When most people think of Medicare, they think of the government-issued health insurance they can get when they turn 65. However, you can still get Medicare coverage even if you are younger. The most common qualification for Medicare is a recognized disability.
If you have a disability, you know that getting access to comprehensive, affordable health care is vital. Fortunately, Medicare makes it relatively straightforward for people with recognized disabilities and conditions to receive health care. This can apply even if they don't meet the traditional age requirement that must be met by most Medicare beneficiaries.
In this guide, we will take a closer look at how Medicare disability coverage works. We will discuss what kinds of disabilities and conditions are covered, what you need to do to apply and qualify, and considerations for how your Medicare disability coverage could change when you retire.
What Disabilities Are Covered Under Medicare?
If you are unsure whether your disability qualifies you for Medicare, you're not alone. Many people have disabilities that have been diagnosed by a medical professional and still do not meet Medicare's disability coverage requirements. Below you will find a comprehensive list of the categories of disabilities covered by Medicare.1
- Musculoskeletal disorders
- Disorder of speech or senses
- Respiratory disorders
- Cardiovascular disorders
- Digestive system disorders
- Genitourinary disorders
- Hematological disorders
- Skin disorders
- Endocrine disorders
- Congenital disorder affecting multiple systems
- Neurological disorders
- Mental disorders
- Immune system disorders
- End-Stage Renal Disease (ESRD)
- Amyotrophic Lateral Sclerosis (ALS)
The majority of these categories encompass dozens, if not hundreds, of unique conditions and disabilities. It is important to talk with your doctor to understand if and how your disability applies to Medicare's requirements. Also note that, in the majority of cases, you will qualify for Medicare disability coverage if you qualify for Social Security Disability Insurance (SSDI). However, excluding patients with ESRD and ALS, you may need to have collected 24 months of SSDI benefits before qualifying for Medicare as a disabled person.
The Social Security Administration also institutes a five-month waiting period from the time that you have been diagnosed with a disability to start receiving your SSDI benefits. This means that you may need to wait as long as 29 months (almost two and a half years) before you get your Medicare disability card in the mail. If you have still not received your card after that time period has passed, you should speak with your doctor and contact Medicare directly for further assistance.
Did You Know: Qualifying for SSDI automatically qualifies most people for Medicare disability coverage. Just remember that you will have to receive your Social Security benefits for 24 months before your Medicare insurance can kick in.
In most cases, you are automatically enrolled in Medicare Part A and B as soon as you meet the requirements through SSDI. For special cases like ESRD and ALS, the timeline is different. If you have ESRD, you will qualify for Medicare three months after starting dialysis treatment or immediately after getting a kidney transplant. If you have ALS, you will qualify for Medicare disability coverage as soon as you start collecting SSDI benefits. If you meet the necessary requirements set by Medicare but do not qualify for SSDI for some reason, you may still purchase Medicare Part A and Part B plans for yourself (you will not be automatically enrolled).
What Kind of Medicare Do You Get With Disability Coverage?
Medicare coverage is the same for those with or without disabilities. You'll be eligible for all of the following once you receive your Medicare card in the mail.
- Part A: This part of Medicare is often known as “hospital insurance.” It covers most kinds of inpatient care at a hospital, skilled nursing facility care, nursing home care, hospice care, and home health care. If you are automatically enrolled in Medicare, Part A will be a standard part of your disability coverage.
- Part B: This part of Medicare covers different kinds of outpatient and preventative care. These might include clinical tests, ambulance services, mental health care, and durable medical equipment (DME). Like Part A, Medicare Part B is part of the standard automatic enrollment package (also known as Original Medicare).
- Part C: Medicare Part C, also known as Medicare Advantage, is not a part of Original Medicare. It is a replacement for Original Medicare if you prefer to get your Medicare through a private insurer. It includes all of the same coverage as Part A and B. Plus, many Medicare Advantage plans may include Part D prescription drug coverage (see below), as well as coverage for things outside of Original Medicare, like vision or dental care.
- Part D: Original Medicare covers very little in the way of prescription drugs. For this reason, many people buy a stand-alone Part D plan. Part D helps cover a significant portion of costs associated with outpatient prescription drugs.
- Medicare Supplement: A Medicare supplement plan, also known as Medigap, helps cover a portion of the out-of-pocket costs you incur with Medicare. This can include copays, deductibles, and similar expenses. Like Part C and Part D, Medigap is not part of Original Medicare, so you will need to sign up for a plan on your own. It is important to note that a Medigap plan can only be combined with Original Medicare, not a Medicare Advantage plan (Part C).
For more information on how the different parts of Medicare work, visit our guide to Medicare and Medicaid.
How to Apply for Medicare Disability Coverage
If you have a disability and get SSDI benefits, you will likely not need to do anything to apply for Medicare disability coverage. You will simply have to wait for the 24-month period to pass after receiving your first month of SSDI benefits. At that point, you should get your Medicare card in the mail and can start using your Medicare coverage immediately.
Did You Know: If you receive SSDI benefits, and only want Original Medicare (Part A and Part B), you'll need to wait to be automatically enrolled. On the other hand, if you want Part C, Part D, or a Medigap plan, you will need to enroll during your initial enrollment period or during an annual open enrollment period.
If you have a disability and do not qualify for automatic enrollment, you will need to apply for Medicare during the annual general enrollment period (Jan. 1 through March 31). You can apply by visiting the Medicare.gov website and following the necessary steps. Typically, you will just need to answer some questions about your identity, income, and health and disability status. You can learn more about this process in our Medicare enrollment guide.
Medicare Disability Benefits for Working People
The SSA and Medicare have special rules for people who are disabled and continue to work. If you are getting SSDI benefits, you can take part in what is called a “trial work period.” This lasts for nine and a half months and allows you to return to work without losing your SSDI benefits. During this time, you can also continue to receive Medicare disability coverage. If you continue to work once the trial work period is over, you will lose your SSDI benefits. However, you will continue to receive Medicare disability coverage for an additional 93 months. This means that you can work with a disability and still get Medicare coverage for up to eight and a half years in total.2
What Happens to My Medicare Disability When I Turn 65?
When you turn 65, the type of coverage you receive will change, albeit in name only. If you are receiving SSDI, it will switch to standard retirement SSI when you turn 65. Similarly, if you are receiving Medicare disability coverage, it will switch to standard age-based Medicare when you are 65 years old.
Though this means that you can continue receiving Medicare coverage without any gaps, you will have an initial enrollment period starting three months before the month in which you turn 65 and ending three months after. During this period, you can make changes to your Medicare, like adding a Part D plan, Medigap, or even switching to a Medicare Advantage plan. If you make no changes, your Medicare coverage will continue just as it was before your 65th birthday.
What Is the Difference Between Medicare and Social Security Disability Insurance?
SSDI provides people with a secure monthly income who cannot work due to a disability. Alternatively, Medicare disability provides health insurance to people with disabilities. The two are closely related because your eligibility for Medicare disability coverage is often based on your eligibility for SSDI.
Did You Know: Medicare and Social Security are closely linked because they both help the same people, primarily retirees and disabled people. Additionally, the two entities work together to set the requirements for disability benefits and coverage.
If you are eligible for SSDI, you are almost always eligible for Medicare disability coverage as well. As previously discussed, you may need to receive 24 months of SSDI benefits before your Medicare coverage begins. Once your Medicare disability coverage starts, you will continue receiving your SSDI benefits. Both of these will be converted to retirement benefits and age-based Medicare once you turn 65.