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Does Medicare Cover Disability Insurance?

HealthPlans of NC

Approximately 54 million people in the United States have a disability. Regarding 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 with Lou Gehrig’s disease, end-stage renal disease, or who are over 65) and social security disability insurance.

For people with disabilities, finding affordable health plan coverage that meets all of their needs can be challenging. Finding a qualified insurance agent can be a big help if you are seeking assistance enrolling in Medicare coverage. 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 these people, eventually adding other conditions in 1973. 

Social Security Disability Insurance, also known as SSDI, is another form of federal insurance that explicitly supports people with disabilities and certain family members. 

Additionally, those who 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.

Medicare Disability Insurance

Social Security Disability Income (SSDI)

People with disabilities can access Medicare at any age through SSDI. After enrolling in SSDI, they become eligible for Medicare after 24 months. 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 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 who 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 monthly premiums, Parts B and D 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 challenging to understand each plan's details without support. However, Health Plans of North Carolina has a team of insurance experts who can help. They can guide you through your benefits so you don’t have to figure it out yourself. 

For more information about Medicare supplement plans, check out this article

Medicare Disability Insurance

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 combines 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 suitable 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 than the 8% of older beneficiaries. 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 difficulty 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 than 31% of older beneficiaries (Figure 6).

The good news is that those who meet required work periods and medical standards are still entitled to 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 specific 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 period, an individual is entitled to receive Medicare and Social Security for a maximum 9-month trial work period. The requirement is that they must make a certain amount of money per month (the amount depends on several factors) or 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. Check out this website to better understand substantial gainful activity levels.

Indefinite Period and Access to Medicare

If an individual still has a disability, they can continue Medicare coverage after the eight-and-one-half-year period. However, they would have to pay monthly premiums for 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 they must have SSDI for 24 months before enrolling in Medicare. On the 25th month, they will automatically enroll in parts A and B. You must speak directly with your private plan provider if you desire Part C or D. Be sure to enroll during your IEP to avoid penalties. The enrollment period is seven months long. 

Do you need help navigating Medicare and other insurance plans? And are you seeking an insurance expert to 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!

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Frequently Asked Questions

Does Medicare Part A cover disability income?

Yes, it does. Medicare Part A is premium-free for those who 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. People with disabilities are eligible for Medicare no matter how old they are. 

Health insurance can be tricky. That’s why having an insurance professional on your side is essential. 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. 

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