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Disability and Medicare coverage before age 65

| March 22, 2023

      Some people may qualify for Medicare due to disability. In this situation, if you have a qualifying disability, you are eligible for Medicare even if you have not reached age 65. To find out if your disability qualifies for disability benefits or for Medicare, you will need to speak with Social Security directly. If you have a qualifying disability, you become eligible for these benefits on the 25th month of receiving Social Security Disability Insurance benefits (SSDI).  

      If you have a qualifying disability, you must first file for disability benefits through Social Security before you can even be considered eligible for Medicare due to disability. Approval of the request by Social Security is an important first step. Many times, people are declined when applying for the benefits, and sometimes it may take multiple efforts to get approved. I have also seen situations where people have been declined multiple times in a year, then they get approved with retroactive benefits. This may result in a larger paycheck for you and eliminate part of the 24-month waiting period. It is also important to note that these benefits are different from Supplemental Security Income (SSI) benefits, and that SSI benefits do not qualify you for Medicare.  

How to Enroll in Medicare with a disability 

       So, you have a qualifying disability and you’ve satisfied the twenty four month waiting period. Now what? Just like when you become eligible for Medicare at age 65, when you are eligible with disability, you have an Initial Enrollment Period of 7 months Your Initial Enrollment Period (IEP) will begin after you have received either disability benefits from Social Security for 24 months or certain disability benefits from the Rail Road Retirement Board for 24 months. Basically, your IEP starts on the 25th month of disability benefits. For information purposes, everything we are discussing pertains to Social Security benefits. You will be automatically enrolled in Medicare Part A and Part B. If you decide you want to get secondary insurance to cover the gaps in Medicare you can  enroll yourself directly with the private plan provider of your choice. Many states treat this period like that of when you turn 65 where you have guarantee issue rights.  You will need to enroll during your IEP to avoid late enrollment penalties. 

Do I have to take Part B? 

      You are not required to take Part B, and some people choose to delay. Deciding to opt out of Part B at this time is a personal choice and depends on your unique situation. Some secondary insurance plans require you to have Part B. Some people who qualify for Medicare under age 65 due to disability but are covered under an employer’s plan or a spouse’s employer plan, may opt to delay. Check with your agent or give one of our agents a call if you need clarity. 

What happens when you turn sixty-five? 

       When you turn 65, you essentially lose your entitlement to Medicare based on disability (SSDI) and become entitled based on age (SSI). In short, you get another chance to enroll, a second Initial Enrollment Period if you will. You can also decide during this time to enroll in a Medicare Supplement, Medicare Advantage or Part D prescription drug plan. If you need more information about what happens at 65, refer to my blog about signing up for Medicare at 65.