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Nurse helping patient stand from wheelchair next to Medicare disability coverage

Medicare Disability Coverage Explained

You may think Medicare is only for people age 65 and older, but people with certain disabilities may qualify for coverage as well. These disabilities include kidney failure (end-stage renal disease or ESRD) Lou Gehrig’s disease (amyotrophic lateral sclerosis or ALS), and other disabilities. There are specific rules set in place for ESRD and ALS Medicare coverage, but here’s what you need to know about other Medicare disability benefits. 

Qualifying

You will qualify for Medicare coverage if you have been receiving Social Security Disability Insurance (SSDI) or the Railroad Retirement Board (RRB) for 24 months. As long as you have been receiving disability benefits for 24 months, Medicare should not deny you coverage for having a specific or chronic condition that will not improve over time. 

If you believe you qualify for disability benefits, you may need a letter from your doctor stating such, and present your case to a Social Security caseworker. They will help you file for disability benefits and navigate the system should you qualify. 

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Enrollment

After you’ve collected disability benefits for 25 months, you will automatically be enrolled in Medicare Part A and Part B. You won’t have to do anything to make this happen–no phone calls, paperwork, or visits to your local Social Security office. 

Your Medicare card will arrive in the mail before your 25th month of receiving disability. You will also receive a letter explaining how your benefits work and that your enrollment was automatic. 

If you have a medical plan through your work or your spouse’s work, you have the option of declining Part B benefits. However, your coverage may be better with Medicare, so call your employer-based plan and inquire about how your benefits compare to Medicare disability benefits. 

Additionally, you may incur a late enrollment penalty if you delay Part B coverage and later decide to enroll. 

Enrolling in Medicare Advantage and Part D 

You may also elect to enroll in a private Medicare Advantage or Part D prescription drug plan during this time. The enrollment period will be similar to the initial enrollment period for those who age into the system. This enrollment period is the three months before, the month of, and three months following the 25th month in which you receive disability benefits. 

Coverage

Medicare disability coverage works the exact same way as it does for those who age into Medicare. 

If you need medical treatment that will not necessarily improve your condition but maintain it or delay it from worsening, your doctor can order it and Medicare should cover it. 

Going back to work 

Getting the itch to return to work? You can go back to work and keep your Medicare coverage as long as you’re considered medically disabled. 

If you have not accumulated enough work credit (40 quarters or about 10 years) to qualify for premium-free Part A coverage, you may have to pay for it. However, you won’t have to pay for it until you’ve been back at work for 8.5 years. Your premium from that point depends on how many work credits you have. 

If you have at least 30 quarters, your premium will be $240 in 2019. If you have fewer than 30 quarters, you will need to pay the full premium of $437 in 2019. 

If you cannot afford the Part A premium, you may qualify for a Medicare Savings Program to cover or offset the cost. 

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