There are 3 ways to be eligible for Medicare for disabled (Medicare Under 65), as long as you are a U.S. citizen, have your resident visa, or you lived in the U.S. for five years in a row:
- If you have been receiving Social Security Disability Insurance (SSDI) then you are qualified after you have received your SSDI check for a period of 24 months.
- If you have Amyotrophic Lateral Sclerosis (ALS), also known as Lou Gehrig’s disease, then you are qualified for Medicare Under 65 the first month you get your SSDI check.
- If you have End-Stage Renal Disease (ESRD), then you qualify for Medicare under age 65 (retroactively) if you meet certain eligibility requirements.
Enrollment in Medicare Under 65: Parts A and B
You’ll be automatically enrolled after you’ve received Social Security Disability benefits for a period of 24 months. You will receive a Medicare Card in the mail 3 months before your 25th month of disability which makes you eligible for both parts of Original Medicare: Part A and Part B when you are under age 65.
If you have Medicare Part B, the premium will be automatically deducted from your Social Security check. You do have the option to turn down Medicare Part B, but you should only consider turning Part B down if you already have group coverage from your employer or your spouse’s employer. Otherwise, you’ll have a premium penalty when you’ll sign up for Part B later, and you may have a gap in your coverage.
Enrollment in Medicare Under 65: Medicare Supplement, Medicare Advantage & Part D
Private insurance companies sell Medicare Supplement, Medicare Advantage, and Part D. Unlike Part A and B, there isn’t an automatic enrollment, so if you are interested in enrolling in any of these plans you either need to enroll yourself, or with the assistance of an agent.
You may consider enrolling in Medicare Advantage Plan (Part C), which provides services covered by Parts A, and B, as well as the Part D (Prescription Drug coverage).
Think about enrolling in a Medicare Supplement Plan (Medigap), which covers Original Medicare out-of-pocket costs, or gaps such as:
- Coinsurance/ copayments
- Excess charges
Medigap plans are generally for people over the age of 65 and according to the federal law insurance companies can refuse to sell Medigap policies to people under 65. Additionally, insurance companies can also charge higher Medigap premiums compared to Medigap premiums for people over age 65.
When you have Medicare under 65, eligibility for Medicare Supplement depends on which state you reside in.
In some states, when you have Medicare under 65, you may not be allowed to buy a Medigap policy.
In other states, insurance companies are required to sell you a policy, even if you have Medicare under 65. These states entitle people under 65 for a Limited Medigap Open Enrollment Period, which occurs within 6 months after you’ve been enrolled in Part B. During this time you may purchase any available Medigap plan without Medical Underwriting. However, the list of available plans for people under 65 may be limited.
When you turn age 65 you’ll be entitled for the Medigap Open Enrollment Period. It will take place independently whether you’ve been entitled for Limited Medigap Open Enrollment Period or not.
You should also consider enrolling in the Medicare Prescription Drug Plan (Part D), which provides you prescription drug coverage if you stay with Original Medicare (Part A or B). Part D is normally included in Medicare Advantage Plans and therefore you don’t need to buy it standalone. If you have limited income and resources, you may qualify for Help with Prescription Drug Costs.
Individual Health Plans if you are Under Age 65
If you are under 65 and not entitled to Medicare, you are always entitled to individual and family health plans available to other individuals under 65:
Medicare Under 65: Let us Help you Choose a Medicare Plan
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