If you have a disability, you may be wondering if you’re also eligible for Medicare, the U.S. federal government’s health insurance program. When determining eligibility for Medicare, you’ll need to take several important factors into account. Learn the basics of Medicare coverage for people with disabilities, including the process of qualifying for disability benefits.
What Is Medicare?
Medicare is the U.S. federal government’s health insurance program that covers all people age 65 and over, some people with disabilities who are younger than age 65 and people who have end-stage renal disease, which results in permanent kidney failure. The Medicare program has four different parts to it, and each part covers different medical services.
Medicare Part A covers inpatient care when you’re admitted to a hospital, along with hospice care, stays in skilled nursing facilities and some home health services. Part B covers outpatient services, such as doctor appointments, preventive care and medical supplies. Part D covers prescription drugs. Part C is a bit different than the other parts; it involves separate Medicare policies that are available through private insurance providers but that still offer the same types of coverage as Original Medicare, which is Part A, Part B and Part D bundled together.
What Is Disability?
When people refer to “disability” in this context, they’re talking about “disability insurance” or Social Security Disability Insurance (SSDI). This is another program that the U.S. federal government provides, and it pays benefits to people who have become disabled and can’t work. If you’ve worked for a certain length of time and paid Social Security taxes during that time, you may be eligible to receive SSDI payments when you become disabled. These payments can replace the income that you’re no longer earning due to your inability to work the way you did before you became disabled.
There are certain conditions you need to meet in order to become eligible for SSDI. You must have experienced a physical or mental condition that is expected to affect your ability to work for at least a year or is expected to result in your death. The Social Security Administration maintains a list of certain conditions that it considers so severe that they’re generally permanent or expected to cause death, but even if one of these conditions hasn’t caused your disability, you may still be eligible for payments.
You must be unable to do the work that you did before. The Social Security Administration must also determine that your medical condition prevents you from adjusting to another type of gainful employment. Finally, you must have worked long enough during a certain time period before you became disabled; generally, you need to have worked for five of the previous 10 years and paid Social Security taxes. If you’re currently working, you may not be eligible for SSDI benefits.
How Are Medicare and SSDI Related?
Anyone who is eligible to receive SSDI is also eligible to receive Medicare benefits. However, SSDI recipients have a 24-month waiting period before they can start receiving Medicare. This two-year period begins when the Social Security Administration determines you became disabled, not the date that you started receiving benefit payments. If you were working before you became disabled, you may still be able to get health insurance from your former employer until your Medicare coverage begins.
Once you’re eligible to start receiving Medicare and you’ve been receiving SSDI payments, you become eligible to receive all parts of Medicare. You’re also required to enroll in Part A once you become eligible, even if you choose not to enroll in the other parts. If you don’t enroll in Part A, you may be required to pay back some of your SSDI benefits. If you choose to enroll in Part B, you may need to pay premiums that are based on your income level.
Medicare Premiums and SSDI
Even when you start receiving Medicare coverage, you’ll likely still need to pay premiums for it every month, similar to how you pay premiums for conventional health insurance. There are also separate premiums for Part A and Part B. Almost everyone pays premiums for Part B. However, people only pay premiums for Part A if they didn’t work long enough or pay enough Social Security taxes before they became disabled and began receiving SSDI. The amount you may need to pay for your Part A premium is determined by the length of time you worked in jobs that paid Social Security taxes.
Receiving SSDI won’t cover your premiums; it only means you’re eligible to start receiving Medicare coverage after the 24-month waiting period. If you need assistance covering the cost of your premiums, your state may have a program that can help.Typically, these are called Medicare Savings Programs. Contact your local department of social or health services to find out about whether this type of program exists and to determine your eligibility.
You may also need to pay premiums for Medicare Part D. These, too, vary based on the Part D plan you choose, but you may be eligible for assistance in covering the cost, depending on your income level. Part D also has a deductible, which some plans waive.