What Disabilities Qualify for Medicare Under 65?

Reviewed and Updated by Kelsey Davis,

Most people are not eligible for Medicare until they turn 65, but that’s not the case for those with a long-term disability or disease. Did you know roughly 9.1 million people under 65 with disabilities are enrolled in Medicare? It’s important to understand the role of Medicare in these qualifying conditions so you can have the best coverage including Medicare Advantage, Medicare Supplements, or Part D plans.

ESRD Medicare Coverage

ESRD Medicare coverage can provide coverage for permanent kidney failure that requires dialysis or a kidney transplant. To be eligible, you must be diagnosed with end-stage renal disease (ESRD) and qualify for SSDI (Social Security Disability Insurance) or Social Security retirement benefits/railroad retirement benefits based on your work history.

Original Medicare covers a kidney transplant, hospital inpatient dialysis, and outpatient dialysis from free-standing facilities and hospitals. However, Medicare does not cover surgeries or services leading up to dialysis. Fortunately,  Chronic Special Needs Plans (CSNPs) can help. CSNPs are a type of Medicare Advantage plan for people with chronic health conditions – like ESRD! This is an excellent option if you are looking for more coverage beyond Original Medicare.

For more information on ESRD Medicare Coverage, click here or fill out this form to get in contact with a licensed agent to learn about enrolling in a Special Needs Plan.

ALS Medicare Coverage

If you have been diagnosed with ALS, also known as Lou Gehrig’s Disease, you will be automatically enrolled in Original Medicare (Part A and B) the first month you receive Social Security Disability Insurance (SSDI) or a railroad disability annuity check.

ALS Medicare coverage includes hospital, hospice, skilled nursing, and home health services through Part A. Preventative services, mental health, lab tests, x-rays, emergency transportation, and medical equipment are covered through Part B.

Once you are enrolled in Original Medicare, you are eligible to enroll in a Medicare Advantage or Part D plan. Medicare Advantage plans offer additional health benefits like hearing, dental, and vision coverage. Part D plans provide prescription drug coverage. Plus, you may be eligible to enroll in a Medicare Supplement plan. These plans work alongside Original Medicare and can cover coinsurance, copayments, and deductibles.

Want to learn more about Medicare Advantage, Part D, and Medicare Supplement plans that are available to you? Click here to get in contact with a licensed agent.

Other Qualifying Disabilities

You are automatically enrolled in Original Medicare (Part A and B) after you have received Social Security disability benefits for 24 months or have certain disability benefits from the RRB for 24 months. If you qualify, you will get your red, white, and blue Medicare card in the mail 3 months before your 25th month of disability.

The following is a list of qualifying impairments with relevant examples.

  • Musculoskeletal disorders (back injuries and joint/bone dysfunction)
  • Cardiovascular conditions (heart failure and coronary artery disease)
  • Senses and speech issues (vision and hearing loss)
  • Respiratory illnesses (COPD, cystic fibrosis, or asthma)
  • Neurological disorders ( cerebral palsy and epilepsy)
  • Immune system disorders (HIV/Aids, lupus, and rheumatoid arthritis)
  • Mental disorders (PTSD, Schizophrenia, autism, and anxiety)
  • Skin disorders (cellulitis and dermatitis)
  • Digestive tract problems (Crohn’s disease, hepatitis, and liver disease)
  • Kidney problems (ESRD and genitourinary problems)
  • Cancer (Breast cancer, prostate cancer, etc.)
  • Hematological disorders (sickle cell disease, hemophilia, and bone marrow failure)

Please note, each condition and qualifying situation is unique, and we can not guarantee qualification or coverage. If your impairment is not on this list, you may still be eligible for disability benefits under other SSA guidelines.

I’m Disabled and Don’t Have Insurance. Can I get Medicare Now?

Sometimes. If you have a qualifying disability, like ALS or ESRD, you may be able to get Medicare now. Alternatively, if you receive SSDI (Social Security Disability Income) for at least 25 months, you can get Medicare.

How to Enroll in Coverage Beyond Original Medicare

Health costs can quickly add up. It’s great that Original Medicare is available with qualifying disabilities to people under 65, but what about coverage beyond Original Medicare? Medicare Advantage, Medicare Supplements, and Part D plans can add additional benefits and help you save on out-of-pocket costs.  However, different states have different laws and some plans may not be at the best possible rate. A licensed agent is your best bet to compare your different options and enroll in the coverage you need at the price you want. Call us today at 844-431-1832 or fill out this form to get in contact with a licensed agent.

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