How To Qualify For Medicare Disability Benefits
If you are under age 65 and get Social Security disability benefits, you may also be eligible for Medicare. Find out if you're eligible, plus how to enroll.
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Medicare benefits are available to individuals under age 65 if they meet certain disability requirements.
Medicare benefits for individuals under age 65 with a disability are the same as those for seniors over age 65.
In many cases, if you are eligible for Medicare due to a disability, you will be automatically enrolled—you don't have to sign up.
There is typically a 24-month waiting period to enroll in Medicare due to a disability. For certain conditions, that waiting period is waived.
Medicare isn't just for seniors. If you are under age 65, you could qualify for Medicare coverage — and it's probably easier than you think. Why? There's not a long list of requirements you must meet to be eligible. In fact, there's just one: You must collect Social Security Disability insurance benefits for 24 months.
Is enrolling in Medicare disability really that simple? There isn't a catch, but there are a few things you should know. Keep reading to find out if you're eligible, what Medicare coverage you can get, and how to enroll.
Meet These Requirements for Medicare Disability
Because Medicare eligibility guidelines mention some specific conditions — like end-stage renal disease (ESRD) and Lou Gehrig's disease — many potential enrollees under age 65 mistakenly assume that you must be diagnosed with one of those conditions to qualify. That's not true.
In most cases, it's not even your specific healthcare condition that qualifies you for Medicare disability. The requirement is actually that you must have received Social Security Disability Insurance (SSDI) disability benefits for 24 months. The 24 months do not have to be consecutive.
You're Not Limited to a Certain Condition
Social Security's disability program does have strict requirements as to what qualifies as a disability, but it's not limited to certain conditions. Under the Social Security disability program, you are considered disabled if you meet all three of the following requirements:
You cannot do work that you did before having the disability
You cannot adjust to other work because of your medical condition(s)
Your disability has lasted or is expected to last for at least one year or to result in death.
There is a Waiting Period for Medicare Disability
After the Social Security program has determined you to be disabled, you'll have to wait five months before you can begin to collect SSDI benefits. When you add that to the 24 months required to be eligible for Medicare disability, that's a total of 29 months from determination of disability to Medicare enrollment.
Not all potential beneficiaries will have to wait to enroll in Medicare disability. If you've been diagnosed with one of the following conditions, you can bypass the 24-month waiting period:
End-stage renal disease (also called kidney failure or ESRD): You'd usually be eligible for Medicare disability benefits after a kidney transplant, or after three months of regular dialysis treatment (on the first day of the fourth month).
Lou Gehrig's disease (also called Amyotrophic Lateral Sclerosis, or ALS): You'd be eligible for Medicare disability immediately upon collecting SSDI benefits.
Medicare Disability is 'Regular' Medicare
There is no special program for younger, disabled beneficiaries — Medicare is Medicare, and the same rules and coverage apply to beneficiaries under age 65 with disability as they do to seniors. Therefore, you can still be enrolled in Medicare when living or traveling overseas. However, Medicare will usually not pay for any care you receive overseas.
If you plan to travel outside the U.S., you may want to consider a Medicare Supplement or Medicare Advantage plan that includes overseas coverage. Beneficiaries under age 65 with disabilities can choose to supplement their Original Medicare just like seniors can.
Note: If you are eligible for Medicare disability because you have ESRD, you may face additional limitations on enrolling in Medicare Advantage plans.
Living Outside the U.S. is Trickier
If you plan to live outside the U.S., you must decide whether or not to keep your Medicare Part A and Part B benefits. Since most Medicare beneficiaries qualify for premium-free Part A, there's no extra cost for you to stay enrolled (even if your care isn't covered).
But if you disenroll in Part A, you must pay back any Part A benefits you've received up until that point. Depending on your specific situation, that could be quite expensive.
If you decide to stay enrolled in Part B, you will still need to pay for your monthly Part B premium ($144.60 in 2020), even though your care won't be covered.
If you travel back to the U.S. occasionally, it might be worth it to keep your Part B benefits since you can schedule care in the U.S. If you are not planning to return to the U.S. often — or at all — you'll have to decide whether the cost of Part B is worth it.
What If You are Still in the Waiting Period?
If you are still within the 24-month waiting period of receiving SSDI benefits, traveling or living abroad may not affect your eligibility for Medicare disability. U.S. citizens living abroad (which includes any stay longer than 30 days) can continue to receive SSDI benefits.
How to Enroll in Medicare Disability
If you are eligible for Medicare disability, you may or may not need to take extra steps to enroll:
If you've been collecting SSDI benefits:
You'll be automatically enrolled in Medicare Parts A and B at the beginning of your 25th month.
You should receive your Medicare card in the mail (from the Social Security Administration) approximately three months prior to your coverage start date.
Your Part B premium (and Part A premium, if you owe one, will be deducted from your Social Security check.
If you've been diagnosed with ALS:
You'll be automatically enrolled in Medicare the first month you start collecting SSDI benefits. The 24-month waiting period does not apply to those with ALS diagnosis.
If you've been collecting SSDI for another disability, and then are diagnosed with ALS within the 24-month waiting period, you can enroll in Medicare immediately.
If you have ESRD, the eligibility process is a little different:
You can choose whether or not to enroll in Medicare — you are not automatically enrolled.
If you want to sign up, you can do so through your local social security office.
Medicare coverage is available to many people under the age of 65 with disabilities. Don't let fear of a complicated eligibility process keep you from getting Medicare benefits.
Andrea Bonner is a healthcare writer with more than 10 years of experience covering senior health. She is from the Raleigh-Durham area in North Carolina.