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Can I Qualify for Medicare if I have a Disability?

August 14th, 2015

Medicare is well-known for providing health insurance for people age 65 and older. However, Medicare can also provide health coverage for younger people with disabilities, so if you have a disability, it is important to know how you may qualify for Medicare. Medicare

The first step is to apply for disability benefits through the Social Security Administration. To qualify for Social Security disability insurance (SSDI) benefits, you must not be working a substantial amount, you must have paid FICA taxes for a long enough period to qualify, and you must have a severe medical condition that prevents you from working and has lasted or is expected to last at least one year, or result in death. If you have not paid enough into the system with your taxes, then you may still be able to apply for Supplemental Security Income (SSI), if you meet the income and asset limits.

Once you have been entitled to Social Security disability benefits, or Railroad Retirement Board benefits, for 24 months, then you will automatically be enrolled in traditional Medicare (Parts A and B), as opposed to a Medicare Advantage plan (Part C). If you wish to switch to Medicare Advantage, or enroll in Medicare Part D prescription coverage, you may do so during your initial enrollment period, which starts three months before your 25th month of disability and ceases three months after your 25th month of disability. You may also make such changes during the yearly enrollment period, which is from October 15 to December 7 each year.

As noted above, after becoming entitled to SSDI benefits, there is a two-year waiting period to become eligible. However, there are two exceptions. People with amyotrophic lateral sclerosis (ALS) can get Medicare when they are entitled to receive disability benefits. For people with end-stage renal disease with kidney failure who require a kidney transplant or ongoing dialysis, Medicare coverage can start three months after your dialysis starts.


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More Mental Health Costs Now Covered by Medicare

February 19th, 2014

Beginning this year, Medicare will cover more mental health care costs for older adults, addressing a long-standing issue. However, some problems with Medicare mental health coverage remain.

For many years, there was an unjustified disparity between Medicare coverage for mental health care compared to coverage for other medical services. While Medicare paid 80 percent of the bill for most medical services (after a relatively low annual deductible), a much smaller percentage of mental health services was covered. However, Congress passed legislation that began phasing in more coverage starting in 2008, and the phase-in is now complete: beginning January 1 of this year, Medicare covers 80 percent of mental health services.

While the change is welcome, full parity for mental health services under Medicare has not been reached. A lifetime cap of 190 days for inpatient psychiatric care still applies, while there is no such cap for other inpatient medical care paid for by Medicare. Meanwhile, it is unclear whether there is otherwise equal treatment of mental health services covered by Medicare compared to other medical and surgical services.

Adding to the difficulties faced by older adults who need mental health services, a study published recently in JAMA Psychiatry revealed that just over half of psychiatrists said they were willing to take payments from Medicare in 2010, a drop of 20 percent since 2005. This is due in part to the fact that Medicare reimbursement rates are relatively low when the amount of time that providers spend with patients is taken into account.

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