Can Someone Getting Ssi Disability Benefits Get Medicare
People who receive Supplemental Security Income aren’t qualified to receive Medicare insurance coverage until they reach the age of sixty-five.
However, upon turning 65, SSI recipients can receive Medicare based solely on age. How? By filing an “uninsured Medicare claim.” The SSI program actually requires SSI beneficiaries to file uninsured Medicare claims, so that some of the Medicaid burden will be taken off of states. It’s cheaper for states to pay the Medicare premiums for their Medicaid recipients rather than to continue paying for all of their medical expenses through Medicaid. By doing this, Medicare becomes the primary payer for the recipient and Medicaid becomes the secondary payer.
Medicare With Als Or Esrd
There are two exceptions to the 2-year waiting period. If you have amyotrophic lateral sclerosis , also known as Lou Gehrigs Disease, youll be enrolled in coverage in the first month you receive SSDI.
Enrolling In Medicare With A Disability
Just like when you become eligible for Medicare at age 65, when you are eligible with disability, you have an Initial Enrollment Period of 7 months.
Your Initial Enrollment Period will begin after you have received either disability benefits from Social Security for 24 months or certain disability benefits from the Rail Road Retirement Board for 24 months.1 In other words, your IEP starts on the 25th month of disability benefits.
You will be automatically enrolled in Medicare Part A and Part B, but if you decide you want to get a Medicare Advantage or Part D prescription drug plan, you will need to enroll yourself directly with the private plan provider. You will need to enroll during your IEP to avoid late enrollment penalties.
NOTE: If you become eligible for Medicare because of ALS or ESRD, your situation is different. See the below special sections for eligibility and enrollment for ALS and ESRD.
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How To Get Help With Medicare If Youre Disabled And Under 65
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Under Age 65 And Receiving Social Security Disability Benefits
If this is your personal situation, after you receive 24 months of Social Security Disability Income benefits, Medicare automatically enrolls you in both:
- Medicare Part A , which is premium-free.
- Medicare Part B , which has a premium.
However, if you receive SSDI due to a specific disability, such as End-Stage Renal Disease or Lou Gehrig’s disease , you’re automatically enrolled in Medicare without the 24-month waiting period.
In either case, you’ll receive your Medicare card in the mail. If Medicare enrolls you after 24 months of receiving SSDI, you’ll get your card about three months before your 25th month of disability benefits. If you don’t want Part B, follow the instructions that come with the card.
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Do You Automatically Get Medicare With Social Security Disability Benefits
Social Security Disability Insurance is a gateway to Medicare for disabled individuals under age 65.
Recipients of SSDI are automatically enrolled in Original Medicare Parts A and B beginning the 25th month of coverage. Find out when SSDI beneficiaries qualify for Medicare Supplement, Medicare Advantage, and Medicare drug coverage.
How Much Does Medicare Cost On Disability
If you qualify for SSDI, you’ll typically qualify for premium-free Medicare Part A based on your work record. Part B requires a monthly premium , automatically deducted from your Social Security check. You can technically opt out of Part B if you dont want to pay the premiums. Just know that without Part B, youll forego extensive medical coverage. Its usually not a good idea to opt out of Part B unless you have other health insurancelike from an employer.
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Disability & Medicare Eligibility And Enrollment What You Need To Know In 2022
Some people can qualify for Medicare due to disability. In this case, if you have a qualifying disability, you are eligible for Medicare even if you are not yet age 65. To find out if your disability qualifies for disability benefits or for Medicare, youll need to speak with Social Security directly, but in general, you become eligible the 25th month of receiving Social Security Disability Insurance benefits .
If you have a qualifying disability, you must first file for disability benefits through Social Security before you can even be considered eligible for Medicare due to disability. Approval of the request by Social Security is an important first step. It is also important to note that these benefits are different from Supplemental Security Income benefits, and that SSI benefits do not qualify you for Medicare.
Who Is Eligible For Medicare
Generally, Medicare is available for people age 65 or older, younger people with disabilities and people with End Stage Renal Disease . Medicare has two parts, Part A and Part B . You are eligible for premium-free Part A if you are age 65 or older and you or your spouse worked and paid Medicare taxes for at least 10 years. You can get Part A at age 65 without having to pay premiums if:
- You are receiving retirement benefits from Social Security or the Railroad Retirement Board.
- You are eligible to receive Social Security or Railroad benefits but you have not yet filed for them.
- You or your spouse had Medicare-covered government employment.
To find out if you are eligible and your expected premium, go the Medicare.gov eligibility tool.
If you did not pay Medicare taxes while you worked, and you are age 65 or older and a citizen or permanent resident of the United States, you may be able to buy Part A. If you are under age 65, you can get Part A without having to pay premiums if:
- You have been entitled to Social Security or Railroad Retirement Board disability benefits for 24 months.
