Medicare coverage is designed to cover the medical expenses of people above 65 years. However, if you are disabled, you can enroll in a Medicare plan even before you turn 65. Remember, not all disabilities are qualified for coverage. That’s why it is crucial to know what disabilities are covered and the types of plans available for the disabled to make an informed decision.
What are the eligibility criteria for early Medicare coverage?
- Have received Social Security Disability Insurance (SSDI) benefits for at least two years -at the end of two years, you will be automatically enrolled in Medicare Parts A and B.
- Are diagnosed with Lou Gehrig’s Disease, you will be automatically enrolled when you start receiving disability benefits.
- Have end-stage renal disease (ESRD) that requires dialysis or kidney transplantation- you can receive benefits with no waiting period.
If you are below 65 years old and meet these eligibility criteria, you can enroll in a Medicare Advantage plan.
What are the types of Medicare plans available for individuals under 65 who are disabled?
Medicare Advantage Plans
- Social Security Disability Advantage plans – This combines Medicare coverage with other benefits like vision and dental coverage and prescription drugs.
- Medicare Advantage plans, either HMO (Health Maintenance Organization) plans or PPO (Preferred Provider Organization) plans, but you must pay monthly premiums, copays, annual deductibles, and coinsurance depending on the provider and plan you choose.
- Medicare Advantage Special Needs Plan covers people with specific disabling health conditions or those who are eligible for both Medicaid and Medicare.
- State’s Medicaid Program covers the medical expenses of people with limited income.
Medicare Supplement Plans
The Medigap plan helps cover your healthcare expenses that are not covered by Medicare, but it may cost more for people below 65 years and disabled. While some states mandate companies to provide at least one Medigap plan to people under 65, others offer Medigap plans only to people with end-stage kidney disease.
Besides, most states deny Medigap plans for people under 65 or premiums tend to increase every year. So, buying an Advantage plan is the best option for the disabled under 65.
Medicare Part D Coverage
Medicare Part D covers your prescription drugs, but you will need to pay premiums and copays/coinsurance. Those who are receiving SSDI benefits may qualify for extra help to pay Part D costs, based on their assets and income. Medicaid beneficiaries will automatically qualify for extra help.
Medicare Plan for Disabled Youngsters
- Children under 20 years with ESRD that require regular dialysis treatment can qualify for Medicare and one of their parents may qualify for Social Security retirement benefits.
- Children over 20 years qualify for Medicare after receiving SSDI benefits for two years.
- Children aged 19 or above who are not Medicare-eligible may qualify for Medicaid.
- Children under 18 years who are not Medicare-eligible may qualify for a state Children’s Health Insurance Program (S-CHIP), provided their family has a lower income.
With these insights, you can decide when you should sign up to make the most of Medicare benefits.
Get Best-in-Class Medicare Coverage from Medicare Advisors
At Medicare Advisors, we are committed to providing the right Medicare coverage for disabled people below 65 years, depending on their healthcare needs. Contact us today to learn more about Medicare coverage or have any questions concerning it.