You’ve just been diagnosed with a disability and may qualify for Medicare. Now what? The type of disability has everything to do with when your coverage begins, and whether you are automatically enrolled or if you need to take steps to start the enrollment process.

If you have a qualifying disability, you must first file for disability benefits through Social Security. Approval of the request by Social Security is an important first step to take before you can be considered eligible for Medicare.

After you have received disability benefits from Social Security (SSA) or the Railroad Retirement Board (RRB) for 24 months, you will automatically be enrolled in Original Medicare. Your Original Medicare coverage will start the first day of month 25. If you want additional coverage through other types of Medicare plans, such as a Medicare Advantage plan or a Part D drug plan, click here to learn how and when to enroll. For more information, contact Social Security at 1-800-772-1213; TTY 1-800-325-0778 (7 a.m. – 7 p.m., local time, Monday – Friday).

The Exceptions

If you have Amyotrophic Lateral Sclerosis (ALS), also called Lou Gehrig’s disease, you will be automatically enrolled in Original Medicare (Parts A and B) as soon as your Social Security disability benefits begin. There is no waiting period for Medicare coverage. Apply for benefits at your local Social Security office at 1-800-772-1213; TTY 1-800-325-0778 (7 a.m. – 7 p.m., local time, Monday – Friday).

If you have End-Stage Renal Disease (ESRD), Medicare.gov says you can get Medicare no matter how old you are if your kidneys no longer work, you need regular dialysis or have had a kidney transplant, and one of these applies to you:¹

• You’ve worked the required amount of time under Social Security, the Railroad Retirement Board (RRB), or as a government employee.
• You’re already getting or are eligible for Social Security disability benefits or Railroad Retirement benefits.
• You’re the spouse or dependent child of a person who meets either of the requirements listed above.

Contact Social Security for more information about the amount of time required to be eligible for Medicare. If you get benefits from the Railroad Retirement Board (RRB), contact the Railroad Retirement Board.

Enrolling in Medicare is your choice, but if you qualify for Part A, you may also want to get Part B to get the full benefits available under Medicare to cover certain dialysis and kidney transplant services.

If you’re on dialysis, Medicare coverage usually starts on the first day of the fourth month of your dialysis treatments. However, coverage may start as early as the first month of dialysis if you meet both of these conditions:¹

• You take part in a home dialysis training program offered by a Medicare-approved training facility to teach you how to give yourself dialysis treatments at home.
• Your doctor expects you to finish training and be able to do your own dialysis treatments.

Learn more about how to sign up for Medicare if you have End-Stage Renal Disease.

For more information about Medicare eligibility requirements, visit Medicare Made Clear.

For more information, contact the Medicare helpline 24 hours a day, seven days a week at 1-800-MEDICARE (1-800-633-4227), TTY 1-877-486-2048.  You may also contact Cruson Insurance Agency at (972) 896-3851 to speak with a Trusted Health Plan Advisor, or click here to have someone call you.

Resources:

Qualifying for Medicare Due to Disability – Special Circumstances, Special Considerations: Medicare Made Clear

I Have a Disability: Find out how Medicare works for people who have a disability. Medicare.gov

How to Sign up for Medicare if you have End-Stage Renal Disease (ESRD): Medicare.gov

1 How to Sign up for Medicare if You Have End-Stage Renal Disease (ESRD): Medicare.gov, April 3, 2015