What Disabilities Qualify for Medicare Under Age 65?

Medicare Eligibility Under Age 65: What Disabilities Qualify?

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If you struggle with a disability and you are under the age of 65, you may wonder about various benefits you might be able to seek. The good news is that, depending on your circumstances, there may be a variety of benefits available. One benefit that people often ask about is Medicare, and what disabilities may qualify for those services. Let’s take a closer look at the law together.

What is Medicare?

Medicare is a federal health insurance program administered by the United States Department of Health and Human Services. Because it is a federal program, it has nationwide standards for coverage and costs, and coverage will be the same for all recipients, regardless of their state of residence. Medicare is funded by the United States Treasury, and recipients typically pay a portion of the costs through monthly premiums, deductibles, and co-insurance.

Medicare recipients are typically initially enrolled in what is known as “Original Medicare,” which consists of:

  • Medicare Part A: Medicare Part A helps to cover inpatient care in hospitals and skilled nursing facilities (not custodial or long-term care). It also covers some home health care and hospice care.
  • Medicare Part B: Medicare Part B is medical insurance that helps cover doctor’s appointments, outpatient care, home health services, mental health care, some outpatient prescription drugs, and other medical equipment and services. It also covers preventative care.

Other elements of Medicare include:

  • Medicare Advantage (Previously known as Part C): This is a Medicare-approved plan often purchased from a private company that bundles Part A, Part B, and often Part D (prescription drug coverage) into one plan.
  • Medicare Part D: Medicare Part D is coverage intended to help with the cost of prescription drugs.

Sometimes recipients also choose to purchase a Medicare Supplement Insurance (Medigap) policy from a private insurance company to cover some costs that Medicare does not pay.

How is Medicare Different from Medicaid?

You have likely also heard of Medicaid, which is also a federally administered program, but which differs from Medicare in important ways. Medicaid is a program jointly administered by the federal government and the states and intended for individuals with low income and limited resources. Although the federal government has certain rules that states must follow, each state typically administers its own program. As a result, specific requirements and benefits may vary by state.

If you are under the age of 65 and you do not qualify for Medicaid because your income is too high or for any number of other reasons, you may wonder if you can receive Medicare instead. In some circumstances, that may be possible.

Exceptions to the Medicare Age Requirement

The truth is that there are not many exceptions to the Medicare age requirement, but the exceptions that do exist are important, especially for disabled individuals.

There are two common ways to receive Medicare before the age of 65. They include:

  • Receiving SSDI benefits for at least 24 months: If you are disabled and you have been approved for Social Security Disability Insurance (SSDI) benefits, you may also begin accessing Medicare services if you have been receiving your SSDI benefits for at least 24 months. Those who meet all the criteria for Social Security Disability are generally automatically enrolled in Parts A and B. Those who don’t receive SSDI benefits but instead receive SSI benefits will not automatically be enrolled in Medicare, but will likely be able to receive Medicaid benefits for their healthcare needs.
  • Having a specified disability: Although most people who are disabled and under age 65 must wait for 24 months before receiving Medicare, even if they receive SSDI benefits, there are two important exceptions to this rule. These exceptions exist for individuals who suffer from End Stage Renal Disease (ESRD) or Amyotropic Lateral Sclerosis (ALS, also known as Lou Gehrig’s Disease).

People with disabilities enrolled in Medicare will receive the same benefits as those enrolled because of age. These benefits are obviously very important and helpful for disabled individuals, especially when they are unable to work and earn income to pay for healthcare needs.

Muse Disability – Here for You

At Muse Disability, we’re passionate about helping our clients through a difficult chapter and on to a better and brighter chapter ahead. We know that struggling with a disability can feel overwhelming, and it can be hard to know how to take the first step forward. That’s why we’ll be here to provide you with the knowledge and guidance you need to move your claim forward. If you’re ready to get started, we would love to learn your story and let you know how we can help. Give us a call today. We look forward to speaking with you soon.

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