medicare for disabled

Some people with disabilities under the age of 65 may be eligible for Medicare coverage. Eligible applicants must have earned Social Security Disability payments for at least 24 months, had End-Stage Renal Disease (ESRD), or have Amyotrophic Lateral Sclerosis (ALS, generally known as Lou Gehrig’s disease). Beneficiaries must wait five months after their disability has been approved before receiving Social Security Disability payments. People with ESRD and ALS are eligible for Medicare immediately, unlike those with other forms of disability who must wait 24 months before receiving benefits.

Individuals with ESRD or ALS must meet the following criteria to be eligible for Medicare:

• End-Stage Renal Disease (ESRD) is often diagnosed three months into a regular dialysis treatment or after a kidney transplant has been performed.
• ALS – Immediately following earning Social Security Disability benefits.

For the most part, those who meet the requirements for Social Security Disability are automatically enrolled in both Parts A and B. Those who are eligible for Medicare but not for Social Security must pay a monthly Part A premium on top of the Part B premium.

HOW CAN DISABLED PEOPLE JOIN MEDICARE?

After waiting the required amount of time, those who are approved for SSDI benefits will automatically be enrolled in Medicare and sent a Medicare card in the mail. If this doesn’t occur or if you have any other questions, you should get in touch with your neighborhood Social Security office.

WHAT MEDICARE BENEFITS ARE AVAILABLE FOR PEOPLE WITH DISABILITIES?

In terms of benefits, persons who qualify for Medicare due to disability receive the same package as those who qualify due to age. If you qualify for Medicare, you can receive all of the advantages that Medicare offers. The services provided by hospitals, nursing homes, home health agencies, physicians, and community clinics are all included. Medical care is paid for regardless of whether or not it has anything to do with the patient’s impairment.

PEOPLE WITH DEMENTIA, MENTAL ILLNESS, AND OTHER LONG-TERM AND CHRONIC CONDITIONS CAN OBTAIN COVERAGE

Medicare accepts everyone regardless of whether they have any preexisting diseases or illnesses.

Each recipient is entitled to a personalized analysis of whether or not they meet coverage requirements.

Medicare coverage should not be rejected because of a patient’s condition, diagnosis, or any other “Rules of Thumb,” but there are requirements that must be followed for specific treatments. Specifically, consider the following examples:

• Beneficiaries should not be denied coverage just because they will need health care for a long period.
• Insurance coverage should not be revoked from a beneficiary only because their underlying condition will not improve.

COVERAGE SHOULD NOT BE DENIED SIMPLY BECAUSE THE SERVICES ARE “MAINTENANCE ONLY” OR BECAUSE THE PATIENT HAS A PARTICULAR ILLNESS OR CONDITION

Even if the projected outcome of physical therapy and other therapies is not an improvement but rather maintenance or slowing of deterioration, they may still be covered.

The Medicare program has been criticized for its potential to improperly deny coverage for medically essential care to those with specific diseases.

These and other chronic diseases are covered under Medicare if the treatment prescribed by a doctor meets Medicare’s standards.

• The onset of Alzheimer’s.
• Ailments of the mind.
• Relapsing-remitting multiple sclerosis.
• That awful disease, Parkinson’s.

In cases when a patient’s enrollment in Medicare or coverage seems to have been denied unjustly, a doctor should be contacted for assistance.

Individuals with Disabilities in the Workforce Are Eligible for Medicare Coverage

There are three different periods in which disabled workers can begin receiving Medicare benefits. The first is the so-called “trial work period,” which lasts for 9 months after a disabled person starts new employment. Two, 93 months (or seven and a half years) after the end of the trial work period. After that 93 months are up, there will be an indefinite pause. (For the law, see 42 U.S.C. 422(c), and for the rule, see 20 C.F.R. 404.1592). Remember that during each of these periods, Medicare coverage is only guaranteed if the individual continues to meet the Social Security Administration’s medical criteria for disability.

• Work Experience Period of Evaluation (TWP)

During a maximum 9-month “trial work” period during any rolling 5-year time period, a person receiving Social Security disability benefits is entitled to continue receiving Medicare in addition to Social Security income. For additional information about the monthly earnings level, as well as the requirements for self-employment, visit http://www.ssa.gov/oact/cola/twp.html. The nine-month trial period need not be worked continuously. Disability status and eligibility for Social Security and Medicare benefits will be maintained during the trial employment term regardless of whether or not the individual can perform the work. However, benefits during the trial employment period could be terminated if there is independent evidence that the individual is no longer disabled. After the nine-month trial work period ends, the person’s earnings during that time could be taken into account for deciding whether or not to terminate their disability benefits (such as Social Security and Medicare) altogether.

• Lengthened Eligibility Window (EPE)

After a trial term of working while receiving Medicare, coverage can be maintained if the individual still has the debilitating handicap but has generated money at or above the “Substantial Gainful Activity” level.

After the 9-month trial work period ends, the new eligibility period may last for an additional 93 months. This brings the total time an employee is eligible to work to over eight and a half years. However, even if the recipient’s SSDI cash benefits end, they are still covered by Medicare’s hospital insurance at no additional cost during this period (Part A). Fees for supplemental health coverage must be paid (Part B). Employers with more than 100 workers are mandated to provide health insurance to disabled workers and their spouses, with Medicare serving as the supplementary insurer in such cases. Medicare will continue to be the principal healthcare insurance payer for disabled people whose employers are too small to offer group coverage.

• Indefinite Access to Medicare

If a disabled worker continues to be disabled after their eight-and-a-half-year period of extended Medicare coverage ends, they are still eligible to receive benefits. The individual (who must be younger than 65) must then pay both the Part A premium and the Part B premium. How much of a premium is required for Part A is determined by how many quarters of employment either the individual or his spouse has contributed to Social Security. Assistance with these premiums is available through a state-run buy-in program for Qualified Disabled and Working Individuals for people with low incomes and assets of less than $4,000 ($6,000 for a couple).