Getting Medicare under the age of 65 year: Disability (SSDI), ALS and ESRD

 People are usually be eligible for Medicare if they are 65 year and older but can also be eligible if  they are under 65, ifthey are on Social Security Disability (SSDI) or have specific qualifying illnesses like ALS or End Stage Renal Disease. Although people over 65 represents the majority of Medicare recipients, there a still around 9.1 million people in the US who are on Medicare and are under the age of 65 years old. This is because it is possible for US residents to get Medicare benefits if they are under the age of 65, primarily in the case if they are disabled or have some specific diseases. In this video we are going to discuss Medicare for people under the age of 65 and who is usually eligible for program. Please do not forget to like and subscribe.

Medicare / Medicare under 65 

 Medicare is a program that is funded by payroll taxes, federal and state money and monthly premiums paid by the individual. For most people who apply for Medicare they will have paid into the program for the entirety of their working life, or at least paid into the program a minimum of 10 years or 40 working quarters. Once somebody has worked enough quarters, they must either reach the Medicare eligibility age, for most people that will be 65 years or older, or become disabled, or have specific health conditions that would allow them to qualify for Medicare prior to turning 65. Once they are enrolled into Medicare part A and part B ( also known as Original Medicare), they will usually still have to pay a monthly premium for a portion of their Medicare coverage, which in 2020 is $144 a month for part B, and other costs associated with their healthcare. These cost can be reduced if somebody applies for a Medicare Advantage or Medicare Supplement plans. They may also be paid  in full by programs for low income individuals like Medicaid or Medi-Cal or the Medicare Savings Program, if they qualify. 

Qualifying for Medicare because of disability

  The majority of people who are receiving Medicare under the age of 65 are because of disability. Enrollment into Medicare will happen automatically once somebody has been receiving Social Security Disability benefits, or SSDI, for two years or 24 months. This does not include the 5-month waiting period that most people must wait, to qualify for SSDI. So, in total they will have been disabled for 29 months before they become eligible for their Medicare coverage. Three months before there 24th month of disability they will receive their red, white and blue Medicare card. This can be used to obtain Medicare covered health services under Medicare Part A and Part B but does not include medication coverage, dental, vision or extra coverages, when only enrolled into Medicare part A and B . Once a person turns 65 then their Medicare eligibility becomes based off their of age rather than their disability. This is an important transition, because once somebody turns 65 they will have an additional one time options to change their Medicare health plans or Medicare supplement plans. 

Medicare based on ALS or ESRD

Another important way that somebody can qualify for Medicare prior to reaching age 65, is to be diagnosed with a specific illness. The two main illnesses are End Stage Renal Disease and (ALS) or also  known as Lou Gehrig disease. End Stage Renal disease is a disease of the kidney and, is when the kidneys stop working. Usually these folks will be on dialysis or can be in the process of getting a kidney transplant. For people qualifying for Medicare Based on ESRD they do not have to wait the full 24 months like people on just disability. Their Medicare plan will start on the 4th month after they start their dialysis treatments. For people who are qualifying for Medicare based on ALS, Medicare can start immediately once they start collecting Social Security Disability benefits and they also, do not have to wait the 24 month waiting period. 

Medicare Advantage 

One important decision for people who qualify for Medicare under the age of 65 will have to make, is whether or not to get additional Medicare coverage. This is because Original Medicare or, Medicare part A and B combined, do not cover all costs. Especially when it comes to things like limiting healthcare costs, Dental coverage, Vision coverage and Prescription drug coverages, which for the most part are not covered by Original Medicare. To qualify for Medicare advantage, people must be enrolled in both Part A and B coverages. Medicare advantage or Part C as it is sometimes called, is a program that is offered by private health insurance companies and is not run by Medicare. But works as a way for people who qualify for Medicare, to get additional benefits they cannot get with Part A and B only. This can include things like transportation, dental, vision, and prescription drug coverage. 

 Med Sup but may have adjusted costs 

An alternate option to a Medicare advantage plan is something called Medicare Supplement or MediGap plans. These plans will have an additional premium to them, and vary in their benefits depending on the plan level you choose. But in short Medigap plans are insurance plans offered by private health insurance companies and pays for much of the costs that Original Medicare does not. One very important thing to note about Medigap plans is that when somebody first become eligible for Medicare, they will have a onetime opportunity to enroll, without having to go through medical underwriting. Medical underwriting, is a process that insurance plans use to either accept, decline, or increase the cost of plan based on an applicant’s preexisting conditions. In some cases, if somebody is applying for MediGap and they are under 65 their only opportunity to apply for a Medigap plan will be in their initial enrollment period when they cannot be declined because of their health conditions. Additionally, Medigap plans do not include prescription drug coverage, so that would need to be purchased separately as a stand along plan. 

Thank you so much for watching, if you have questions about your Medicare or Medicare health plan options please feel free to contact us and we can make a new post or video to cover your questions. We here at California know health insurance weather it is private health insurance, Medicare, Medicaid / Medi-Cal, Medigap or health insurance for your small business. It can be very confusing coming from your work insurance and trying to look at options on the private market or turning 65 and trying to figure out which Medicare option is best for you. That is exactly what we can do, we can walk you through your options and help you find the plans that fits your needs and your budget.