What You Should Know About Medicare Disability Coverage

25 minute read| Updated for October, 2020
Key Takeaways:
  • If you are eligible for Social Security disability benefits or Railroad Retirement Board (RRB) disability benefits, you will more than likely also be eligible for Medicare disability.
  • To qualify for Medicare disability, most people need to have been collecting Social Security disability benefits or RRB benefits for at least two years, or have been diagnosed with end-stage renal disease or Lou Gehrig’s disease.
  • If you are eligible for Medicare disability, you automatically get Part A and Part B coverage.
  • You don’t need to sign up if you automatically get Part A and Part B. You’ll get your Medicare card in the mail three months before your 25th month of disability.
  • Your monthly Part B premium will automatically be deducted from your Social Security check or railroad disability annuity check, unless you opt out based on job-based insurance.

If you have a disability and have been receiving Social Security disability benefits, you may be eligible for Medicare coverage, which is a monthly benefit that covers lost income due a person’s permanent disability.

You can apply online for Social Security disability benefits via the Social Security Administration’s website if you have been diagnosed with a permanent disability and cannot work for a period of 12 months or longer.

To be eligible, your disability must inhibit you from working your normal job, as well as prevent you from finding alternative work. It’s essential that you have worked a Social Security-eligible job and pay Social Security taxes. It is also important to note that if you decline to follow your doctor’s suggested treatment plan, you could lose your Social Security disability benefits.

You must have received Social Security disability benefits for at least 24 months or have a condition such as end-stage renal disease (ESRD) or Lou Gehrig’s disease (also known as ALS) to enroll in Medicare disability coverage.

Who is Eligible to Enroll in Medicare Disability Coverage?

Medicare disability coverage is available to certain people who have disabilities and are under the age of 65. They must have received Social Security disability benefits for at least 24 months or have a condition such as end-stage renal disease (ESRD) or Lou Gehrig’s disease (also known as ALS).

Any U.S. citizen who qualifies for Social Security Disability (SSD) is eligible to receive medicare disability benefits, even while living overseas. There may be some exceptions to this rule, which can be determined by visiting your nearest U.S. consulate or embassy abroad.

If You are Eligible, What Kind of Medicare Coverage Do You Qualify For?

If you have already been receiving Social Security disability benefits for 24 months or certain disability benefits from the Railroad Retirement Board for 24 months, you can rest easy. Knowing that you don’t need to sign up for Medicare coverage because you will be automatically enrolled in Part A and Part B.

Medicare is divided into four categories, which include Medicare Part A, Part B, Part C, and Part D. When you are automatically enrolled in Medicare, Part A automatically covers hospital bills, as well as some medical and hospice expenses. Part B covers your doctor visits and other medical supplies and services that Part A does not cover.

Your monthly Part B premium will be automatically deducted from your Social Security check or railroad disability annuity check, unless you opt out based on you or your spouse’s job-based health insurance.

Can You Turn Down Part B Coverage?

Medicare isn’t completely free for most disability recipients, but there is a lot of guidance out there about what to expect from Medicare bills. You’ll more than likely have to pay a premium, deductibles, and copays for most parts of Medicare.

Since you need to pay a premium for Part B coverage, certain people may choose to delay enrolling, or turn it down altogether. However, unless you have job-based health insurance, you should avoid refusing the coverage. This is because you may incur a premium penalty if you need to apply for Medicare coverage in the future.

Also, make sure your employer insurance is primary to Medicare. If it’s secondary due to the fact that your employer has fewer than 20 employees, you may still need Part B coverage.

Once you enroll in Medicare disability coverage, your Medicare card will arrive in the mail a few weeks before the start date of your eligibility, and your Medicare coverage will begin on the first day of the month you receive your 25th disability check.

If You Have a Disability But Want to Go Back to Work, Can Your Keep You Medicare Coverage?

Yes, you will be able to keep your Medicare coverage for as long as you’re medically disabled. You won’t have to pay your Part A premium for the first 8-and-a-half years. However, after that initial time period, you will have to pay the Part A premium.

If you’re unable to afford the Part A premium, you may qualify for the Medicare Savings Program, which is otherwise known as the Qualified Medicare Beneficiary (QMB) program. This is a state program that helps pay for Part A premiums, Part B premiums, and other costs such as deductibles, coinsurance, and more. So, if you’re worried about not being able to afford the premium, make sure to ask about this program.

Steps to Enroll in Medicare Disability Coverage

Once you enroll in Medicare disability coverage, your Medicare card will arrive in the mail a few weeks before the start date of your eligibility, and your Medicare coverage will begin on the first day of the month you receive your 25th disability check. If you have any issues with a lost or stolen Medicare card, you can request a new one through your Social Security account.

You will still have your Initial Enrollment Period (IEP), which is when you will be able to make decisions about your Medicare coverage. While the typical Open Enrollment Period for Medicare runs from October 15 to December 7, your Initial Enrollment Period lasts seven months and includes the 25th month of disability, as well as the three months before and after.