Medicare is best known as insurance for adults aged 65 and above, but children and adults under the age of 65 can also enroll in Medicare if they qualify due to a covered disability or medical condition.
Medicare for Adults Under Age 65
Adults under the age of 65 qualify for Medicare if they meet ANY of the following criteria:
- They have received Social Security Disability checks for at least 24 months. At the end of 24 months, they will be automatically enrolled in Medicare Parts A and B.
To qualify for Social Security Disability benefits, the adult must be unable to work due to his or her medical condition. The disability must be expected to last at least 12 months or result in death. In addition to meeting the disability requirement, the individual must have worked long enough to earn the number of work credits needed to be eligible. In general, you need 40 credits to qualify, but this varies depending on the age when the disability begins. Younger workers may be eligible with fewer credits.
- They have end-stage renal disease (ESRD) and need dialysis or a kidney transplant. There is no waiting period in this situation. Individuals can apply for Medicare at their local Social Security office.
- They have Lou Gehrig’s disease (ALS). This qualifies them for automatic enrollment in Medicare when they begin receiving disability benefits.
Medicare for Children
A child of any age with ESRD may qualify for Medicare based on certain criteria.
The child must meet ONE of these requirements. He or she:
- Was diagnosed with end-stage renal disease.
- Needs regular dialysis or has had a kidney transplant.
At least one of the child’s parents must also meet ONE of these requirements. The parent must:
- Have earned at least six work credits within the past three years by working and paying SS taxes.
- Be receiving or be eligible for Social Security or Railroad Retirement Board benefits.
Medicare coverage will end one year after the completion of dialysis or three years after a kidney transplant.
Medicare for Disabled Adult Children (DAC)
A disabled adult child is an unmarried individual who is over the age of 18 and became disabled before the age of 22. Instead of receiving benefits based on their own work history, disabled adult children receive disability benefits as a survivor or dependent under a parent’s work record. If they meet these criteria, they are eligible for Medicare. They will receive Medicare immediately if they have ESRD or ALS.
Choosing the Right Medicare Coverage
Once a disabled individual has Part A and B, he or she can enroll in a Medicare Advantage plan, PDP, Medigap plan, or C-SNP (if one is available). Medigap plans for those under 65 are regulated at the state level. While some states guarantee that applicants under 65 will have access to at least one Medigap plan, other states offer no such guarantee. For instance, Arizona does not require Medigap insurers to offer plans to disabled Medicare beneficiaries under the age of 65.
Individuals who qualify for Medicare due to a disability have complex health issues and medical needs. You can play an important role in helping them navigate their Medicare options to find the best coverage for their specific needs.
If you have additional questions regarding Medicare Enrollment for under-65 disabled beneficiaries, including children, please contact us today. The team at Western Asset Protection is committed to supporting you and helping you achieve your career goals.