Disability and Medicare Eligibility: What You Need to Know In 2021

Disability and Medicare Eligibility: What You Need to Know In 2021
Medicare coverage

By this time, you probably understand that Medicare coverage is available to individuals aged 65 or older. However, what you may not know is that Medicare coverage is also available for Americans with disabilities.

If you qualify for disability benefits from the Social Security Administration, you may be eligible for Medicare coverage. Understanding when your Medicare will begin, what it will cover, and how much it will cost can help you make critical and informed decisions.

In this post, we discuss everything you need to know about disability and Medicare eligibility in 2021. Keep reading to learn more.

Medicare Eligibility for People with a Disability

Typically, three groups of people are eligible for Medicare coverage if they are under the designated Medicare age of 65.  The three groups are;

However, the timeframe that each group has to wait before they start enjoying Medicare benefits varies.  If you have been approved for Social Security Disability Insurance, you will have to wait for at least 24 months (two years) before your Medicare coverage begins.

The two-year waiting period usually begins the first month you receive your Social Security benefits check. You will automatically be enrolled in Medicare at the start of the 25th month of SSDI coverage.

If you qualify for Medicare coverage after being diagnosed with end-stage renal disease, your Medicare coverage will typically begin after receiving three months of dialysis treatment.

If you have been diagnosed with amyotrophic lateral sclerosis (ALS), commonly referred to as Lou Gehrig’s disease, you qualify to be enrolled in Medicare in the first month you receive your Social Security check.

How Do I Enroll for Medicare Coverage If I Have a Disability?

The first thing you need to do if you have a disability is to apply for SSDI. Your disability must meet the standards set by SSA for you to qualify for coverage. Generally, it means that you can no longer work, and your condition is expected to last for at least one year.

Medicare doesn’t play a role in determining who is eligible for disability coverage. You don’t need to take any further steps once the Social Security Administration has approved your SSDI application. All you have to do is wait for two years, and you will automatically be enrolled in Medicare.

Once you have been approved for Social Security Disability benefits, you will automatically be enrolled for Medicare coverage at the start of the 25th month of receiving your SSA benefits. You will receive your Medicare coverage card in the mail during your 22nd month of receiving SSDI benefits.

Once you are approved to join Medicare, you will enjoy coverage for Medicare Parts A and B, also known as Original Medicare.

Medicare coverage

Medicare Part A is usually used to pay for hospitalization and other types of short-term medical care, such as skilled nursing facilities. Medicare beneficiaries generally don’t pay a monthly premium for Part A coverage.

Medicare Part B is used to cater to a wide range of medical services, including doctor and specialist appointments, ambulance services, emergency room services, preventive care, medical equipment, and other medical services. Typically, you will be required to pay a monthly premium for Medicare Part B coverage.

What Medicare Benefits Are Available for People with Disabilities?

Medicare coverage is the same for individuals who qualify based on disability as for those who qualify after turning 65. As long as you are eligible, you will enjoy the full range of Medicare benefits regardless of how you qualified.

As mentioned above, Original Medicare coverage includes hospital stay, home health, doctor appointment, nursing home services, and community-based services.  The healthcare services don’t have to be related to your disability to be covered.

What Happens If You Get Medicare Coverage for Disability and Then Return to Work?

If you qualify for Medicare coverage through disability and then decide to go back to work, you can still keep your coverage for as long as you are medically disabled.  You still won’t be required to pay the Part A premium for the first 8.5 years after returning to work.

Medicare Part A is free for individuals with a disability and under 65 years only if they are approved for Social Security Disability Insurance or enjoy Railroad Retirement Board benefits for at least 24 months or are diagnosed with any of the two diseases mentioned above.

If you are above 65 years old, Medicare Part A is premium-free if you or your partner worked and faithfully paid Medicare taxes for at least ten years.

You also qualify for premium-free Part A if you receive retirement benefits from Social Security Administration or are eligible for these benefits, but you haven’t filed for them yet.

What Happens to Your Medicare Coverage When You Turn 65?

Nothing changes much when you turn 65. Basically, you lose your entitlement to Medicare coverage based on disability and become entitled based on age.

In simple terms, you get another chance to enroll for Medicare coverage afresh since you will have a second Initial Enrollment Period of seven months.

Medicare coverage

If you decided not to take Medicare Part B when you were eligible through disability, you would now be automatically enrolled in Medicare Part B. Your new Medicare card will be mailed to you at least three months before your 65th birthday.

During this time, you can also choose to enroll in Medicare Advantage or the Part D drug prescription plan.  Once you have enrolled in Medicare Part B, you can enroll in a Medigap plan if you wish.

Does Medicare Cover Every Medical Service?

The simple answer is “no.”  Medicare doesn’t cover several medical services.  You can always check out the comprehensive list of what is covered on the official Medicare website.

Some of the medical services that Medicare doesn’t cover include:

  • Vision care services.
  • Dental services
  • Long-term care.
  • Hearing aids.
  • Cosmetic surgery.

However, it doesn’t mean that you can’t have a coverage plan for these services.  A significant number of Medicare beneficiaries usually purchase Medicare Advantage to cover vision, dental, hearing aids, and many other added benefits.

You should also consider purchasing a long-term care insurance plan if you think you might require long-term care in the future.  Such a plan can save you a lot of money in the long run.


You will automatically be enrolled in Medicare Parts A and B after 24 months if you are approved for Social Security Disability benefits. The Medicare coverage for individuals who qualify through disability is identical to coverage for individuals who qualify after turning 65.

Individuals with a disability and want to add prescription drug coverage to the Medicare plan are free to do so. They can also opt to enroll in a Medicare Advantage plan which could replace Medicare Parts A, B, and D.

Do you have any questions or concerns regarding Medicare coverage that need expert advice? Our experienced team of licensed Medicare agents is always ready to help you.

Contact us today to speak to a licensed Medicare agent who will listen to you and guide you accordingly.