Medicare before turning 65
When you hear the word ‘Medicare’ most people think of ‘health insurance for seniors’. While it is true that a majority of Medicare beneficiaries are over the age of 65, Medicare also covers people under age 65 in certain scenarios. In fact, roughly 17% (~8 million people) of Medicare beneficiaries are under the age of 65. We wanted to do a quick write up on the reasons why Medicare could start under age 65 and some key things to pay attention to in those cases.
In order to qualify for Medicare under age 65 individuals must meet one of several eligibility requirements.
Receiving SSDI payments for 24 months
Diagnosed with ALS (Lou Gehrigs disease)
Diagnosed ESRD (End Stage Renal Disease)
Medicare through Disability/SSDI
The most common reason why someone under age 65 would get Medicare is due to disability. In order to qualify for Medicare under disability you have to receive SSDI payments for 24 months (2 years). Your Part A and Part B would typically start the 24th month after your payments began. You do not need to do anything in order to enroll in Medicare Parts A and B. This will be done automatically based on the date your SSDI benefits started.
In some cases, SSDI claims can be backdated or retroactive. For example, say you were eligible and applied for SSDI in February but weren’t approved for benefits until December. In most cases, your benefits will actually go back to the eligibility date of February, and that would be your actual first month. So the 24 month period would be based on the Feb start date.
Medicare through ALS/Lou Gehrig's Disease
ALS “is a progressive neurodegenerative disease that affects nerve cells in the brain and the spinal cord.” For individuals diagnosed with ALS/Lou Gehrigs you become eligible for Medicare the month that your disability benefits begin. There is no 24 month waiting period in this case. However, there is a 5 month waiting period before your SSDI benefits will begin. Your Medicare would become effective in the same month that your SSDI benefits start.
Medicare through End Stage Renal Disease
ESRD “is a medical condition in which a person’s kidneys cease functioning on a permanent basis leading to the need for a regular course of long-term dialysis or a kidney transplant to maintain life.” You can qualify for Medicare if you have ESRD if you:
Have received a diagnosis of kidney failure from a medical professional
Are on dialysis or have had a kidney transplant
Are able to receive SSDI, Railroad Retirement benefits or qualify for Medicare.
Typically Medicare would start on the 4th month of dialysis if the individual is receiving dialysis treatments in a dialysis facility. In some cases Medicare coverage could start the first month you receive dialysis.
Important things to consider
If you qualify for Medicare before turning 65 it’s important to be aware of any state specific laws regarding Medicare. For example, in some states, only certain plans are available to individuals under age 65. There may also be plans available in your area that are specifically designed to work with people who are diagnosed with ESRD or certain other conditions/situations.
If you have employer coverage through a spouse or family member, then you might not even need Medicare. In most cases, employer coverage will be primary over Medicare. Since Part B has a monthly cost ($148.50 in 2021) you may better off dropping that and sticking with the employer plan.
There are many variables that go into making a decision with Medicare. In these unique situations it’s important to be aware of what you’re entitled to and when. If you would like to speak with someone about your Medicare coverage we’d love to hear from you. Visit us at www.doctorschoiceusa.com for more information. Thanks for reading!
Sources:
https://www.als.org/understanding-als/what-is-als
https://www.cms.gov/Medicare/Coordination-of-Benefits-and-Recovery/Coordination-of-Benefits-and-Recovery-Overview/End-Stage-Renal-Disease-ESRD/ESRD#:~:text=End%2DStage%20Renal%20Disease%20(ESRD)%20is%20a%20medical%20condition,kidney%20transplant%20to%20maintain%20life.
