Medicare For Disabled Individuals

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Medicare is a government program primarily designed to help lower health care expenses for people age 65 and older. However, there are some provisions to help those under 65 years of age. There are certain conditions under which you can qualify for Medicare before age 65. This article will examine the basics of Medicare for disabled individuals, as well as some strategies to maximize the money-saving possibilities of this coverage.

How To Get Medicare For Disabled Individuals

Disability is one of the conditions that can qualify you for Medicare eligibility prior to age 65. It is important to understand what kinds of disability circumstances will trigger eligibility for Medicare. It requires long term disability in order to become eligible for Medicare. You must receive qualifying disability income for 24 consecutive months in order to gain Medicare eligibility. There are only two valid sources of disability income that qualify:

  • Social Security Disability, or
  • Railroad Retirement Board Disability

This means that any type of short-term disability won’t qualify you for Medicare. It also means that private disability insurance won’t qualify you, either, even if you receive payments for more than 24 months. Also keep in mind that it often takes many months or years to qualify for Social Security Disability (the most common source of disability income). This means that you may end up being disabled for more than 24 months before gaining your Medicare eligibility. On the other hand, when you are finally approved for Social Security Disability Income after a long application process, it is often granted retroactively, so while you may have to wait a long time to get approval, you may be granted retroactive credit for many months, making you eligible rather quickly.

When you’ve received qualifying disability payments for 24 consecutive months, you become eligible for Original Medicare. You don’t actually enter the program until the first day of the 25th month that you get disability income. This is when your coverage starts. It’s also the time that any private Medicare Plan you enroll in will take effect.

Part C Medicare For Disabled Individuals

There are a number of things to keep in mind when you gain Medicare eligibility due to disability. The first is that Original Medicare doesn’t cover all of your health care expenses. Instead, you are expected to pay a share of your costs. These costs, which you pay when you use Medicare-covered services, come in several forms, including:

  • Deductibles
  • Co-insurance / co-payments

There is no limit or cap on these costs, whether for the year or for your lifetime. You keep paying every time you receive a covered service or procedure. These costs can add up and cause financial distress. Fortunately, there are a couple of private options to help reduce or eliminate these costs. One of the more popular options is Medicare Supplement Insurance. Unfortunately, most people are not eligible for Medicare Supplement Insurance until they turn 65. There are a few states that allow you to get this coverage before age 65. However, it tends to be extremely expensive and few people under 65 enroll in Medicare Supplement Insurance.

The other option to protect against high out of pocket expenses is Medicare Advantage. This program, which is also known as Part C of Medicare, allows you to receive all of your Part A and B coverage through a private insurance company. There are many benefits to doing this, but one of the biggest is that Medicare Advantage plans have a hard Out of Pocket Maximum (OOPM) cap on your yearly costs. This spending limit can bring great peace of mind, since you know you’re no longer exposed to unlimited health care expenses.

The second fact you need to know about Medicare for disabled individuals is that everyone who is eligible for Medicare must have Part D prescription drug coverage. If you don’t enroll in Part D when you’re first eligible, you’ll have to pay a late enrollment penalty whenever you do enroll.

You can get qualifying Part D coverage in one of two ways:

  • Standalone Medicare Prescription Drug Plans (PDP)
  • Medicare Advantage Prescription Drug Plans (MAPD)

Since you probably can’t or won’t get Medicare Supplement Insurance, this means that Medicare Advantage plans are the most efficient way to lower your out of pocket spending and get qualifying Part D drug coverage. This will prevent you from having to pay a penalty for late enrollment in a drug plan.

Nurse talking with disabled senior woman about her medicare options
Since you probably can’t or won’t get Medicare Supplement Insurance, this means that Medicare Advantage plans are the most efficient way to lower your out of pocket.

How Medicare Advantage Plans Work

Part C plans put caps on your health care costs by offering fixed co-payments for services and procedures. This makes Medicare Advantage work like most private health insurance you’re accustomed to. Besides offering fixed co-payments for most services, and providing a hard out of pocket spending cap, Medicare Advantage plans also come with extra benefits beyond what Original Medicare provides. These extra benefits are a popular feature, and can include:

  • Routine vision coverage
  • Hearing coverage
  • Dental coverage
  • Transportation benefits

These extra benefits can help pay for necessary items that aren’t covered by Original Medicare.

Medicare Advantage And Medicaid – Better Together

When you’re disabled to the extent that you qualify for Medicare early, your income is often very limited. This means that you might qualify for Medicaid. This is especially true if you are single, or if your disability payments are the sole source of your household income. If you think that you have any chance of qualifying for Medicaid, you should definitely apply through your State. If you qualify for full Medicaid benefits, you become eligible for some significant cost savings.

When you’re eligible for both programs you’re known as “dual-eligible.” There are special Medicare Advantage plans known as Dual Special Needs Plans (D-SNP) that are designed to provide maximum coverage for dual eligible people. Some of the great benefits of these plans include:

  • Extremely low prescription drug costs
  • Zero out of pocket costs for medical services
  • Help paying for your Part B premium (not a plan benefit, but a benefit of being eligible for full Medicaid benefits)

In addition, Dual Special Needs Medicare Advantage plans tend to come with even richer “extra benefits.” This usually takes the form of more money available to pay for dental expenses, routine eyewear, and hearing aids. Besides these, D-SNPs frequently come with monthly allowances to purchase healthy and fresh foods. In short, it is worth the time and effort to apply for Medicaid; it can really help you lower costs, which is critical when you’re on a fixed disability income.

If you’re disabled and on Medicare, or will be on it soon, now is the time to plan. If you’ll be younger than 65 when you gain Medicare eligibility, you’ll want to find a Medicare Advantage plan that will work with your doctors and cover your medications. You’ll also want to see if you’re eligible for Medicaid. If you’d like some help navigating these waters, reach out to a licensed health insurance agent. A licensed agent can help you find a plan that fits your needs, and you never have to pay an agent for their help. Request a free, no obligation consultation today to see what plans are available in your area.

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Justin Brock

President & CEO of Bobby Brock Insurance