People under 65 can qualify for Medicare if they meet a few criteria.
Benefits
To aid those with disabilities, the federal government offers Medicare to those who have been receiving Social Security benefits for 24 months as well as to those who have End-Stage Renal Disease (ESRD) or Amyotrophic Lateral Sclerosis (ALS, also known as Lou Gehrig’s disease).
If you have had Social Security Disability benefits for 24 months, your Medicare card will be sent to you in the mail. You automatically receive Medicare Part A and Part B at the start of your 25th month of receiving benefits.
Those with ALS or ESRD do not have to wait this 24 months. Those with ALS can receive Medicare immediately upon receiving Social Security benefits. Those with ESRD can begin receiving Medicare benefits three months after starting a course of dialysis. With ESRD Medicare, Part A coverage is retroactive for twelve months, starting no earlier than the first month you become eligible for ESRD Medicare.
Age
Children under age 20 with ESRD can qualify for Medicare benefits if they meet two conditions: they need dialysis regularly or require a kidney transplant, AND they have a parent who receives or is eligible for Social Security retirement benefits.
Individuals over the age of 20 qualify for Medicare after receiving Social Security Disability Insurance (SSDI) benefits for at least 24 months. They can receive SSDI without a work history if they developed a disability before age 22, have a parent receiving Social Security retirement benefits, and are unmarried.
Children under age 19 that do not qualify for Medicare may qualify for your state’s Children’s Health Insurance Program. Those 19 or older should apply for Medicaid. To save money on Medicare, apply to the Medicare Savings Programs or Extra Help.
Disability
The Qualified Disabled and Working Individual (QDWI) program covers individuals with a monthly income of less than $4,338 and less than $4,000 in resources. It covers couples with a monthly income of less than $5,832 and less than $6,000 in resources. The plan covers the Medicare Part A premiums for disabled individuals younger than 65 who lost their premium-free Part A because they returned to work.
Individuals with disabilities wanting to return to work and keep their Medicare benefits go through a three-step process. During the trial work period, which can last nine months, the person gets a job and performs work. The next stage is the extended period of eligibility, where individuals who have earned at least the minimum to be considered “substantial gainful activity” are still working for another 93 months. After these 8 ½ years have passed and the individual is still considered medically disabled, they are eligible for indefinite access to Medicare for as long as they are disabled. At this point, they have to pay the Part A premium and Part B premium.
Important to those with disabilities is the lack of “Improvement Standard” for all Medicare beneficiaries. The Jimmo Settlement of 2011 spurred Medicare into changing its policies such that no improvement standard will be used to determine coverage in claims that require skilled care. Skilled care is needed in many cases for maintenance purposes. Coverage is determined based on whether skilled care is required, not on the beneficiary’s potential to improve in condition.
