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Jan. 26, 2021, 5:13 p.m. EST

Qualifying for Medicare disability

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Key takeaways:

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 .

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