- You are a kidney dialysis or kidney transplant patient.
While most people do not have to pay a premium for Part A, everyone must pay for Part B if they want it. This monthly premium is deducted from your Social Security, Railroad Retirement, or Civil Service Retirement check. If you do not get any of these payments, Medicare sends you a bill for your Part B premium every 3 months.
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Is Medicare Mandatory If You’re On Disability
Social Security will start to automatically enroll most SSDI recipients in both Medicare Parts A and B before their 25th month of SSDI benefits. Three months before your coverage starts, the SSA will send you your new Medicare card, with your name, your Medicare number, and the dates your Part A and Part B coverage will start. The SSA will automatically deduct your monthly premiums from your Social Security check at the start of your 25th month of benefits unless you send back your Medicare card . Then your coverage begins.
For practical purposes, you can’t decline Medicare Part A, which covers hospitalization and skilled nursing stays. So Medicare Part A is mandatory if you’re on disability, but Social Security doesn’t usually take any money out for Part A premiums anyway.
You can decline Medicare Part B, which covers doctors’ visits, x-rays, lab fees, surgery, and the like. Social Security will take money out of your SSDI check for Part B premiums, so people who are covered under their spouse’s employer-based health care insurance sometimes want to decline it .
If you don’t want Part B, send the card back to Medicare . If you keep the card, you will have Part B coverage and Social Security will take the Part B premium out of your SSDI benefits.
Can You Get A Medicare Supplement Plan On Disability
At the present time, there is no federal legislation that guarantees enrollment in Medigap for beneficiaries under age 65. It is left to the states to enact legislation that makes Medigap coverage a guaranteed issue.
Only 11 states require insurers to offer at least one Medigap plan to those under age 65 with an equal number making all plans guaranteed-issue, but under-65 premiums can be much higher. Twelve states make all plans guaranteed-issue and include restrictions on premiums. Also, 12 states and Washington, D.C., have no coverage requirement for insurers. Four states have not even addressed the issue of Medicare for those under 65.
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What Does Medicare Part B Cover
Medicare Part B is medical insurance and includes coverage for:
- Certain doctors services
- Durable medical equipment
- Mental health services
Medicare Part B is optional, separate from Medicare Part A . In order to qualify, you typically must be 65 years or older. You must also be a U.S. citizen, or a permanent lawful resident for at least five continuous years.
If you are under age 65, you may also be eligible if you receive Social Security or Railroad Retirement Board disability benefits for more than 24 months.
Understand Your Coverage Options
Even if you’re under 65, you may still qualify for Medicare benefits. Most people assume you must be 65 to sign up for Medicare, but there are exceptions:
- If you’re under age 65 and youve received disability benefits from Social Security or the Railroad Retirement Board for at least 24 months, youll automatically get Medicare Part A and Part B
- If you’re a disabled federal, state or local government employee who is not eligible for Social Security or Railroad Retirement Board benefits, you may be eligible for Medicare 24 months after you qualify for disability
Most people whove worked and paid taxes for a certain amount of time dont have to pay a premium for Medicare Part A .
With Part B, which covers things like doctor visits, lab tests and preventive services, most people have to pay a monthly premium. In 2022, the monthly Part B premium is $170.10 .
If youre disabled but still covered under your own or a qualified family members employer plan, you may want to keep that coverage and postpone enrolling in Medicare Part B to postpone paying the premium. Your Part B premium won’t begin until your Part B benefits do.
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Should I Sign Up For Medical Insurance
With our online application, you can sign up for Medicare Part A and Part B. Because you must pay a premium for Part B coverage, you can turn it down.
If youre eligible at age 65, your Initial Enrollment Period begins three months before your 65th birthday, includes the month you turn age 65, and ends three months after that birthday.
Note: Important Upcoming Change Rules for 2023 and later: If you accept the automatic enrollment in Medicare Part B or if you sign up during the first three months of your IEP, your coverage will start the month youre first eligible. Beginning January 1, 2023, if you sign up during the month you turn 65 or during the last three months of your IEP, your coverage starts the first day of the month after you sign up.
The following chart shows when your Medicare Part B becomes effective in 2022:
|In 2022, if you sign up during this month of your IEP||Your Part B Medicare coverage starts|
|One to three months before you reach age 65||The month you turn age 65.|
|The month you reach age 65||One month after the month you turn age 65.|
|One month after you reach age 65||Two months after the month of enrollment.|
|Two or three months after you reach age 65||Three months after the month of enrollment.|
The following chart shows when your Medicare Part B becomes effective in 2023:
How Do People With Disabilities Enroll In Medicare
If youre under 65 and receiving Social Security disability benefits, enrolling in Medicare is easy. In most cases, you wont need to do anything. Youll automatically get Part A and Part B coverage as soon as youre eligible. For most disabilities, your Medicare coverage automatically starts after youve received SSDI for 24 months.
