Medicare and Disabilities
Medicare is the government health insurance program for older adults. However, Medicare isn’t limited to only those 65 and up—Americans of any age are eligible for Medicare if they have a qualifying disability.
Most people are automatically enrolled in Medicare Part A and Part B once they’ve been collecting Social Security Disability Insurance (SSDI) payments for 24 months. But some people may be eligible for Medicare even sooner. We’ll discuss each eligibility scenario in detail below.
Medicare enrollment for SSDI recipients
To become eligible for Medicare based on disability, you must first qualify for Social Security Disability Insurance. SSDI pays monthly benefits to people with disabilities who might be limited in their ability to work. If you are injured or have a medical condition that limits your ability to work, you may be eligible for SSDI.
Applying for SSDI
If you think you might qualify for SSDI, be prepared for a process. The government has a strict definition of disability. For instance, the disability must be expected to last at least one year. Your work history will also be considered—usually, you must have worked for about 10 years but possibly less depending on your age.
If you meet these criteria from the Social Security Administration1, you may qualify for disability:
- You cannot perform the duties of your occupation.
- Social Security determines that you cannot adapt to another occupation due to your disability or condition.
- Your disability will last at least a year (or already has lasted a year) or will result in death.
Want to learn more about Social Security Disability Insurance? Need help applying? Our guide walks you through the whole process.
Once you apply for SSDI, the Social Security Administration (SSA) reviews your application. If it determines you are eligible, your Social Security disability benefits will begin five months after your disability started—a start date ultimately decided by the SSA.
How long do people on disability have to wait to become eligible for Medicare?
Once you have collected SSDI payments for two years, you will become eligible for Medicare. You won’t even have to sign up—Medicare will automatically enroll you in Part A and Part B and mail your Medicare card to you shortly before your coverage begins.
Thankfully, your 24-month waiting period doesn’t have to be all at once. For example, if you qualify for SSDI, lose eligibility, then re-qualify for SSDI, each month you collect checks counts toward the total 24-month waiting period.
Similarly, if you apply for SSDI and are denied disability benefits, you can appeal the decision. If you appeal and the decision is reversed, your 24-month waiting period will be backdated to when your disability benefits should have started. The result: your wait for Medicare will be shorter than two years.
Medicare enrollment for people with ESRD and ALS
Even though most people on Social Security Disability Insurance must wait for Medicare coverage to begin, two conditions might ensure immediate eligibility: end-stage renal disease (ESRD) and Lou Gehrig’s disease (ALS).
End-stage renal disease (ESRD)
ESRD, also known as permanent kidney failure, is a disease in which the kidneys no longer work. Typically, people with ESRD need regular dialysis or a kidney transplant (or both) to survive. Because of this immediate need, Medicare waives the waiting period.2
However, even if you’re diagnosed with ESRD, you must have an employment history—typically around 10 years—to be eligible for Medicare. If your work record doesn’t meet the standard, you may still qualify if you are the spouse or child of someone with an eligible work history.
Amyotrophic lateral sclerosis (ALS)
ALS, also known as Lou Gehrig’s disease, slowly deteriorates neurons and weakens muscles until the body eventually loses essential functions. There is no known cause nor cure for this disease. Medicare doesn’t require a waiting period for people diagnosed with ALS, but they need to qualify based on their own or their spouse’s work record.3
How long do Medicare benefits last for people with disabilities?
As long as you’re receiving Social Security disability benefits, your Medicare coverage will continue. In some cases, your Medicare coverage can extend beyond your disability payments.
For example, if you return to work and become ineligible for SSDI, you could stay on Medicare for another eight and a half years—93 months—as long as your disability persists. However, you have to opt in to your employer’s health plan if they offer one.
In this case, your employer's health plan would become the primary payer, and Medicare would pay secondary (if you decided to continue with Medicare and keep up with your Part B payments). Unfortunately, if your employer offers only an HSA plan, you won’t be able to use Medicare since HSAs and Medicare don’t mix.
How much does Medicare cost on disability?
If you qualify for SSDI, you'll typically qualify for premium-free Medicare Part A based on your work record. Part B requires a monthly premium ($144.60 in 2020), automatically deducted from your Social Security check. You can technically opt out of Part B if you don’t want to pay the premiums. Just know that without Part B, you’ll forego extensive medical coverage. It’s usually not a good idea to opt out of Part B unless you have other health insurance—like from an employer.
Getting help with Medicare costs
You might be able to get help paying for your Medicare coverage (Part A, Part B, and Part D) if your income and resources are below a specified limit. You could qualify for Medicaid, a government program for low-income individuals.
If your income is too high to qualify for Medicaid, try a Medicare Savings Program (MSP), which generally has higher limits for income. As a bonus, if you qualify for an MSP, you automatically qualify for Extra Help, which subsidizes your Part D costs.
Contact your state’s Medicaid office for more information.
Sources:
1. Social Security Administration, “What We Mean By Disability.” Accessed 7/15/2020
2. Medicare, “I Have End-Stage Renal Disease.” Accessed 7/15/2020
3. Medicare, “Getting Medicare if You Have a Disability.” Accessed 7/15/2020
Content on this site has not been reviewed or endorsed by the Centers for Medicare & Medicaid Services, the United States Government, any state Medicare agency, or any private insurance agency (collectively "Medicare System Providers"). Eligibility.com is a DBA of Clear Link Technologies, LLC and is not affiliated with any Medicare System Providers.
