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When you have a disability, paying for health care is a major concern. The good news is that people who qualify for railroad or Social Security disability payments also qualify for Medicare disability. Here’s what you need to know about getting Medicare disability coverage.
If you get payments from Social Security Disability Insurance (SSDI) or railroad disability, you are eligible for Medicare disability. Your eligibility date depends on the reason you are disabled.
In most cases, you are eligible for Medicare disability two years after you become eligible for SSDI or railroad disability payments. If you have end-stage renal disease (ESRD) or amyotrophic lateral sclerosis (ALS or Lou Gehrig’s disease), the two-year waiting period doesn’t apply.
For most people, your Medicare eligibility date is 24 months after your date of entitlement for disability payments. The good news is you may not have to wait two full years after you get your first benefit check. This is because the disability waiting period and retroactive benefits period can impact the date you get coverage.
There is a mandatory five-month waiting period for disability payments once you qualify for benefits. For example, if you became eligible for disability on August 1, 2020, you would get your first payment five months later in January, 2021.
Social Security also allows people to get up to 12 months of retroactive benefits . This is because it can take several months to complete the application, qualification, and appeals process. The waiting period and retroactive payments period can affect your Medicare effective date.
In most cases, you don’t have to do anything to enroll in Medicare . You will be automatically enrolled in Part A and Part B as soon as you become eligible . Medicare sends your “Welcome to Medicare” kit and ID card about three months before your coverage is effective.
Your Part B premium ($148.50 in 2021) is automatically deducted from your SSDI or railroad disability payment.
You aren’t automatically enrolled in Part D . If you want prescription drug coverage, you need to buy a plan during your Initial Enrollment Period , which extends six months after your Medicare effective date. As soon as you get your Medicare ID, you can shop for Part D plans in your area using the Medicare Plan Finder .
If you take daily medications, be sure to enter them into the screening tool. By doing so, you’ll be able to see how much you’ll pay for each prescription drug and find the most cost-effective coverage.
If you choose Medicare Advantage, Part D is generally included in your plan.
Anyone eligible for Medicare can enroll in a Medicare Advantage plan . Once you get your Medicare ID card and effective date, you can apply for any plan sold in your area.
If you choose Medicare Advantage, you may have to pay a separate premium to your insurance company in addition to your Part B premium. Most people have access to a $0 premium, $0 deductible Medicare Advantage plan.
If you are concerned about out-of-pocket spending with Original Medicare, a Medicare Advantage plan might be a good option. All Medicare Advantage plans have an annual out-of-pocket maximum . This means that once you reach your plan’s limit, the insurance company pays 100% of your costs.
While the government maximum is $7,550 in 2021, the average out-of-pocket maximum among Medicare Advantage plans is about $4,900 .
Some people with disabilities qualify for a Medicare Advantage Special Needs Plan (SNP). These plans always include Part D coverage. They usually have $0 premiums and $0 deductibles, and include extra benefits such as dental, vision, and care coordination to help you manage your condition. Benefits are specifically tailored to help keep costs low.
Under federal law, insurance companies aren’t required to sell Medicare Supplement plans to people under age 65. If you become eligible for Medicare disability before you turn 65, you may not be able to buy Medigap.
The good news is that 33 states currently have laws requiring insurers to sell at least one of the standardized Medicare Supplement plans to people under 65 who are enrolled in Medicare. This means that if a company sells Medigap plans in the state, it must offer at least one type of plan to people who are under 65 and on Medicare disability.
People who get Medicare disability due to ESRD may not be able to buy a Medicare Supplement plan . Not all states that require insurers to sell Medigap to people under age 65 extend that protection to people with ESRD. For this reason, if you have ESRD, it is advised that you check with your state insurance department to see how the laws affect you.
There is only one Medigap Open Enrollment Period . It begins the month you are both age 65 (or over) and enrolled in Part B.
If you get Medicare before age 65, you can apply for a Medicare Supplement plan , but you’re not guaranteed coverage. If you live in one of the states listed above, you will be able to buy at least one plan, but the insurance company can charge you a much higher premium. You also may not be able to get the type of coverage you want.
When you turn 65, you will have guaranteed issue rights during your Medigap Open Enrollment Period. This means you can buy any plan sold in your state, and you can’t be charged a higher premium because of your disability.
If you are worried about budgeting for health care costs and you can’t get a Medicare Supplement plan until you turn 65, a Medicare Advantage plan could be a good alternative for you.
Medicare is a lifeline for people with disabilities who worry about health-care costs. You’re not locked into Original Medicare if a Medicare Advantage plan better meets your needs. Many people with disabilities qualify for low-cost Special Needs Plans with extra benefits and services to help you manage your condition.
If you’re interested in a Medicare Supplement plan, talk to your disability benefits coordinator or state insurance department to find out how state law affects your eligibility. You can also talk to a licensed Medicare professional at 844-259-6504 to help you make sense of your options and choose the best coverage to fit your unique needs.