What Disabilities Qualify for Medicare?

When you think of Medicare, you may think it’s just health coverage for senior citizens. And while Medicare is primarily for Americans aged 65 and older, it’s also for people living with a disability. In fact, more than 10 million people in the United States currently qualify for Medicare based on their disability.

There’s a lot to know, so here are the basics.

To qualify for disability Medicare coverage, you need to meet some specific criteria – the first being Social Security Disability Insurance (SSDI) benefits. Administered by the U.S. Government, SSDI provides financial assistance to people who can't work because of a disability. If you’ve been receiving SSDI benefits for at least 24 months, you qualify for Medicare Part A and Part B.

People who have been diagnosed with Amyotrophic Lateral Sclerosis (ALS) – also known as Lou Gehrig's disease – qualify for Medicare coverage. Also, individuals who are living with End-Stage Renal Disease (ESRD) and require regular dialysis or a kidney transplant. In this case, coverage will be offered after a waiting period. (More on that later.)

It's important to note the Medicare coverage you receive with a disability comes with the same benefits you would get if you qualified based on your age. This includes coverage for a nursing home, home health care and other community-based services.

How old do you have to be to get Disability Medicare?

The Medicare eligibility age of 65 doesn’t matter when it comes to disability coverage. As long as you meet the disability standards and are at least 18, you can receive Medicare coverage no matter how old you are. People who meet all the criteria for Social Security Disability Insurance will generally be enrolled in Medicare Parts A and B. Should you choose to get a Medicare Advantage Part C or Part D (Prescription Drug Coverage) plan, you will need to enroll with a private provider.

Qualifications for Those with Disabilities to Get Medicare

Medicare eligibility for those under 65 includes people who already receive Social Security Disability Insurance benefits, those diagnosed with ALS (Lou Gehrig’s disease) and individuals living with End-Stage Renal Disease.

When it comes to receiving SSDI benefits, the Social Security Administration (SSA) defines disabling medical conditions as:

• A physical or mental condition that can be medically diagnosed and documented.
• An impairment that significantly limits the ability to perform basic work-related activities (i.e., walking, sitting and concentrating).
• An impairment that is expected to be long-term (more than a year) or terminal (eventually resulting in death).
• A condition that leaves an individual unable to engage in substantial gainful activity (SGA).

Once you qualify for SSDI benefits, you will typically qualify for Medicare Part A and Part B after 24 months. Certain qualifying conditions must also be met with End-Stage Renal Disease. Medicare requires the following:

• Your kidneys no longer function.
• You need regular dialysis or have had a kidney transplant.

One of the following must also be true:

• You’re already eligible for or are currently getting Social Security or Railroad Retirement Board (RRB) benefits.
• You have worked the required amount of time under Social Security, the RRB or as an employee of the government.
• You are either the spouse or child of someone who meets either of the above requirements.

How long does it take to get Disability Medicare?

This is where it can get complicated. The time it takes to get Disability Medicare can vary depending on the situation. Everyone who gets Social Security Disability Insurance benefits is eligible for Medicare after 24 months. During this time, you may be eligible to get health insurance through a former employer, so it’s a good idea to ask them about possible health insurance coverage.

If you’ve been diagnosed with ALS, your Medicare benefits will begin as soon as you start collecting your SSDI benefits. No qualifying period is required. With End-Stage Renal Disease, Medicare eligibility generally begins three months after a kidney transplant or a course of regular dialysis.

Living with a disability can bring some challenges, and the last thing you need to worry about is the extra financial burden. That’s why it’s good to know Medicare can serve as a lifeline. Coverage will provide you with the assistance you need and access to vital healthcare services so you can focus on your well-being. If you’re unsure whether you qualify based on your disability, it’s a good idea to contact the Social Security Administration and start the application process for SSDI benefits and Medicare coverage.

Frequently Asked Questions

What disabilities are eligible for Medicare?

Amyotrophic Lateral Sclerosis (ALS), also known as Lou Gehrig's disease, and End-Stage Renal Disease (ESRD) are both eligible for Medicare coverage. Also covered are certain cancers, respiratory illnesses and some musculoskeletal disorders.

What is considered a disabling medical condition for Medicare? A disabling medical condition for Medicare is typically defined by the Social Security Administration (SSA) to be:

• A physical or mental condition that can be diagnosed and documented by medical evidence.
• An impairment that significantly limits the ability to perform basic work-related activities, such as walking, sitting, and concentrating.
• An impairment that is expected to be long-term (more than a year) or terminal.
• A condition that leaves you unable to engage in substantial gainful activity (SGA).

Can you get Medicare at 62?

Yes, you can get Medicare under the standard eligibility age of 65 if you have a disability that meets the necessary criteria.

8 a.m.-8 p.m., 7 days a week.

 

More about Eligibility

• What Age Is Eligible for Medicare?
• How to Qualify for Both Medicare and Medicaid
• Can a Veteran Have Medicare and VA Benefits?

Disclaimers
Sources
Center for Medicare Advocacy: Medicare Coverage for People with Disabilities
Medicare.gov - Special Needs Plans
Medicare.gov - End Stage Renal Disease