Getting Medicare If You Have a Disability

Medicare is available for certain Florida and Texas residents with disabilities who are under 65. These people must have received Social Security Disability Benefits for two years or have ESRD or ALS.

There’s a five-month waiting period after a Medicare beneficiary is deemed disabled before they begin to collect Social Security Disability Benefits. Those with ESRD and ALS do NOT have to collect benefits for two years to qualify for Medicare.

The criteria for Medicare eligibility for those with ESRD and ALS are:

  • ESRD — Typically three months after a course of regular dialysis or after a kidney transplant.
  • ALS — Immediately after collecting Social Security disability benefits.

Lacayo Group Insurance will identify the Medicare benefits available for people with disabilities and explain how to enroll.

You’re Under 65 and Have a Disability

In this case, you automatically get Medicare Parts A and B after you receive one of these:

Disability benefits from Social Security for two years
Certain disability benefits from the RRB for two years

Some people in Florida may choose to delay Part B enrollment. If you automatically get Parts A and B, you don’t need to sign up. You’ll get your Medicare card in the mail three months before your 25th month of disability benefits. If you don’t get this card or other questions come up, contact your local Social Security office.

When you choose how to get your Medicare coverage, you may decide on:

Note: There are certain times when you can join these plans or make changes to your existing coverage.

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If You Have ALS

ALS stands for Amyotrophic Lateral Sclerosis, and is also called Lou Gehrig’s disease. In this case, you automatically get Medicare Parts A and B the month your disability benefits get going.

Some folks may choose to delay Part B enrollment. If you automatically get Parts A and B, you don’t need to sign up. You’ll get your Medicare card in the mail the month that your disability benefits start.

When ALS patients in Florida and Texas choose how to get their Medicare coverage, they may decide on:

Note: There are certain times when you can join these plans or make changes to your current coverage.

Frequently Asked Questions

What Medicare Benefits Are Available for Those with Disabilities?

Medicare coverage is the same whether you qualify based on disability or age. Eligible people have access to the FULL range of Medicare benefits. Your coverage includes certain hospital, home health, nursing home, physician, and community-based services. The healthcare services do NOT have to be related to your disability to be covered.

Can People with Dementia, Mental Illness, and Other Long-Term and Chronic Conditions Get Coverage?

Yes. There are NO illnesses or pre-existing conditions that would disqualify you for Medicare coverage. As a beneficiary, you’re entitled to a personal assessment of whether you meet coverage requirements.

Can Working People (Under 65) with Disabilities Also Get Medicare?

Yes. Medicare eligibility for these people falls into three time frames:

  • Trial Work Period (TWP): extends for nine months after a disabled person gets a job.
  • Extended Period of Eligibility (EPE): 93 months after the end of the TWP.
  • Indefinite Access to Medicare: as long as the person remains medically disabled, he or she can continue to receive Medicare benefits — even after the 8.5 year period of extended coverage has ended.

I’m under 65 and have a disability. I want to return to work. Can I keep my Medicare benefits?

Yes. You can keep your coverage for as long as you’re medically disabled. If you go back to work, you won’t have to pay your premium for Part A for the initial 8.5 years. You’ll pay the premium after that.

If you cannot afford it, you may qualify for the Medicare Savings (QMB) Program that helps pay premiums and other cost-sharing.

For more information on Medicare and your coverage options in Florida or Texas, give Lacayo Group Insurance a call.