Medicare Coverage If You’re Disabled
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If you qualify for Social Security disability benefits (a monthly benefit to help replace lost wages that result from your permanent disability), you may also qualify for Medicare to cover your medical expenses.
To be eligible to enroll in Medicare, most people need to have been collecting Social Security disability for a period of two years, but this two-year waiting period doesn’t apply to everyone.
Qualifying for Social Security Disability and Medicare benefit
If you’ve been diagnosed with a condition that’s left you permanently disabled — meaning you cannot work for a period of 12 months or longer — you can apply for Social Security disability through the Social Security Administration at www.ssa.gov. You must have worked a Social Security-qualified job and paid Social Security taxes to be eligible.
In addition, your medical condition must prevent you from performing your normal job function, and you must have been unable to find a suitable replacement position or new line of work because of your age, education levels, or physical limitations. If you do not continue to follow your doctor’s recommended treatment plan to improve your condition, you may be disqualified from Social Security disability benefits.
Usually, you must collect Social Security disability benefits for at least 24 months to enroll in Medicare. Some people may enroll right away. Here’s when and how to enroll based on various disability situations.
If you’re diagnosed with Lou Gehrig’s disease
If you have amyotrophic lateral sclerosis (ALS or Lou Gehrig’s disease), you will automatically be enrolled in Medicare Part A (hospital insurance) in the first month that you begin receiving Social Security disability benefits. You will automatically be enrolled in Medicare Part B (medical insurance) if you live within the 50 United States or District of Columbia. You will have the option to refuse the automatic enrollment in Medicare Part B if you already have medical insurance. If you need prescription drug insurance, you will have to enroll in a Medicare Part D prescription drug plan separately.
If you’ve been collecting Social Security Disability benefits for 24 months
You will be automatically enrolled in Medicare Parts A and B at the beginning of the 25th month after you first received your Social Security disability benefits. Exceptions include those who do not live in any of the 50 United States or the District of Columbia or if you have end-stage renal disease (ESRD).
You can apply separately for a Medicare prescription drug plan (Medicare Part D) through a private insurance carrier if you want prescription drug insurance. Enroll in a Medicare prescription drug plan as early as three months before the 25th month of your Social Security disability benefits.
To enroll in a Medicare Prescription Drug Plan, you can:
- Use the eHealth plan comparison tools on this page.
- Use the Medicare Plan Finder at Medicare.gov.
- Enroll directly with a plan online, by phone, or by mail.
- Call 1-800-MEDICARE (1-800-633-4227), TTY users 1-877-486-2048, 24 hours a day, seven days a week.
If you have end stage renal disease (ESRD)
If you have ESRD (also known as kidney failure) you must enroll in all parts of Medicare manually. To do so, log on to www.socialsecurity.gov/medicareonly or call 1-800-772-1213 (TTY users 1-800-0778), Monday through Friday, from 7AM to 7PM. You can also visit your local Social Security office to enroll in Medicare Part A and Part B. See above for how to apply a Medicare prescription drug plan.
If you live outside the 50 United States and District of Columbia
If you do not live within the 50 United States or Washington D.C., but you do live in a U.S. territory (such as Puerto Rico), any qualified automatic enrollment will be limited to Medicare Part A (hospital insurance). You will otherwise have to enroll yourself when you become eligible. Enrollment in Medicare Part B and a Medicare prescription drug plan is always separate.
You can enroll:
- Online at www.socialsecurity.gov/medicareonly/.
- By phone at 1-800-772-1213 (TTY users 1-800-0778), Monday through Friday, from 7AM to 7PM
- In person at your local Social Security office.
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