Medicare & Disabilities

How do people under age 65 with disabilities qualify for Medicare?

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.

You automatically get Part A and Part B after you get one of these:

You automatically get Part A and Part B after you get one of these:

  • Disability benefits from Social Security for 24 months
  • Certain disability benefits from the Railroad Retirement Board for 24 months

If you automatically get Part A and Part B, you don’t need to sign up for Medicare. You’ll get your red, white, and blue Medicare card in the mail 3 months before your 25th month of disability.

If you have End Stage Renal Disease (ESRD) or amyotrophic lateral sclerosis (ALS), there are different requirements for Medicare eligibility.

  • ESRD – Generally 3 months after a course of regular dialysis begins or after a kidney transplant
  • ALS – Immediately upon collecting Social Security Disability benefits.

Enroll in Medicare Part B

Generally, you should not turn down Part B unless you are covered under your or your spouse’s employer health insurance. If you do not have job-based insurance and you turn down Part B, you may incur a premium penalty if you need to sign up for Medicare coverage in the future.

COBRA is not considered employer health coverage. If you have COBRA, you should enroll in Part B to avoid penalties.

Also, if your job-based insurance pays secondary after you become eligible for Medicare, you should consider enrolling in Medicare to have primary coverage and pay less for your care.

disabled woman receiving hug from caregiver

What Other Disabling Conditions Qualify for Medicare?

There are no illnesses or underlying conditions that disqualify people for Medicare coverage. People with chronic and other long-term conditions are entitled to coverage if the care ordered by their doctors meets Medicare criteria:

  • Alzheimer’s Disease
  • Mental Illness
  • Multiple Sclerosis
  • Parkinson’s Disease

Enrollees are entitled to an individualized assessment of whether they meet coverage criteria.

What is Covered under Medicare for People with Disabilities?

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 are available. Coverage includes certain hospital, nursing home, 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.

Medicare Options

Once you’re eligible for Medicare, you have the same options as other Medicare enrollees.

Option 1: Original Medicare + Optional Insurance

Part A & Part B & Part D + Medigap

Option 2: Part C—Medicare Advantage

Go to Your Medicare Options on the Understanding Medicare page to learn about the basics of Medicare, your Medicare options, the differences between Original Medicare and Medicare Advantage (Part C).

Optional Insurance

Based on your Medicare choice, if you chose Original Medicare, then it is recommended that you buy a Medicare Supplement (a.k.a. Medigap) plan to save you money. Original Medicare only pays 80% of your covered doctor’s bills, plus there are other deductibles that you will be responsible for paying.

The best time to buy a Medigap plan is during your 6-month Medigap Open Enrollment period that begins with your Medicare Part B effective date. During this Open Enrollment period, you will have guarantee issue rights and cannot be refused or pay more for pre-existing conditions.

Call or email SHIP for more information about the Medigap plans available to under 65 Medicare enrollees in Maryland.

Medical Assistance with the Maryland EID Program

The Employed Individuals with Disabilities (EID) Program offers Medical Assistance (Medicaid) coverage to Marylanders with disabilities who work for pay and who meet certain eligibility requirements.

The EID program provides full fee-for-service Medical Assistance coverage and wrap around services for those with other health insurance or Medicare. The EID program lets you return to work and keep your health benefits by paying a small fee.

For questions on EID program eligibility, contact SHIP.

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