. Medicare Advantage plans set limits on out-of-pocket costs, but you will likely need to see doctors and visit pharmacies that are in a local provider network to get the most out of the benefits. 

If you need more help with your healthcare expenses, there are additional resources available. Let’s look at a few possibilities: 

Medicaid 

Medicaid is another public health insurance program, separate from Medicare, that’s available to people with low incomes. Since individual states run their own Medicaid systems, details and eligibility differ based on where you live. 

Many people who receive disability benefits qualify for Medicaid as well as Medicare, often referred to as being dual eligible. Enrolling in both can make your coverage more affordable: Medicare will be the primary payer for your healthcare costs, and Medicaid will help with Part B premiums and out-of-pocket costs. 

Extra Help for Medicare Part D 

Extra Help, also known as the Low-Income Subsidy (LIS), makes Medicare Part D prescription drug coverage more affordable by: 

• Reducing the plan deductible to $0 and the monthly premium to as low as $0. 
• Lowering the copays for both generic and name-brand drugs. 

These savings are only available to people who have low incomes and limited financial resources. Financial resources can include any checking, savings, or retirement accounts you have open and any stocks or bonds you own.  

As of 2024, you could qualify for Extra Help if:  

• You earned less than $22,950 as an individual or $30,660 for a married couple. 
• You owned less than $17,220 in resources for an individual or $34,360 for a married couple. 

Medicare Advantage Special Needs Plans 

A Special Needs Plan (SNP) is a type of Medicare Advantage plan created for people who either have qualifying conditions, are eligible for Medicaid, or live in a long-term care facility. These plans frequently offer lower costs and additional benefits like an allowance to pay for groceries and over-the-counter items. 

A Chronic Condition SNP (C-SNP) is only available to people who are living with certain severe and disabling chronic conditions like: 

• Alcohol dependence 
• Autoimmune disorders 
• Cancer 
• Cardiovascular disorders 
• Certain chronic lung disorders 
• Certain mental health conditions 
• Certain neurologic disorders 
• Chronic heart failure 
• Dementia 
• Diabetes mellitus 
• End-stage liver disease 
• End-stage renal disease requiring dialysis 
• HIV/AIDS 
• Severe hematologic disorders 
• Stroke 

In a C-SNP, the coverage for medical services and drugs, plus supplemental benefits like meal delivery and transportation assistance, can be tailored to meet the needs of people with particular health concerns. 

Returning to Work 

Even if you go back to working at a level considered substantial gainful activity, that doesn’t necessarily mean you have to give up your Medicare coverage. As long as you are still considered medically disabled, you can choose to stay enrolled for up to 93 months. At that point, disabled people under 65 still have the option to stay on Medicare, but there are additional costs for Part A coverage. 

You may also be able to enter the Qualified Disabled & Working Individual (QDWI) Medicare Savings Program administered by your state. This program helps with Part A premiums when disabled people who have lost their Social Security benefits and premium-free coverage by returning to work. 

For people who are living with disabilities, it’s especially crucial to get the most value out of your health insurance. By evaluating your options and seeking guidance, you can find the best Medicare coverage options for you. 

About GoHealth 

GoHealth is a leading health insurance marketplace and Medicare-focused digital health company. Enrolling in a health insurance plan can be confusing for customers, and the seemingly small differences between plans can lead to significant out-of-pocket costs or lack of access to critical medicines and even providers. GoHealth combines cutting-edge technology, data science, and deep industry expertise to build trusted relationships with consumers and match them with the healthcare policy and carrier that is right for them. Since its inception, GoHealth has enrolled millions of people in Medicare plans and individual and family plans. For more information, visit GoHealth.com.