Individuals with disabilities have different rules when it comes to Medicare enrollment and coverage. It’s important to know all of your options regarding Medicare prior to enrollment. That way, you don’t miss out on any additional benefits. If you have a disability, what do you need to be aware of?
Medicare Disability – Eligibility
Medicare eligibility typically begins at age 65, and individuals may have to apply to enroll in Original Medicare (Parts A and B). The Medicare eligibility age only applies if you do not have a disability. If you receive disability insurance (SSDI) from the Social Security Administration (SSA), you will be automatically enrolled in Original Medicare after receiving those benefits for 24 months, regardless of age. The first 24 months of disability benefits is considered your qualifying period for Medicare coverage.
If you have Lou Gehrig’s Disease (ALS) or end-stage renal disease (ESRD), you are eligible for Medicare benefits at any time. Other requirements or waiting periods may apply, depending on the treatments being received. Unlike other Medicare-qualifying disabilities, there is no two-year waiting period to qualify.
Medicare Disability – Enrollment
After 24 months of collecting disability insurance, you will be enrolled in Original Medicare (Parts A and B). Medicare Part A (hospital care) covers inpatient hospital and nursing home care, as well as home health care. Part B (medical care) covers medically necessary and preventative services.
Once you have enrolled in Original Medicare (Parts A and B), you have the option to enroll in a prescription drug plan (Part D) or a Medicare Advantage plan (Part C), which bundles Parts A, B and usually Part D.
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Additional Disability Options with Medicare Advantage (Medicare Part C)
Original Medicare doesn’t cover everything, such as needed benefits like dental, vision and hearing. On top of this, Original Medicare can get expensive, especially for those with a disability. You must meet your Part B deductible before Medicare will contribute 80 percent coverage. That remaining 20 percent can add up quickly.
Medicare Advantage plans, offered by private insurance companies, generally offer additional benefits with low to no premiums, copays or deductibles. There are many types of Medicare Advantage plans that offer different benefits, and those with disabilities may be able to select from a range of plans that offer additional financial assistance and cater to certain specialized healthcare needs. These subset of Medicare Advantage plans are called Special Needs Plans.
Special Needs Plans are Medicare Advantage plans designed to serve you if you have certain unique healthcare needs. Eligibility for a Special Needs Plan is determined by having a severe chronic condition, living in an institution, or being eligible for both Medicare and Medicaid (also known as being dual eligible.)
Special Needs Plans typically offer benefits, coverage, and healthcare provider access related to the condition for which the plan is designed. Chronic conditions that may make you eligible for a Special Needs Plan include:
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Autoimmune disorders
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Cancer
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Chronic heart failure
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Dementia
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End-stage liver disease
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Chronic lung disorders
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Neurological disorders
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Stroke
These plans often include prescription drug coverage, which is typical of most Medicare Advantage plans.
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Frequently Asked Questions
No. If you were automatically enrolled in Original Medicare prior to age 65, your benefits will not change. This doesn’t mean you can’t change your enrollment if you wish. You can enroll in a Medicare Advantage, Prescription Drug, or Medicare Supplement Insurance plan (underwriting may apply).
Enrollment Eligibility
Annual Enrollment Period (AEP)
Medicare Annual Enrollment Period runs each year from October 15 to December 7. What is the Annual Enrollment Period vs. Open Enrollment Period?
Initial Enrollment Period (IEP)
Your Initial Enrollment Period generally surrounds your 65th birthday but may occur if you otherwise become eligible for Medicare for the first time.
Special Enrollment Period (SEP)
You may be eligible if you experience a qualifying life event such as moving to a new zip code, losing employer coverage, or change in Medicaid status.
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