Medicare is for 3 different populations: people 65 and older, younger people with disabilities, and younger people with End-Stage Renal Disease. Today, we’ll focus on people with disabilities. If you think you’re eligible for Medicare due to a disability, read on.
Disability Medicare Eligibility
Medicare for people with disabilities is based on Social Security. To be considered eligible for Medicare as someone with a disability, you have to have been eligible for Social Security disability for 24 months. These months don’t need to be consecutive. You then apply for Medicare through the Social Security Administration. To be considered eligible for Medicare as a person with a disability, you must specifically meet the following criteria:
- You must be a U.S. citizen or permanent legal resident who has lived in the U.S. for at least 5 years.
- You must have been entitled to Social Security Benefits for at least 24 months (not necessarily consecutively); or
- You receive a disability pension from the railroad retirement board and meet certain conditions; or
- You have Amyotrophic Lateral Sclerosis/Lou Gehrig’s disease.
If you meet these criteria and are interested in applying for Medicare, take a look at our resources section and apply through Social Security.
Coverage Options Under Medicare
Medicare has different coverage options: Original Medicare and Medicare Advantage Plans. If you are eligible for Medicare because of your disability, you are automatically eligible for Original Medicare. Original Medicare is composed of two main parts: Part A and B. Part A covers inpatient hospital stays while Part B focuses on outpatient and preventive visits. There is also Part D, an optional portion to add prescription drug coverage. While Original Medicare is comprehensive, there is a special type of Medicare Advantage Plan that offers additional benefits to people who have chronic conditions. Some of these chronic conditions may overlap with your disability. These plans are called Special Needs Plans.
There are three different types of SNPs: plans for people who are institutionalized, plans for people eligible for both Medicaid and Medicare, and plans for people who have severe or disabling chronic conditions. The plan most relevant to people with disabilities is called a C-SNP. Only certain chronic conditions qualify for a C-SNP. Typically, conditions that qualify are severe or medically complex. There are 15 conditions/categories. Take a look to see if your disability may fall under one of the following categories:
- Chronic Alcohol or Drug Dependence
- Autoimmune Disorders limited to: Polyarteritis nodosa, Polymyalgia rheumatica, Polymyositis,
- Rheumatoid arthritis, and Systemic lupus erythematosus
- Cancer, excluding pre-cancer conditions or in-situ status
- Cardiovascular disorders limited to: Cardiac arrhythmias, Coronary artery disease, Peripheral vascular disease, Chronic venous thromboembolic disorder
- Chronic Heart Failure
- Diabetes Mellitus
- End-Stage Liver Disease
- End-Stage Renal Disease requiring dialysis
- Severe hematologic disorders limited to: Aplastic anemia, Hemophilia, Immune thrombocytopenic
- purpura, Myelodysplastic syndrome, Sickle-cell disease (excluding sickle-cell trait)
- Chronic Lung Disorders limited to: asthma, chronic bronchitis, emphysema, pulmonary fibrosis, pulmonary hypertension
- Chronic and disabling mental health conditions limited to: Bipolar disorders, Major depressive disorders, Paranoid disorder, Schizophrenia, Schizoaffective disorder
- Neurologic Disorders limited to: Amyotrophic lateral sclerosis (ALS), Epilepsy, Extensive paralysis
- (i.e., hemiplegia, quadriplegia, paraplegia, monoplegia), Huntington’s disease,
- Multiple sclerosis, Parkinson’s disease, Polyneuropathy, Spinal stenosis, Stroke-related neurologic deficit
If you are eligible for Medicare due to your disability and your disability is related to one of the above conditions, you may also be eligible for a C-SNP. These plans are beneficial because they can often target the specific benefit needs of each person with a different chronic condition.
Things to keep in mind
There are a number of things to keep in mind that are unique to people with disabilities.
People with disabilities can have a difficult time finding the best plans for them. Insurance companies consider them to be in a higher risk category than the average patient. This higher risk categorization can limit your choices for certain Medicare options differ depending on your area.
Finding a qualified agent
Because it’s hard to find a good plan, it’s important to have the best agents who are familiar with Disability Medicare specifically. Not all Medicare agents specialize in disability insurance. We’ve made a website, MedicareDisabilityHelp.com, to help you find qualified Medicare Disability agents.
If you’re turning 65
If you go on Medicare disability in your early 60s, keep in mind that you will have more options open to you shortly at 65. Expect your out-of-pocket expenses to decrease and your options to increase. Make sure to talk to your agent at that time to take a look at your new options.
We’ve compiled a list of resources available to you on Medicare Disability. Feel free to use our resources to help you better understand Medicare.
Medicare is already a confusing topic. Adding disability under Medicare can be even more confusing depending on your eligibility status. Not every Medicare insurance agent specializes in Disability Medicare. While we at Medicare On Video don’t specialize in disability insurance, we’ve compiled a list of resources and a website to help you find people who do. Don’t hesitate to reach out to us at Medicare On Video with questions and concerns today.