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If you qualify for disability insurance, there’s a chance you could already qualify for Medicare coverage. We can make sure you’re getting the benefits you deserve. There’s no obligation to enroll.
Medicare Disability Coverage
Does Medicare cover disabilities?
If you are disabled—regardless of age—and qualify for Social Security disability insurance (SSDI), then you may also be eligible to receive Medicare disability coverage.
What’s the process to obtain Medicare for individuals with disabilities?
To receive both SSDI and Medicare disability coverage, consider the following steps:
Step 1
Apply for Social Security Disability
In order to collect Social Security disability, you must meet the following requirements:
- Diagnosed with a condition that’s left you with a permanent disability, meaning you cannot work for a period of 12 months or longer
- Have worked a Social Security-qualified job and paid Social Security taxes
- Your medical condition must prevent you from performing your normal job function, and you must have been unable to find a suitable replacement position or new line of work because of your age, education levels or physical limitations
- You must be complying with your doctor’s treatment plan for your condition
You can apply for Social Security disability through the Social Security Administration at https://www.ssa.gov/.
Step 2
Apply for Medicare Disability Coverage
To begin receiving Medicare disability benefits, most individuals must have been collecting Social Security disability for at least two years (24 months), but some may qualify sooner. Here is a case-by-case look at eligibility:
- If you’ve been diagnosed with amyotrophic lateral sclerosis (ALS or Lou Gehrig’s disease).
- You’re automatically enrolled in Medicare Part A (hospital insurance) in the first month that you begin receiving Social Security disability benefits.
- You’re automatically enrolled in Medicare Part B (medical insurance) if you live within the 50 United States or District of Columbia. You can refuse the automatic enrollment in Medicare Part B if you already have medical insurance.
- You have the option to enroll in a Medicare Part D prescription drug plan to help cover your prescription drug expenses.
- If you’ve been collecting Social Security disability for at least two years (24 months), you will:
- Automatically be enrolled in Medicare Part A at the beginning of the 25th month after you first received your Social Security disability benefits.
- Automatically be enrolled in Medicare Part B at the beginning of the 25th month after you first received your Social Security disability benefits.
- To help cover your prescription drug expenses, you can also opt to enroll in a Medicare Part D prescription drug plan. You can enroll in a Medicare prescription drug plan as early as three months before the 25th month of your Social Security disability benefits.
- If you have end-stage renal disease (ESRD):
- If you have ESRD (also known as kidney failure) you must enroll in all parts of Medicare manually by logging on to https://www.ssa.gov/benefits/medicare/ or by calling 1-800-772-1213 (TTY users 1-800-0778), Monday through Friday, from 7AM to 7PM. You can also visit your local Social Security office to enroll in Medicare Part A and Part B.
- If you live outside the 50 United States and the District of Columbia:
- If you do not live within the 50 United States or Washington D.C., but you do live in a U.S. territory (such as Puerto Rico), any qualified automatic enrollment will be limited to Medicare Part A (hospital insurance). You will otherwise have to enroll yourself when you become eligible. Enrollment in Medicare Part B and a Medicare prescription drug plan is always separate.
Important Facts about Premium Costs and Other Expenses
- Original Medicare Part A is free for most people and you must keep it. You cannot decline Part A unless you’re willing to pay back all the SSDI benefits you received, so you’ll likely need to keep it even if you are covered by your spouse’s employer insurance.
- Original Medicare Part B has a monthly premium and you can disenroll if you have other health insurance coverage through your employer or your spouse’s employer. IMPORTANT: Be sure to check with the employer’s human resources office to find out how their plan works with Original Medicare Part B as there are differences depending on the number of employees. If 20 employees or more: the employer insurance will be primary (i.e. that insurance is billed first, and most likely covers more of your care than Medicare Part B). If less than 20 employees: your Medicare insurance will be primary—and you’ll therefore need to join Part B.
- Expect co-pays and deductibles, even with Medicare disability coverage. Having a disability does not affect whether you have out-of-pocket expenses, although if you have employer insurance that is primary to Medicare, you may have fewer. If you don’t have employer insurance and you are enrolled in Original Medicare (Parts A & B), you may want to add a Medicare Supplement Insurance plan (Medigap plan) or opt for the Original Medicare alternative—a Medicare Advantage plan.
- Original Medicare Part A is free for most people and you must keep it. You cannot decline Part A unless you’re willing to pay back all the SSDI benefits you received, so you’ll likely need to keep it even if you are covered by your spouse’s employer insurance.
- Original Medicare Part B has a monthly premium and you can disenroll if you have other health insurance coverage through your employer or your spouse’s employer. IMPORTANT: Be sure to check with the employer’s human resources office to find out how their plan works with Original Medicare Part B as there are differences depending on the number of employees. If 20 employees or more: the employer insurance will be primary (i.e. that insurance is billed first, and most likely covers more of your care than Medicare Part B). If less than 20 employees: your Medicare insurance will be primary—and you’ll therefore need to join Part B.
- Expect co-pays and deductibles, even with Medicare disability coverage. Having a disability does not affect whether you have out-of-pocket expenses, although if you have employer insurance that is primary to Medicare, you may have fewer. If you don’t have employer insurance and you are enrolled in Original Medicare (Parts A & B), you may want to add a Medicare Supplement Insurance plan (Medigap plan) or opt for the Original Medicare alternative—a Medicare Advantage plan.
Can I lose my Medicare disability coverage?
If your treatment results in you becoming well enough to return to work, your SSDI benefits may be immediately affected, however you are still eligible for Medicare for seven years, even if you return to what Social Security deems “substantial gainful activity” i.e. a job paying above a certain income level, depending on your disability.
In this case, whether your new employer offers health insurance and also the number of employees covered can affect if Medicare is the primary or secondary payer. Be sure to discuss this with human resources. Also be sure to call Social Security to find out how many hours you are allowed to work and still qualify to receive your SSDI payments.
Let SelectQuote Help
Let us help you navigate the complexities of Medicare disability coverage. In just minutes, we can compare all the options available for you in your area from our trusted carriers to ensure you’re getting all the benefits you deserve. It’s a free service, and there’s no obligation to enroll.