All you need to do is check the mail for your Medicare card. Your new card should arrive three months before your Medicare coverage starts. This means that most adults qualifying for Medicare with a disability will get their card in month 21 of their SSDI. Youll have lots of time to find out exactly whats covered before your Medicare coverage starts on the first day of month 25.
If you are on disability when eligible for Medicare at age 65, youll be automatically enrolled in Original Medicare. Your Part B monthly premium can be deducted from your Social Security benefits, and you can start using your Medicare coverage as soon as you turn 65.
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But What About Medicare
If you are eligible for SSDI, you are automatically eligible for Medicare after 24 months. The Social Security Administration automatically enrolls eligible SSDI recipients into Medicare Part A and Part B. You are given the option to decline or delay Part B. Some people choose to decline or delay Part B because they want to remain on a spouses employer-based plan.
If you did not decline Medicare Part B when you are switched from SSDI to Social Security retirement benefits, there is nothing you need to do. Your coverage will continue and the Medicare Part B premium will be paid from your SSR instead of your SSDI.
If you did decline Medicare Part B, you can continue to use your other coverage until you have a change in circumstances . At that point, you have eight months to sign up for Medicare Part B. The Social Security Administration will have the specific forms you will need. If you do not sign up during that eight month enrollment period, you may have to pay a penalty of up to 10% for each 12-month period you could have been enrolled in Medicare Part B but werent signed up.
If you have questions about switching from Social Security Disability Income to Social Security Retirement, contact us online or call 338-1153.
Special Circumstances: Medicare With Als Or End
Medicare eligibility rules for people with ALS or end-stage renal disease are different. Individuals who qualify for Medicare with ALS or ESRD do not have to wait for your 25th month of disability to be eligible for Medicare.
If you qualify with ALS: You will automatically get Medicare Part A and Part B the month your disability benefits begin.7
If you qualify with ESRD:8
- For most people, Medicare coverage will start on the 1st day of the 4th month of dialysis treatment.
- If you have an employer group health plan, Medicare will begin on the fourth month of dialysis.
- Treatments if you have employer coverage.
- If you participate in an at-home dialysis training program, your coverage may begin the first month of a regular course of dialysis provided the following are true:
- You participated in training from a Medicare-approved training facility for the first three months of your regular dialysis
- Your doctor expects you to finish training and be able to do your dialysis treatments yourself
Note, according to Medicare in order to qualify with ESRD all of the below must apply:9
For further information related to ALS and Medicare, visit www.alsa.org.
For further information related to ESRD and Medicare, visit www.medicare.gov.
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Ways To Apply For Disability Benefits:
- If you or your spouse worked for a railroad, call the Railroad Retirement Board at 1-877-772-5772.
Once your disability benefits start, well mail you a welcome package with your Medicare card.
Sign up for Part B if you live in Puerto Rico or outside the U.S.You get Part A automatically. If you want Part B, you need to sign up for it. If you dont sign up for Part B within 3 months after your Part A starts, you might have to wait to sign up for Part B and pay a monthly late enrollment penalty.
Returning To Work With Medicare Disability Enrollment
You are allowed to keep your Medicare coverage for as long as a medical professional deems you medically disabled.
If you under age 65 and return to work, you wont have to pay a premium for Part A for the next 8.5 years.
If youre still younger than age 65 once that 8.5-year time period as passed, youll begin paying the Part A premium. In 2021, the standard Part A premium is $259.
Your Medicare costswill depend on your specific circumstances. Its important to know that unlikestandard insurance plans, each Medicare part has its own costs and rules.
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How Social Security Affects Your Medicare Part B Premiums
by Christian Worstell | Published January 14, 2022 | Reviewed by John Krahnert
Many Medicare beneficiaries receiving Social Security benefits may receive a lower monthly premium for your Medicare Part B benefits. Medicare Part B is medical insurance for seniors aged 65 and older, or for certain younger people with qualifying disabilities or conditions. It covers a wide range of medically necessary services including doctor visits, medical equipment and more.
Social Security And Medicare Part B
by Christian Worstell | Published January 20, 2022 | Reviewed by John Krahnert
If you receive Social Security benefits, you can have your Medicare Part B premiums automatically deducted from your benefits payments. You may also be automatically enrolled in Medicare based on your Social Security status. Learn more about Medicare Part Bs costs, as well as how Social Security may affect your Part B premiums.
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