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What Disabilities Qualify for Medicare Under 65?

When most people think of Medicare, they think about health insurance for American seniors. While Medicare was primarily created to serve kupuna, people with disabilities under the age of 65 may also qualify. In fact, there are more than 8 million people with disabilities under the age of 65 who are enrolled in Medicare. Disabled Medicare beneficiaries who are under the age of 65 are entitled to the same health insurance benefits as seniors who are enrolled in the program. Just like Medicare for those over 65, the benefits apply only to the individual and not to their family.

Who qualifies for Medicare under 65?

In order to qualify for Medicare as a person under the age of 65, you must first apply for Social Security disability benefits. The Social Security Administration will then determine if you meet the criteria for disability. In order to qualify, the individual must have a diagnosis of an illness or condition that is expected to last at least 12 months that will make it impossible to earn a certain amount of income each month.

Once approved for social security disability how long does a person wait for Medicare?

After completing all the required steps and meeting approval for disability status, Social Security Disability Insurance (SSDI) payments will begin in five months. There is typically a two-year waiting period from the first SSDI payment before Medicare benefits kicks in.

There are a few exceptions to the two-year waiting period:

  • For those who are diagnosed with ESRD or ALS, Medicare coverage starts as soon as they begin receiving SSDI payments.

  • If your initial application for disability is rejected but you qualify following an appeal, the 24- month waiting period is backdated to the first month you would have received SSDI.

  • If you receive SSDI for a few months and lose eligibility but then regain eligibility a few months or years later, all the months and years you should have been collecting SSDI are added together and count toward the 24-month waiting period.

What disabilities qualify for Medicare under 65?

The following is a list of disabilities that qualify a person for Medicare under the age of 65:

  • Amyotrophic lateral sclerosis (ALS)

  • Cystic fibrosis

  • Heart disease

  • Mental illness

  • Multiple sclerosis

  • Parkinson’s disease

  • Permanent kidney failure (also known as end-stage renal disease (ESRD))

What does Medicare cost for disabled people under 65?

While the cost of Original Medicare (Parts A and B) is the same for both seniors and disabled people under the age of 65, there are big price differences in the cost of Medicare Supplement (Medigap) policies. Insurers are not required to offer Medigap policies to people under the age of 65 and they typically charge a lot more for these plans for disabled people under the age of 65.

Speak to a qualified local Medicare agent to discuss your Medicare and Medicare supplement options.

Medicare Advantage for disabled under 65

Medicare Advantage plans (Part C) are available to disabled Medicare beneficiaries under 65. Medicare Part C may be a great option for people with disabilities because there are Special Needs Plans (SNPs) that cater to specific disabilities. In general, Medicare Advantage plans also cover a wider range of services than Original Medicare such as dental care and prescription drug benefits; making them a “one-stop” option. Those who choose Original Medicare will need to purchase a separate Part D plan to get prescription drug benefits and many also sign up for a Medicare supplement plan to help cover out-of-pocket expenses.

Perhaps most importantly, Medicare Advantage plans come with an annual out-of-pocket maximum, protecting beneficiaries from limitless costs. This is important because Medicare comes with coinsurance, copays, and deductibles that can add up quickly for someone dealing with a chronic health condition.

Our independent insurance agents are dedicated to assisting people on Medicare and those who are ready to transition from employer coverage to personal retirement coverage. We help kupuna understand their benefits options and apply for additional coverage, as needed. Because we represent all the major Medicare Advantage and supplement plans in Hawaii, we are able to offer unbiased advice; all at no cost to our clients.

At PBC, our clients are our number one priority and we look forward to getting to know you and your needs. Call us today at (808) 738-4500 to see how we may be of assistance.

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