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Medicare Coverage For Disabled Under 65

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April 30, 2022

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ALS and ESRD Exceptions If you're younger than 65 and have amyotrophic lateral sclerosis (ALS or Lou Gehrig's disease), you'll automatically get Medicare Part A and Part B the month your disability benefits begin. The Medicare program that Americans know and cherish has been allowed to wither. Traditional Medicare, preferred by most beneficiaries, has not been improved in years, yet private Medicare Advantage plans have been repeatedly bolstered.

After those 30 months, if you still have coverage under your group health plan, it will become secondary coverage and Medicare will become primary. Here at Century Medicare, we go over everything for Medicare coverage for the disabled under 65.

Medicare Coverage for Working People with Disabilities

Medicare eligibility for working people with disabilities falls into three distinct time frames.  The first is the trial work period, which extends for 9 months after a disabled individual obtains a job.  The second is the seven-and-three-quarter years (93 months) after the end of the trial work period. 

Finally, there is an indefinite period following those 93 months. Keep in mind that Medicare eligibility during each of these periods applies only while the individual continues to meet the medical standard for being considered disabled under Social Security rules.

People under age 65 become eligible for Medicare if they have received SSDI payments for 24 months. Because people are required to wait five months before receiving disability benefits, SSDI recipients must wait a total of 29 months before their Medicare coverage begins.

People under age 65 who are diagnosed with end-stage renal disease (ESRD) or amyotrophic lateral sclerosis (ALS) automatically qualify for Medicare upon diagnosis without a waiting period.

Medicare beneficiaries under age 65 with disabilities differ from beneficiaries age 65 or older in several ways, including their demographic, socioeconomic, and health status profiles.

Of those who were receiving SSDI in 2014, 34% qualified due to mental disorders, 28% due to diseases of the musculoskeletal system and connective tissue, 4% due to injuries, 3% due to cancer, and 30% due to other diseases and conditions.

What Medicare Benefits are Available for People with Disabilities?

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Medicare coverage is the same for people who qualify based on disability as for those who qualify based on age. For those who are eligible, the full range of Medicare benefits is available. Coverage includes certain hospitals, nursing homes, home health, physician, and community-based services.  The health care services do not have to be related to the individual’s disability in order to be covered.

People under age 65 become eligible for Medicare if they have received SSDI payments for 24 months. Because people are required to wait five months before receiving disability benefits, SSDI recipients must wait a total of 29 months before their Medicare coverage begins. Medicare coverage becomes effective 24 months after you start receiving Social Security disability insurance (SSDI) payments.

Specifically, the law expanded access to health insurance coverage through the expansion of Medicaid or Marketplace plans People who meet the standards but do not qualify for Social Security benefits, can purchase Medicare by paying a monthly Part A premium, in addition to the monthly Part B premium.

How do Medicare Advantage Plans work?

A Medicare Advantage is another way to get your Medicare Part A and Part B coverage. Medicare Advantage Plans, sometimes called "Part C" or "MA Plans," are offered by Medicare-approved private companies that must follow rules set by Medicare.

If you join a Medicare Advantage Plan, you'll still have Medicare but you'll get most of your Part A and Part B coverage from your Medicare Advantage Plan, not Original Medicare.

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What Are the Centers for Medicaid Services (CMS)?

The Centers for Medicare & Medicaid Services (CMS) is the agency within the U.S. Department of Health and Human Services (HHS) that administers the nation’s major healthcare programs. The CMS oversees programs including Medicare, Medicaid, the Children's Health Insurance Program (CHIP), and the state and federal health insurance marketplaces. CMS collects and analyzes data, produces research reports, and works to eliminate instances of fraud and abuse within the healthcare system. 

These individuals must have received Social Security Disability benefits for 24 months or have End-Stage Renal Disease your package and card will come from the Social Security AdministrationThis will help when you have your interview with a Social Security representative. The interview may take place on the phone or in-person at your local Social Security office.

Long-Term Disability and SSDI

If you can establish that you have a long-term disability that prevents you from working, you may qualify for monthly Social Security Disability Insurance (SSDI) payments, which will also automatically qualify you for Medicare.

However, getting approved for SSDI can be a long process, and even after you're approved, you'll have to wait 24 months before your Medicare benefits begin You can apply for Social Security disability benefits online, over the phone, or at a local Social Security office. To be eligible, you must have worked enough hours to qualify for Social Security benefits, or be a spouse or dependent of someone who has.

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Why is Medicare Advantage a good choice for disabled Medicare beneficiaries under 65?

Medicare Advantage plans are the best choice for disabled Medicare beneficiaries under 65 because many combine cost savings with convenience, allowing those who are disabled to bypass certain costs while making it possible for them to enroll in plans tailored to their needs.

Medicare Advantage plans, also known as Medicare Part C plans, function as "all-in-one" alternatives to Original Medicare, encompassing Medicare Part A, Part B, and usually Part D prescription drug coverage. The plans eliminate the need to purchase Part D and supplemental plans separately, which is done with Original Medicare.

Drawbacks of Medicare Advantage

Medicare Advantage plans have some advantages over original Medicare. Most annual expenditures for Medicare Advantage are related to the use of health services. This is difficult to plan the costs of health insurance. People with disabilities often need more services than their undisabled relatives, which means they pay a lot more in medical insurance premiums than in co-pays. Before signing up for Medicare Advantage, it is important to review its Summary Of Benefits, a document detailing medical expenses such as hospital and other medical services.

Keeping Medicare benefits after going back to work

In some circumstances, disabled persons are able to retain Medicare benefits even after they have lost their SSDI status. Tell me about the case if you lose an SSDI payment after you've returned from employment. You can still receive Medicare coverage within eight years. If you have other conditions that affect your Medicare benefits. If an employer provides coverage, it is necessary to obtain it. In this situation, the employer's insurance becomes primary and Medicare is primary.

Medicare costs

The costs associated with Medicare Part A - B are similar for seniors and those who can't reach age 65. The costs associated with Medicare Supplementary are hugely different. Medigap plans are significantly more expensive for disabled Medicare patients younger than seniors in Medicare.

Social Security Disability Trial Work Period (TWP)

During the trial work period, you will be assessed for work for at least nine months but these will not be consecutive over an arbitrary period of ten years if you remain considered disabled. You may start your TWP within 1 month of filing your claim. If your monthly earnings exceed the monthly earnings requirement then the workday will count towards the test period for your job. The annual earnings limit of $960 is expected in 2021, and this number is growing each year.

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