If you’re among the five percent of people under age 65 receiving Social Security disability benefits, your ability to work has been impacted, and health insurance coverage might be a concern. The good news is that you can qualify for Medicare coverage under 65 if you receive SSDI.
Though navigating systems like Medicare and SSDI can seem complicated or overwhelming, our skilled SSDI lawyer can help. We can walk you through what healthcare disability coverage you may qualify for and help you understand your SSDI Medicare eligibility. You’re not alone in this process. Turn to the experienced legal team at Phillip M. Hendry Law and learn how we can help you today.
What to Know About SSDI Medicare Eligibility
Understanding your SSDI Medicare eligibility can seem frustrating because of the many different factors involved. Our experienced SSDI attorney has a few facts to help you navigate the process.
Can SSDI Recipients Qualify for Medicare Under Age 65?
If you are under the age of 65 and receiving SSDI benefits, you will be eligible for Medicare after a waiting period. In fact, the Social Security Administration states that: “Everyone eligible for Social Security Disability Insurance (SSDI) benefits is also eligible for Medicare after a 24-month qualifying period.”
The situations involving the parts, coverages, and specifics of Medicare coverage can vary. Because every situation can be so unique and the SSA rules can be challenging to navigate, working with a qualified SSDI lawyer can help walk you through the various details surrounding coverage.
Waiting Periods With Medicare and SSDI
For most people receiving SSDI under age 65, there is a waiting period (also called an enrollment period) of 24 months. After those 24 months, people receiving SSDI is automatically enrolled in Medicare. However, there are some special circumstances regarding SSDI Medicare eligibility.
These include:
- The waiting period is waived for those with Amyotrophic lateral sclerosis (ALS, also known as Lou Gehrig’s disease) and End-stage renal disease (ESRD).
- The waiting period may differ in certain situations if a person had previous disability benefits before the current disability for which they are receiving SSDI.
There is typically a five-month waiting period after the SSA has determined your disability before you start receiving SSDI. Taking that into account, the timeframe of your disability determination and disability health coverage with Medicare benefits is generally 29 months.
Medicare Options
Medicare consists of multiple parts and coverage options. These include Original Medicare and Medicare Advantage.
Original Medicare
Original Medicare consists of:
- Part A, hospital coverage
- Part B, medical coverage
- Part D, medication coverage
- Supplemental coverage (also known as Medigap)
Medicare Advantage
Medicare Advantage, or Part C, bundles parts of the other Medicare plans. These plans are available through Medicare-approved private companies and may include extra benefits. The costs, coverage, and requirements may be different than Original Medicare.
Medicare Coverage for Those Receiving Disability Benefits
If you receive SSDI, you will automatically be enrolled in Medicare after the 24-month enrollment or waiting period. You will be enrolled in Medicare Part A and Medicare Part B.
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If you receive SSDI, you can’t decline Part A (unless you are willing to pay back your previously issued SSDI benefits). Part A is free.
- Part B requires a monthly premium. You may de-enroll from Part B if you have coverage from a spouse’s employer and the company has 100 employees or more. If you keep both employer coverage and Part B, employer coverage will be the primary insurance.
- Once you’re eligible, you also have the option to enroll in a Medicare Advantage plan or purchase supplemental coverage.
SSDI, Medicare, and Working
Disability health coverage can be complicated, and if you regain substantial gainful activity or SGA), there are several things to keep in mind. If your disability responds to treatment and you can begin working again, you may keep your Medicare benefits for a certain timeframe.
There is a trial work period (TWP) of nine months, then a 93-month period in which you remain eligible for Medicare (if your income meets certain guidelines) even if SSDI benefits cease. You may also be able to purchase Medicare coverage if you are eligible after the 93-month period ends.
Phillip M. Hendry Law Can Guide You Through the SSDI and Medicare Process
SSDI and Medicare are anything but simple, but Phillip M. Hendry Law is here to help. If you are still in the SSDI application process or struggling with a denial, we can help you work through each step to ensure a thorough, error-free application with a higher chance of approval.
As you navigate the murky waters of Medicare, we can provide the clarity and guidance you need to understand eligibility, the various options, and what choices will be most beneficial for your specific situation. Reach out to our caring, compassionate to help with your disability health coverage.