This post is about How to Get Medicare
This post is about how to get medicare when you have a disability, and covers hiccups that you might expect when applying, and how to resolve them. This post was written by Kathleen Downes who knows an awful lot about this subject, but you should do your due diligence and follow her links to the official sites
This post covers some questions people tend to ask about Medicare, and common problems and pitfalls.
The subsections are linked below, so you can jump to the relevant
How to Get Medicare If You Are Disabled
Medicare with Social Security Disability Insurance (SSDI) Under Age 65
How do people with disabilities get (SSDI)?
In this context, we mean people who are “disabled” by the Social Security definition for Social Security Disability Insurance benefits or SSDI. You can be medically disabled, but not meet the government criteria of disability.
To get SSDI, your disability has to prevent you from working in what the government counts as a substantial way. In 2021, that means you didn’t earn more than an average of $1310 monthly for the year (Social Security Administration 2021).
It has to be severe by government standards and expected to last 12 months or result in death (2021). (For more on SSI and SSDI, read Key Differences Between SSI and SSDI)
Typically, people who have been receiving SSDI for 24 months (2 years) will be automatically enrolled in Parts A and B at the start of the 25th month (Center for Medicare Rights 2021f).
What is the “Waiting Period”?
The 2 years before Medicare starts (after a person has been receiving SSDI) are called the Medicare waiting period.
People with Lou Gehrig’s Disease/ALS or End Stage Renal Disease do not have the same waiting period (Center for Medicare Rights 2021f).
You can read about the special rules for people with these conditions here: ALS or Kidney Disease and SSDI
The waiting period makes life difficult for folks not yet on Medicare. They might not have other insurance while they wait.
Those in the waiting period may be able to apply for other coverage through the Affordable Care Act (Obamacare) Marketplace or pay for COBRA, a program that lets them keep their job-based insurance for a time after they can no longer work. You can read about those choices here: Waiting Period Coverage
But the costs of these options may be unaffordable for someone on SSDI.
Some people who have little or no income (earnings) or assets (savings, property etc.) may be able to get Medicaid during this time (put link back to my article about Medicaid).
However, for people with very complex medical needs, Medicaid alone may not cover all the things they need sufficiently (Example: a wheelchair with the right type of supports, a certain doctor for a rare condition, or the right type and number of catheters)
In the future, I’d like to see the waiting period eliminated. In my view, someone disabled enough to get SSDI shouldn’t have to wait two years for Medicare!
In addition to meeting the definition of disabled under the law, you need to have the right number of work “quarters” to get SSDI checks. Your number of quarters depends on the age that you became disabled. You can read more about how to get SSDI and how the law defines disability here: SSDI
Like those who qualify by age, those who get Medicare through SSDI will receive a package in the mail 3 months before Medicare starts (Center for Medicare Rights 2021f).
SSDI recipients, as I said before, are automatically signed up for Part A and Part B. You don’t have to keep Part B but you should in most cases—we’ll talk more about that later.
Also like the age-related recipients, your Part A will be premium free if you or your spouse worked 40 quarters (about 10 years).
If you or your spouse worked fewer than 30 quarters, you will pay $471 per month. If you or your spouse worked 30-39 quarters, you will pay $256 a month in 2021 (Disability Secrets 2021).
To keep SSDI, you need to have Part A once you are eligible. However, you can choose to opt out of Part B when you are first eligible.
The Part B premium will be taken out of your benefit check automatically unless you decide you don’t want Part B (2021f).
What if You Don’t Want Medicare Part B?
If you decide you don’t want Part B, there are directions about what to do.
You can read about those directions here: What If I Don’t Want Part B?
You should only decline Part B if you have other job-based insurance from you or a spouse and it is the primary payer…meaning it pays bills before Medicare.
For folks who are disabled, job insurance pays first if the job has 100+ employees.
Medicare pays first If your job has fewer than 100 employees.
If you opt out of Part B in a situation where Medicare is the first payer, you will have a lot of costs out of pocket (Center for Medicare Rights 2021g).
If your job- based insurance is the second payer, you do not get an SEP and should accept Part B as soon as you are eligible to avoid high costs. You can read more: SSDI Recipients and Part B
If that job- based insurance is going to end and it is the primary payer, you have a special enrollment period to sign up for Part B without financial penalty. That SEP lasts 8 months after coverage ends (2021g).
If you declined Part B when you were enrolled automatically, you have an initial enrollment period or IEP in which you can join Part B if you change your mind. Like an IEP for age-related recipients, the time period is 7 months long—the 3 months before your 25th month on SSDI, the 25th month on SSDI, and the 3 months after (United Healthcare 2021).
The month you enroll within your IEP (For example: The 1st month vs. the 3rd month of IEP) will affect your Part B start date, just like those who qualify based on age.
What a Chart Might Look Like:
The chart would look something like this:
If you enroll in Part B during the….
25th month you receive SSDI- it starts 1 month after
1 month after the 25th month you receive SSDI- it starts 2 months after
2 months after the 25th month you receive SSDI- it starts 3 months after
2 months after the 25th month you receive SSDI- it starts 3 months after
If you opt out of Part B during the IEP and decide you want it later… but don’t have a special enrollment period, you will have to wait until general enrollment (GEP) to sign up. The GEP is the time between January 1 and March 31 (Center for Medicare Rights 2021e)
You will pay a financial penalty if you wait until the GEP and your coverage won’t start until July.
**If you are eligible for Medicaid as well as Medicare, you should take Part B**
This is the case for some low-income Medicare recipients.
Why should you take Part B in this situation?
Because Medicaid is always the “payer of last resort.” If you opt out of Part B and also have Medicaid, you will get a lot of bills (2021g). Medicaid may be able to help you pay Medicare premiums.
Remember to subscribe to Unpacking Disability to receive more posts on Medicare, Medicaid, Social Security and handy resources!
Social Security & Systems Resources Related Posts
|The Difference Between SSI and SSDI|
|It Happened to Me: Reporting Income with SSDI!|
|How to Get SSI for My Child with a Disability|
|What is a Disability Benefits Planner?|
Kathleen Downes (she/her/hers) is a licensed social worker and activist for disability justice from Floral Park, New York. She was born with cerebral palsy and enjoys doing advocacy work for people with all types of disabilities. She volunteers to create educational programs for families of disabled youth through a small non-profit in the New York area.A two time graduate of the University of Illinois at Urbana-Champaign, she holds a master’s in social work and a bachelor’s in community health and rehabilitation studies.She is particularly passionate about long term care policy and strengthening the Medicaid program.Kathleen blogs at The Squeaky Wheelchair and has been featured in The Huffington Post and in the online publication of the Women’s Media Center.In her free time she enjoys reading, writing, spending time with her dog, taking seated dance classes, and learning new things.