Medicare Disability

How do I become eligible for Medicare if I am under age 65 and disabled?

Before you can receive Medicare you must apply, be approved and have received Social Security Disability Insurance (SSDI) for a period of time. You can apply for disability benefits at your local Social Security office, apply online at www.socialsecurity.gov or call toll free 1-800-772-1213 or 1-800-325-0778 (TTY) to make an appointment to file an application.

When will my Medicare begin?

In most situations you can receive Medicare disability benefits once you receive Social Security disability income (SSDI) benefits for 24 months. Medicare disability coverage begins the 25th month. The 24-month period begins the month you are entitled to receive Social Security disability benefits. In some cases this could be earlier than the month you receive your first disability benefit check. A person who has ALS (Lou Gehrig’s Disease) and is under age 65 can get Medicare benefits the first month he or she is entitled to SSDI or railroad retirement disability benefits. If you have ESRD (End Stage Renal Disease), you are eligible for Medicare benefits:

  •  the first month you start to administer a regular course of dialysis treatment after receiving selfcare training, or
  •  the fourth month you receive treatment at a dialysis center (period of non-coverage is called qualifying or waiting period), or
  • the month the transplant is done or the month of hospitalization as an inpatient up to two months before the transplant, if pre-transplant testing has begun.

How do I enroll in Medicare

Automatic Enrollment Period

A person receiving SSDI for the required time period is automatically enrolled in Medicare Part A (hospital insurance) and Medicare Part B (medical insurance). Beneficiaries should receive a Medicare card in the mail a few months before they become eligible. This will notify beneficiaries of their automatic enrollment in Medicare Part A and Medicare Part B. If you do not receive this card, you should contact the Social Security office as you approach Medicare eligibility. Medicare Part A is usually premium-free for everyone. If you have worked fewer than 40 quarters, the premium is based on the number of quarters worked. For Medicare Part B there is a monthly premium which is usually deducted from your Social Security check. The monthly Part B premium can change annually. A person has the option to turn down Medicare Part B. If you are a beneficiary or your spouse is actively working for an employer that is providing an employer group health plan (EGHP), you may be able to continue the EGHP coverage if you or your spouse’s employer has 100 or more employees. In this situation you will be able to delay enrollment in Medicare Part B. If you are going to delay your enrollment in Medicare Part B, you should meet with a Social Security representative or call 1-800-772-1213 or 1-800-325-0778 (TTY).

Special Enrollment

If you are an individual on Medicare disability who is younger than 65 and is covered under an EGHP either from your own or your spouse’s current employment, you have a “special enrollment period” in which to sign up for Medicare Part B. This means that you may delay enrolling in Medicare Part B without having to wait for a general enrollment period or pay the 10 percent penalty for late enrollment. The rules allow you to:

  • enroll in Medicare Part B any time while you are covered under the employer group health plan; or
  • enroll in Medicare Part B during the eight-month period that begins the first full month after your employment or employer group health plan coverage ends, whichever comes first.

If you do not enroll by the end of the eight-month period, you will have to wait until the next general enrollment period, which runs January 1 throu-h March 31. You will also have to pay a 10 percent penalty for each year you were not enrolled from the original point of Part B eligibility. To ensure there is no break in coverage, the best time to contact the Social Security office is at least two months before the final month of employment.-

For more details and further information, please see the SHIIP publication Health Insurance Options for People on Medicare Due to Disability or give SHIIP at call at 1-855-408-1212 Monday through Friday from 8am to 5pm.