Approximately 54 million people in the United States have a disability. As it pertains to health insurance, insurers consider a person disabled when they cannot perform job duties due to an illness or injury. Also, people who struggle with a disability often struggle to get the medical coverage they need. Medicare covers a wide range of issues, but does Medicare cover disability insurance?
This article will focus on Medicare services and whether or not it covers disability insurance. It will also offer specifics about who Medicare can help (those that have Lou Gehrig’s disease, end-stage renal disease, or are over 65) as well as social security disability insurance.
For people with disabilities, finding affordable health plan coverage that meets all of their needs can be challenging. If you are seeking assistance enrolling in Medicare coverage, finding a qualified insurance agent can be a big help. Health Plans of North Carolina can help. Explore our options today.
What is Medicare, and Does It Cover People with Disabilities
Medicare is a form of federal health insurance designed to help people with disabilities, end-stage renal disease, Lou Gehrig’s disease, and those over 65. It was established in 1965 specifically for people over 65, eventually adding other conditions in 1973.
Social Security Disability Insurance, also known as SSDI, is another form of federal insurance that specifically supports people with disabilities and certain family members.
Additionally, those that enroll in Medicare with Social Security Disability Insurance can enjoy affordable, cost-effective health plan coverage with minimal monthly premiums. People with disabilities are eligible for Medicare no matter how old they are.
People under age 65 become eligible for Medicare if they have received Social Security Disability Insurance payments for 24 months. Also, people under age 65 who are diagnosed with end-stage renal disease (ESRD) or amyotrophic lateral sclerosis (ALS) automatically qualify for Medicare. Plus, they qualify upon diagnosis without a waiting period. Of those who were receiving Social Security Disability Insurance in 2014, 34% qualified due to mental disorders. Moreover, 28% qualified due to diseases of the musculoskeletal system and connective tissue. Lastly, 4% qualified due to injuries, 3% due to cancer, and 30% due to other diseases and conditions.
Qualifying for Medicare’s Coverage and Disability Benefits
If you don’t have a disability, you can enroll in Medicare Part A and B starting three months before your 65th birthday. This also applies if you do not have Lou Gehrig’s disease or end-stage renal disease. You may also potentially qualify for a special enrollment period for Part B. If your group health plan coverage ends during your initial enrollment period, you won’t qualify for a special enrollment period. In addition, Medicare and SSDI have other requirements before they can be accessed.
Social Security Disability Income (SSDI)
People with disabilities can access Medicare at any age through SSDI. After enrolling in SSDI, it takes 24 months for them to be eligible for Medicare. On the 25th month, Medicare coverage begins.
Lou Gehrig’s Disease
Those with ALS (Lou Gehrig’s disease) do not need to wait until the 25th month. They can bypass the waiting period entirely. Additionally, they are entitled to Medicare Part A as soon as they are eligible for Social Security or RRB disability cash benefits.
End-Stage Renal Disease
Those with end-stage renal disease can access Medicare Part A without paying monthly premiums. This only applies if they’re eligible or related to someone eligible (spouse or dependent child) for social security. In addition, they can access Part A if they are a part of the Railroad Retirement Board or are a government employee. They may also surpass monthly premiums if they have regular dialysis treatments or have had a kidney transplant. In all cases, they must also apply to Medicare.
Other Medical Conditions Covered By Medicare
Individuals struggling with mental illness, Parkinson’s disease, multiple sclerosis, and Alzheimer’s disease may also be eligible for SSDI as long as they meet Medicare criteria.
What are the Disability Benefits from Medicare?
Medicare benefits are the same for everyone that qualifies. Anyone eligible has access to the full range of benefits. However, monthly premiums differ depending on your particular Medicare plan. For instance, although you may be eligible for Part A without any monthly premiums, Parts B and D will require monthly payments. Monthly premiums may be deducted from your SSDI benefits. Medicare covers nursing home costs, home health plans, community-based services, physician care, and certain hospitals.
It’s important to find a Medicare plan that fits all of your needs. It can be particularly difficult to understand all the details of each plan without support. But, Health Plans of North Carolina has a team of insurance experts that can help. They can guide you through your benefits so you don’t have to figure it out by yourself.
For more information about Medicare supplement plans, check out this article.
Medicare Part A with SSDI
The purpose of Medicare Part A is to help individuals cover their inpatient hospital stays. This includes medical testing, blood transfusions, nursing care, diagnostic testing, and all hospitalization costs (room and meals).
Medicare Part B with SSDI
Part B is meant to cost outpatient services. This includes physical therapy, ambulance services, some forms of preventative care, doctor visits, mental health services, limited prescription drugs, prosthetics, and durable medical equipment.
