Disability Coverage & Medicare: How-To Enroll & Other Disability Questions

All recipients of Social Security disability benefits can also receive Medicare coverage two years after they are eligible for monthly disability benefits. Some individuals, however, can get Medicare coverage sooner depending on their situation. Here’s a guide to help you navigate disability and Medicare coverage. 

How to Get Medicare if You’re Under 65 and Have a Disability

If you are disabled—regardless of age—and qualify for Social Security disability insurance (SSDI), then you may also be eligible to receive Medicare disability coverage. The coverage is the same for people who qualify based on disability as those who qualify based on age. 

Step 1: Apply for Social Security Disability

In order to collect Social Security disability, you must meet the following requirements:

1. Have been diagnosed with a condition that’s left you with a permanent disability, meaning you cannot work for a period of 12 months or longer

2. Have worked a Social Security-qualified job and paid Social Security taxes

3. Your medical condition must prevent you from performing your normal job function. You must have been unable to find a suitable replacement position or new line of work because of your age, education levels or physical limitations

4. You must be complying with your doctor’s treatment plan for your condition

You should apply for Social Security disability benefits as soon as you are disabled, as processing an application for disability benefits can often take three to five months.¹

Step 2: Apply for Medicare Disability Coverage

Eligibility for Medicare coverage usually begins once you have received disability benefits for 24 months. You will be automatically enrolled in Original Medicare (Medicare Part A and Medicare Part B). Our coverage will begin on the first day of the 25th month of receiving disability checks.

Medicare Enrollment if You Have End-Stage Renal Disease (ESRD)

Historically, individuals with ESRD, including those under age 65, have been eligible to enroll in Original Medicare at any time, but prohibited from enrolling in Medicare Advantage plans, unless they developed ESRD after enrollment or were grandfathered in through employer-sponsored coverage. Effective January 1, 2021, those with ESRD are allowed to enroll in Medicare Advantage plans, which increases their options for chronic-disease management and potentially more flexible or affordable payment opportunities. 

Medicare benefits can begin as soon as the first day after three months following a course of regular dialysis or kidney transplant. Under certain conditions, Medicare could start on the first month of dialysis. 

Medicare Enrollment if You Have ALS (Amyotrophic Lateral Sclerosis) or Lou Gehrig’s Disease

If you have ALS, you are automatically enrolled in Original Medicare the month your Social Security disability benefits begin. You also have the choice of adding other coverage options like Medicare Part D or a Medicare Advantage plan.

How long does it take to get Medicare after being approved for SSDI?

Generally, there is a two-year waiting period for getting Medicare coverage after being approved for Social Security Disability Insurance, but some individuals may qualify sooner. Once qualified, your Medicare coverage should begin on the first day of the 25th month of receiving your disability checks. 

What happens when you turn 65 and are already on disability?

Once you turn 65, your Social Security disability benefits stop and you’ll then automatically start receiving Social Security retirement benefits. Typically, the amount of money you receive each month remains the same. 

Other Common Medicare Disability Coverage Questions

Am I allowed to keep my Medicare coverage if I go back to work?

While your disability benefits may be affected, you can likely keep your Medicare coverage for at least eight and a half years after you return to work.²

Is Medicare mandatory if you have a disability?

If you qualify for Medicare due to a disability, you can delay enrollment into Medicare if you, your spouse or family member have health coverage through an employer. This should give you a Special Enrollment Period that allows you to enroll in Part B up to eight months after you no longer have coverage through yours, your spouse’s, or your family member’s employer. 

Is Medicare free if you have a disability?

Once qualified, Medicare Part A is free for most people and you are required to keep it, while Part B has a monthly premium and you’re allowed to disenroll. Part A and Part B cover a good amount of healthcare expenses, but you’ll still have to pay for premiums, deductibles and copays. You can alleviate some of these costs by enrolling in a Medicare Advantage, Medicare Supplement plan, or a Part D prescription drug plan depending on your needs.

Enroll in a Medicare Plan

It can be difficult to navigate Medicare on your own, especially Medicare disability coverage. We’ll help you save both time and potentially money by navigating Medicare and explaining it to you every step of the way. In just minutes, we can compare all the options available for you in your area from our trusted carriers to ensure you’re getting all the benefits available to you. It’s a free service, and there’s no obligation to enroll.

¹ https://www.ssa.gov/pubs/EN-05-10029.pdf

² https://www.ssa.gov/disabilityresearch/