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Medicare Benefits for People with Disabilities

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When the Medicare program was originally created, there were no benefits for people under 65 with disabilities. That changed in 1973. Since then, the disabled have become the fastest growing population receiving Medicare benefits, according to the Social Security Administration.

Today, Medicare benefits work hand-in-hand with disability benefits to help you get the health care you need. Here’s how Medicare helps people with disabilities.

I’m under 65 and have a disability. When do I get Medicare benefits?

You are generally eligible for Medicare benefits after you’ve received Social Security Administration (SSA) disability payments for a full 24 months in a row. You’ll automatically get your Medicare ID card in the mail about three months before your 25th month on disability.

  • People with Lou Gehrig’s disease (amyotrophic lateral sclerosis, or ALS) don’t have this waiting period.

If you have ALS, your Medicare benefits will start the month you start getting SSA disability benefits.

  • If you have end-stage renal disease (ESRD), you might qualify for Medicare, but you won’t be signed up automatically. You have to sign up through Social Security.

In most cases, you can choose to get coverage through a Medicare Advantage plan. Medicare Advantage plans are offered by private insurance companies approved by Medicare. These plans cover everything Medicare Part A and Part B cover, and sometimes more.

If you qualify for Medicare through end-stage renal disease (ESRD), you may not be eligible for a Medicare Advantage plan.

Can I get Medicare benefits for prescription drugs if I have a disability?

Anyone eligible for Medicare benefits is eligible to enroll in a Part D prescription drug plan. However, you must be enrolled in Part A and/or Part B to enroll in a stand-alone Medicare Part D prescription drug plan.

If you get Medicare benefits through Original Medicare, and if you want prescription drug coverage, you typically need to sign up for a stand-alone Medicare Part D prescription drug plan. However, most Medicare Advantage plans include Part D coverage for prescription drugs.

Can I buy a Medicare Supplement insurance plan if I have a disability?

Medicare Supplement insurance plans may help cover out-of-pocket costs under Part A and Part B.

If you are under age 65 and have Medicare benefits because of a disability, you might not be able to buy Medicare Supplement insurance.

However, some states have laws that require companies to sell at least one Medicare Supplement plan to anyone eligible for Medicare regardless of age. If you live in one of those states, you might be able to buy a plan, but your premium might be higher than if you wait until you reach age 65 to apply.

I have health insurance through my spouse’s employer. Can I still get Medicare benefits?

If you have other health insurance coverage, usually you are still eligible for Medicare benefits after your 24th month of disability payments. However, Medicare benefits are generally secondary to your other coverage, which means Medicare only pays for covered services after your primary health insurance pays its share.

What are Medicare Special Needs Plans?

Special Needs Plans (SNPs) are a type of Medicare Advantage plan for people who meet certain conditions. For example:

  • You’re eligible for both Medicare and Medicaid
  • You live in an institution such as a nursing home
  • You have a certain illness or disability

Medicare benefits in these plans are designed to best help people with particular conditions or diseases. For example, an SNP for people with disabilities would have doctors who specialize in treating disabled people in its provider network, and would include commonly prescribed medications in its prescription drug formulary. All Special Needs Plans include Part D coverage for prescription drugs.

Most SNPs are Health Maintenance Organizations (HMOs). Under an HMO, you choose a primary care provider to oversee your care and refer you for specialist care when you need it. SNPs help coordinate your medical care and health services to help you stay healthy and follow any treatment plan your doctor recommends.

Can I get help paying for my Medicare benefits if I am disabled?

You may be eligible for different programs to help with your out-of-pocket costs under Medicare. You might be able to get help paying Medicare premiums, copayments, coinsurance amounts, and/or deductibles.

State Medicare Savings Plans are designed to help people with financial need pay Medicare premiums, deductibles, and coinsurance payments. The Extra Help program is available to help qualified low-income people cover their Part D prescription drug costs.

You may also qualify for Supplemental Security Income, which is separate from your disability payments, if you meet income and financial resource requirements.

To find a Medicare Advantage plan in your area, enter your zip code on this page.

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