Medicare Part C with SSDI
Medicare Part C is also known as Medicare Advantage. Advantage plans may offer slightly different benefits and costs may vary. In 2019, the average monthly premium was $29 per month according to the Kaiser Family Foundation. You may be liable for copays and deductibles as well.
Part C is a combination of parts A and B. Advantage plans, depending on the private insurance company, may include vision, fitness, dental, and prescription drug coverage.
Medicare Coverage for Working People with Disabilities
In 2012, a much larger share of beneficiaries under age 65 with disabilities than older beneficiaries had low annual incomes (Figure 1). Nearly one quarter (24%) of younger beneficiaries with disabilities had incomes less than $10,000 per year. Meanwhile, two-thirds (67%) had incomes less than $20,000 per year, compared to 13% and 39%, respectively, of older beneficiaries.
Access to care is generally good for a majority of Medicare beneficiaries overall across several standard measures. However, a larger share of younger beneficiaries with disabilities than older beneficiaries report experiencing a range of access problems. This is often due to the cost of care.
In 2013, nearly one quarter (23%) of younger beneficiaries with disabilities reported that they had a health problem they thought a doctor should see. But, they didn't see a doctor. This number is significantly higher compared to 8% of older beneficiaries. And of those not seeing a doctor, 25% of beneficiaries with disabilities cited cost as the main reason they didn't see a doctor, compared to 14% of older beneficiaries.
Also in 2013, 1 in 6 (16%) beneficiaries under age 65 with disabilities reported that they had trouble receiving health care. This is compared to only 4% of beneficiaries aged 65 or older. Among those with trouble getting care, close to half (45%) of younger beneficiaries with disabilities reported that it was because they did not have enough money. This is higher compared to 31% of older beneficiaries (Figure 6).
The good news is, those who meet required work periods and medical standards are still entitled to their Medicare coverage. While monthly premiums may be challenging for some, Medicare is much more affordable for the vast majority.
To get Medicare benefits for your disability, you must meet certain requirements. This section will inform the reader about the requirements necessary to maintain benefits for those with disabilities.
If you are confused about your Medicare coverage and need assistance navigating, Health Plans of North Carolina is here to serve. Our team of highly qualified insurance agents can take you through the process so you don’t have to figure it out alone. Explore all of our agents today.
Trial Work Period
During any rolling 5-year time period, an individual is entitled to receive Medicare and Social Security during a maximum 9-month trial work period. The requirement is they must make a certain amount of money per month (the amount depends on several factors). Or, they must work more than 80 hours of self-employment each month.
Extended Period of Eligibility (EPE)
After the trial work period, individuals can continue to receive benefits if their income meets the Substantial Gainful Activity level. To better understand Substantial Gainful Activity levels, check out this website.
Indefinite Period and Access to Medicare
As long as an individual still has a disability, they are eligible to continue Medicare coverage after the eight-and-one-half-year period. However, they would have to pay monthly premiums for both Part A and Part B.
How to Enroll in Medicare with a Disability Insurance
Understanding the world of Medicare and health insurance can be difficult for many people. Without assistance, some struggle to enroll in a comprehensive plan. Individuals with Social Security Disability Income should know that they must have SSDI for 24 months before enrolling in Medicare. On the 25th month, they will be enrolled in parts A and B automatically. If you desire Part C or D, you must speak directly with your private plan provider. Be sure to enroll during your IEP to avoid penalties. The enrollment period is 7 months long.
Do you need help navigating Medicare and other insurance plans? And are you seeking an insurance expert that can take you through the process? Get a quote from one of our qualified and experienced insurance agents today. We will help you get the plan you need!
Frequently Asked Questions
Does Medicare Part A cover disability income?
Yes, it does. Medicare Part A is premium-free for those that meet the requirements for disability.
What is the difference between Medicare and Social Security disability?
Social Security disability covers living expenses for those with disabilities. On the other hand, Medicare covers health care costs specifically.
Is Medicare taken out of Social Security disability?
Yes. Social Security will deduct the premium from your monthly benefit, especially for Medicare Part B.
What disqualifies a person from a disability?
Not following a doctor’s treatment plan or not providing the Social Security Administration with required health information may disqualify you from disability benefits.
What is the maximum Social Security disability benefit amount an insured can receive?
The maximum amount is $3,627 a month.
Can I Have Medicare That Covers My Disability?
Individuals with SSDI can enroll in a Medicare plan. After 24 months with SSDI, you are automatically enrolled in Medicare Parts A and B. Those who enroll in Medicare with Social Security Disability Insurance can enjoy affordable, cost-effective health plan coverage with minimal monthly premiums. And people with disabilities are eligible for Medicare no matter how old they are.
Health insurance can be tricky. That’s why it’s important to have an insurance professional on your side. Health Plans of North Carolina can take you through the fine print of your Medicare plan. Our trusted insurance agents are ready to assist! Let’s get started. Get a quote today.