If you get Social Security Disability Insurance, you’re eligible for Medicare coverage.
For most qualifying disabilities, Medicare coverage kicks in after you’ve received disability insurance for longer than 24 months.
If you have ALS, your Medicare coverage begins as soon as you start receiving disability benefits. If you have end-stage renal disease (ESRD), Medicare coverage starts after three months of regular dialysis treatment.
Adults with qualifying disabilities have access to all the same Medicare benefits as adults over 65. You’ll also be able to enroll in a Medicare Advantage or Part D prescription drug plan.
If you have a disability, the costs of healthcare can add up quickly, especially if you’re no longer working. That’s why Medicare provides healthcare coverage for adults with qualifying disabilities.
When you have Social Security disability, Medicare eligibility is not based solely on the disability you have. Instead, your eligibility is determined by the Social Security Administration. If you receive Social Security Disability Insurance (SSDI), you’re eligible for Medicare coverage even if you’re younger than 65.
This is how Social Security defines disability:
- You cannot keep working because of your health condition.
- You cannot adjust to a new job because of your health condition.
- Your disability is expected to last for one year or more.
Conditions such as heart failure, cancer and musculoskeletal problems may qualify as a disability, as well as numerous other conditions that affect your daily life.
Early Medicare eligibility: Disability
You can qualify for Medicare coverage if you’ve been approved for Social Security Disability Insurance coverage. After you’ve received SSDI for two years, you’ll meet the requirements for Social Security disability Medicare eligibility. Typically this means you can enroll in Medicare.
When Does Coverage Begin?
Medicare eligibility after disability usually doesn’t start right away. The date your Medicare coverage will start depends on your disability.
- For most qualifying disabilities, you’ll need to wait for two years to receive Medicare benefits. Your Medicare coverage begins after you’ve received SSDI for 24 months.
- If you have Lou Gehrig’s Disease, also known as ALS, you’ll get coverage right away. Your Original Medicare Part A and Part B coverage starts the first month you get your Social Security disability benefits.
- If you have end-stage renal disease (ESRD), your Medicare coverage starts after three months of regular dialysis treatment.
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If you’re under 65 and receiving Social Security disability benefits, enrolling in Medicare is easy. In most cases, you won’t need to do anything. You’ll automatically get Part A and Part B coverage as soon as you’re eligible. For most disabilities, your Medicare coverage automatically starts after you’ve received SSDI for 24 months.
All you need to do is check the mail for your Medicare card. Your new card should arrive three months before your Medicare coverage starts. This means that most adults qualifying for Medicare with a disability will get their card in month 21 of their SSDI. You’ll have lots of time to find out exactly what’s covered before your Medicare coverage starts on the first day of month 25.
If you are on disability when eligible for Medicare at age 65, you’ll be automatically enrolled in Original Medicare. Your Part B monthly premium can be deducted from your Social Security benefits, and you can start using your Medicare coverage as soon as you turn 65.
Enrolling in a Medicare Advantage Plan
If you want additional benefits beyond Original Medicare coverage, you can choose to enroll in a prescription drug plan or a Medicare Advantage plan. The best time to enroll is during your seven-month Initial Enrollment Period.
- Your enrollment period starts three months before your Medicare coverage begins. You can start looking for plans in month 21 of receiving SSDI, once you have your Medicare ID card.
- Your enrollment period includes the first month your Original Medicare coverage starts. This is usually month 25 of your SSDI.
- Your enrollment period ends three months after your Original Medicare coverage begins. This is usually in month 28 of receiving SSDI.
As soon as you get your Medicare ID card in the mail, you can enroll in a plan that provides additional services. Medicare Advantage (Part C) plans often include benefits such as dental and vision coverage, as well as prescription drug coverage. Part C plans also have a yearly cap on out-of-pocket spending to help keep your healthcare costs affordable.
Whether you qualify for Medicare based on age or a disability, Medicare Part A and Part B coverage stays the same. Medicare beneficiaries have the same benefits and can access the same services. The same coinsurance and copayments also apply to Medicare beneficiaries under 65. Here’s a brief rundown of what each covers:
Part A benefits include:
- Inpatient hospital care
- Skilled nursing care
- Some home health care
- Hospice care
Part B coverage includes:
- Doctor’s visits
- Preventative services
- Durable medical equipment like wheelchairs and walkers
- Ambulance services
Regardless of age, you may qualify for a Special Needs Plan (SNP) if you have a chronic health condition such as an autoimmune disorder, a cardiovascular disorder or a mental health condition. SNP benefits can include:
- Inpatient hospital care
- Home health services
- Physical therapy
- Occupational therapy
- Durable medical equipment
- Prescription drug coverage
- Additional benefits such as dental or vision coverage
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Other disabilities and health conditions, such as dementia, mental illnesses and long-term or chronic conditions can also qualify adults for Medicare coverage before they turn 65. If you meet the Social Security disability criteria and receive SSDI, you can get Medicare coverage.
Medicare covers the cost of some services for adults with dementia. Covered services can include physical therapy and preventative care.
For adults with dementia, Original Medicare covers:
- Inpatient hospital stays
- Home health care
- The first 100 days of nursing home care
- Hospice care
When it comes to mental illness — if you are disabled, you may qualify for SSDI and Medicare coverage. If you’ve been receiving treatment and you’re not able to work, you may qualify for Social Security disability benefits.
Some qualifying conditions include:
- Affective disorders
- Anxiety disorders
- Personality disorders
Along with Original Medicare coverage, you can also access mental health benefits including psychotherapy and medication management.
Long-term and chronic conditions
Adults with long-term or chronic conditions are also eligible for Social Security benefits and Medicare coverage. No one is denied coverage on the basis of needing ongoing or long-term support. Chronic conditions can meet SSDI eligibility and allow you to access Medicare coverage.