What Disabilities Qualify for Medicare Under 65?
Medicare, a federal health insurance program, helps people who are 65 and older to pay their healthcare expenses. However, it is possible to qualify for Medicare under 65 years of age.
Someone with a disability may qualify for Medicare under certain circumstances. There are some disabilities, such as permanent kidney failure, that make a person eligible for Medicare regardless of age.
What is Medicare?
Medicare is a health insurance program administered and funded by the federal government. There are three separate parts to Medicare coverage:
- Medicare Part A: Part A is hospital coverage and pays for treatment when you are a patient admitted to a hospital. It also covers care at a skilled nursing facility and hospice care. It may pay for some of the health care in your home.
- Medicare Part B: If you want coverage for expenses related to physicians, medical supplies, outpatient treatment, and visits to a doctor for preventive care, you’ll need Medicare Part B.
- Medicare Part D: Prescription drugs, including routine vaccinations, are not covered by Parts A and B, but they are covered by Medicare Part D.
If you or your spouse worked and paid Medicare taxes on the money earned, you get Medicare Part A for free. Those who have not paid Medicare taxes can obtain Part A coverage by paying a monthly premium provided they are otherwise eligible for coverage.
You can add Part B coverage by paying a monthly premium provided you qualify for Medicare coverage. You’ll need to become part of a Medicare-approved plan through a health insurance provider to obtain Part D coverage.
Who Is Eligible For Medicare?
Medicare Parts A and B are available to the following people:
- Anyone who is 65 years of age or older.
- People younger than age 65 who are disabled.
- People diagnosed with end-stage renal disease.
Eligibility for Medicare based on age or a diagnosis of end-stage renal disease is self-explanatory, but eligibility based on other types of disabilities needs to be explained in more detail.
What Disabilities Make Someone Eligible For Medicare Coverage?
A person who qualifies for Social Security disability benefits through SSDI or Social Security Disability Insurance becomes eligible for Medicare 24 months after receiving SSDI benefits. Someone receiving disability benefits through the Supplemental Security Income program may qualify for Medicaid instead of Medicare.
However, a person receiving SSI benefits may qualify for Medicare and Medicaid at age 65 or because of a disability. It’s called dual eligibility, and your Medicare becomes the primary health insurance coverage. Anything that Medicare does not pay then goes through Medicaid.
What Disabilities Qualify For Medicare Under Age 65?
You automatically qualify for Medicare with a diagnosis of amyotrophic lateral sclerosis, which is also known as ALS or Lou Gehrig’s disease. If you have ALS, you also qualify for SSDI benefits. The 24-month waiting period for Medicare eligibility that usually applies to someone receiving SSDI benefits does not apply when the medical condition is ALS.
If you have end-stage renal disease, you qualify for Medicare regardless of your age, provided all of the following factors exist:
- Your kidneys do not function.
- You require dialysis or have a kidney transplant.
- You’re eligible for Social Security retirement or SSDI benefits, you receive retirement or SSDI benefits, or you are the dependent child or spouse of someone who qualifies for SSDI or Social Security retirement benefits.
There may be waiting periods or limits on how long Medicare coverage remains in effect, but disability advocates can review your situation and determine what, if any, of them apply to you.
Other medical conditions that could make you eligible for coverage under Medicare before you are age 65 include the following:
- Multiple sclerosis
- Cystic fibrosis
- Congestive heart failure and heart disease
- Parkinson’s disease
- Lupus
The Social Security Administration maintains listings of impairments, frequently called the Blue Book, with medical and mental health impairments that satisfy the eligibility requirements for SSD benefits and Medicare. Talk to a disability advocate to get more information.
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