Medicare Coverage If You Have a Disability

What is Medicare Disability?

If you are disabled at any age, you may qualify for Social security Disability Insurance (SSDI) and Medicare disability coverage.

Who Qualifies for Medicare Disability?

If you qualify for Medicare Disability, you must also be eligible for Social Security disability.

  • Must be diagnosed with a medical condition that leaves you permanently disabled (cannot work for 12 months or more)
  • Must have worked long enough to qualify for Social Security and paid Social Security taxes
  • Must have a medical condition that prevents you from performing your regular job function and unable to find suitable replacement work due to age, education, or physical limits
  • Must comply with your doctor's treatment plan

Then, you may qualify for Medicare Disability if you are under age 65 with a qualifying disability or have ALS (Lou Gehrig's disease). Also, you must have received Social Security disability for at least 24 months. In some cases, people qualify earlier, such as:

  • If you were diagnosed with ALS
  • Received disability for at least 24 months
  • Have end-stage renal disease (kidney failure or ESRD)

Medicare automatically enrolls you for Part A and Part B. For prescription drug coverage, you opt-in to Part D unless you have ESRD. Unfortunately, ESRD patients must register manually.

To learn more about qualifying for Medicare disability, visit the Social Security Administration website.

When Does Medicare Disability Start?

If you qualify, Medicare automatically enrolls you for Part A and Part B.

How Does Medicare Disability Work?

If you are disabled, apply for Social Security Disability, then request Medicare Disability.

Request a Social Security disability review through the Social Security Administration at https://www.ssa.gov/.

Once you are enrolled, you will receive ID cards in the mail. You can begin using your coverage at Medicare-approved providers.

How Much Does Medicare Disability Cost?

Most people pay $0 for Medicare Part A

Because payroll taxes cover the cost of Medicare Part A (hospitalization) premiums, most people pay nothing. You are not permitted to drop Part A coverage unless you no longer qualify for Medicare. If you also have employer health insurance, you must keep Medicare Part A.

Medicare Part B Has a Monthly Premium

You must pay a monthly fee for Medicare Part B (medical insurance). You must keep it unless you have health insurance through your employer. If so, you are permitted to disenroll from Medicare Part B.

Medicare Has Out-of-Pocket Costs

Medicare requires the recipient to pay copays, deductibles, and coinsurance. However, the out-of-pocket costs may be lower if you also have employer health insurance.

Alternatively, if you want additional coverage, you can opt for a Medicare supplement plan or a Medicare Advantage policy.

Will Medicare Disability Cancel My Coverage If I Get Better?

If you are fortunate enough to recover from your disability, you may still be eligible for Medicare for seven years.

Even if you return to work and lose SSDI benefits immediately, the SSA looks to see if you have "substantial gainful activity." In other words, your new job pays above a specific income level, depending on your disability.

If you do not earn above that level, you may be able to keep your Medicare as well as use employer health insurance. It is a good idea to discuss your insurance situation with human resources.

Also, check with Social Security to find out how many hours you can work and maintain your SSDI benefits.

AARDY Can Help You Understand Medicare Disability

AARDY is the nation's fastest Medicare insurance marketplace. You can compare Medicare supplements and Medicare Advantage plans to find the one that best fits your needs.

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