Medicare Coverage for the Disabled

Medicare is available to some people under age 65 with disabilities. To qualify, you must receive disability benefits from Social Security for 24 months or have end-stage renal disease (ESRD) or amyotrophic lateral sclerosis (ALS).

Medicare Eligibility If You Have a Disability

In some cases, people under age 65 with a disability can qualify for Medicare.

To qualify for Medicare before the age of 65, you must meet one of the following criteria:
  • You’ve received Social Security Disability Insurance for at least 24 months.
  • You have end-stage renal disease (ESRD)
  • You have amyotrophic lateral sclerosis (ALS).

After you receive disability benefits from Social Security for 24 months, you are automatically enrolled in Original Medicare (Part A and Part B).

You may also choose to receive your Medicare coverage through a Medicare Advantage (Part C) plan or purchase a stand-alone prescription drug Part D plan.

If you decide to return to work later, you can keep your Medicare coverage for at least 8.5 years.

As long as you still meet Social Security Administration disability standards, you can continue receiving Medicare Part A hospital insurance premium-free.

Medicare Part B medical insurance coverage will also continue after you return to work, though you will owe a monthly premium.

Applying for Disability Benefits

To qualify for Medicare disability coverage, you must first apply for Social Security Disability Insurance (SSDI).

This lengthy process can take several months to complete.

In order to qualify for Social Security disability, you must prove you are unable to work because of a medical condition that is expected to last at least a year or result in death.

It can take three to six months for the Social Security Administration to approve your disability application.

As part of your application process, you will need to provide extensive information, including:
  • Your name and Social Security number
  • Information about your minor children and/or spouse
  • Details about your medical illnesses or injuries
  • Names of medicines you take and who prescribed them
  • How much money you earned in the last two years
  • The names and addresses of previous employers
  • Information about any workers' compensation or similar benefits you filed

If approved, you will need to undergo a five-month waiting period before your SSDI benefits begin.

Medicare Coverage for Lou Gehrig’s Disease (ALS)

Amyotrophic lateral sclerosis, also known as Lou Gehrig’s Disease, is a progressive illness that affects nerve cells in the brain and spinal cord, resulting in the loss of muscle control.

There is no known cure for ALS.

If a neurologist has diagnosed you with ALS, you should qualify for Social Security disability benefits.

Unlike other disabilities, you do not need to wait 24 months to qualify for Medicare.

Instead, you are immediately eligible for Original Medicare as soon as you become entitled to Social Security Disability Insurance.

Does Medicare Cover End-Stage Renal Disease?

Kidney failure, also called end-stage renal disease (ESRD), is the most advanced stage of chronic kidney disease.

People with ESRD need dialysis or a kidney transplant to stay alive. If you have ESRD, you can enroll in Medicare without a two-year waiting period, regardless of your age.

However, you must manually sign up for this coverage. You are not automatically enrolled.

You can enroll in Medicare Part A and Part B by visiting your local Social Security office or by contacting the Social Security Administration.

If you have ESRD, you usually receive your health care through Original Medicare. You can only join a Medicare Advantage plan under specific situations.

Coverage for ESRD works differently than other types of Medicare eligibility.

FAQs

What Medicare benefits are available for people with disabilities?
Original Medicare offers many benefits. It covers some or all costs for various services, including skilled nursing care, doctor visits, hospital stays, home health care and hospice.
How long can I keep Medicare if I go back to work?
If you go back to work but still have a disabling condition recognized by Social Security, you can keep your Medicare coverage for at least 8.5 years after rejoining the workforce. Your Medicare Part A coverage will remain premium-free. Your Part B coverage will also continue, but you will be responsible for paying your Part B premium if your SSDI cash benefits stop due to returning to work.
Can I enroll in Medigap if I am under 65 and have a disability?
It depends on what state you live in. People age 65 and older can buy a supplemental insurance policy, also known as Medigap, when they sign up for Medicare. However, the same right may not apply to young beneficiaries with disabilities, according to the Kaiser Family Foundation.
Last Modified: July 24, 2020

8 Cited Research Articles

  1. Boccuti,C. et al. (2018, July 11). Medigap Enrollment and Consumer Protections Vary Across States. Retrieved from https://www.kff.org/medicare/issue-brief/medigap-enrollment-and-consumer-protections-vary-across-states/
  2. Neuman, T. and Cubanski, J. (2016, September 27). The Gap in Medigap. Retrieved from https://www.kff.org/medicare/perspective/the-gap-in-medigap/
  3. ALS Association. (n.d.). Medicare Information. Retrieved from http://www.alsa.org/als-care/resources/medicare-information.html
  4. Medicare.gov. (n.d.). Getting Medicare if you have a disability. Retrieved from https://www.medicare.gov/getting-medicare-if-you-have-a-disability
  5. Medicare.gov. (n.d.). How do I get Parts A and B? Retrieved from https://www.medicare.gov/sign-up-change-plans/how-do-i-get-parts-a-b
  6. Medicare.gov. (n.d.). I have End-Stage Renal Disease (ESRD). Retrieved from https://www.medicare.gov/manage-your-health/i-have-end-stage-renal-disease-esrd
  7. Medicare.gov (n.d.). What if I have End-Stage Renal Disease (ESRD)? Retrieved from https://www.medicare.gov/sign-up-change-plans/types-of-medicare-health-plans/medicare-advantage-plans/what-if-i-have-end-stage-renal-disease-esrd
  8. Social Security Administration. (n.d.). Medicare Information. Retrieved from https://www.ssa.gov/disabilityresearch/wi/medicare.htm