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Follow the steps below if you need to actively enroll in Medicare. If you decide to enroll in Medicare during your Initial Enrollment Period, you can sign up for Parts A and/or B by: Visiting your local Social Security office. Calling Social Security at 800-772-1213.
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When to sign up for Medicare. Most people sign up for Part A (hospital insurance) and Part B (medical insurance) when they're first eligible, typically at age 65. It's important to sign up promptly to avoid gaps in coverage or late enrollment penalties.
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- Overview
- Early eligibility for Medicare
- Social Security, disability, and Medicare
- Eligibility for people with ESRD
- Eligibility for people with ALS
- How to enroll early
- What is Extra Help?
- Summary
Medicare usually requires that people are 65 years of age or older to qualify for a plan. However, some individuals can qualify for Medicare earlier if they have a disability or certain medical conditions.
These medical conditions include end stage renal disease (ESRD) and amyotrophic lateral sclerosis (ALS).
A person can qualify for Medicare insurance when they are under 65 years of age if they have one of the following conditions:
•a disability that a doctor can confirm in writing
•ESRD
•ALS
In these instances, a person may be able to receive Medicare Part A without paying a premium. Part A covers in-hospital treatment and long-term skilled nursing care.
They may also be able to receive Medicare Part B, which covers medical treatment and consultations, such as doctor’s visits and physical therapy sessions.
A person may have a disability that restricts their ability to work. People with these disabilities may often qualify for Social Security (SSA) or Railroad Retirement Board (RRB) benefits.
Once a person has received these benefits for 24 months, they can start a Medicare plan, even though they are under 65 years of age.
A person with a disability may otherwise have difficulty getting health insurance, as a private insurer may charge them higher premiums due to pre-existing medical conditions.
As a result, Medicare provides a more cost-effective coverage option for people who have disabilities.
Examples of disabilities that may qualify a person for Social Security or RRB benefits include:
•back injuries and other musculoskeletal issues
End-stage renal disease (ESRD) is the final stage of chronic kidney disease and indicates that a person’s kidneys are not functioning.
As a result, the kidneys cannot filter fluids and electrolytes while removing waste. A person with ESRD produces very little urine, if any. The waste that the body usually removes from the body in urine can build up.
This can become fatal without treatment. However, a person can receive dialysis treatments to act as an artificial kidney system and remove waste from the body. Some people with ESRD may require a kidney transplant.
Those with ESRD can qualify for Medicare if they meet the following criteria:
•They have ESRD, and their kidneys are no longer functioning.
•They require dialysis or have had a kidney transplant.
People with ALS, or Lou Gehrig’s disease, can qualify for Medicare when they are under 65 years of age.
ALS is a progressive, neurodegenerative disorder that disrupts a person’s ability to speak, move, eat, and ultimately breathe. The condition has no cure and is eventually fatal.
According to the ALS Association, an estimated 16,000 people in the United States have the disorder. A doctor usually diagnoses ALS between the ages of 40–70 years.
Unlike ESRD, those with ALS can receive Medicare Part A benefits in their first month of receiving Social Security or RRB benefits.
The SSA automatically enrolls a person with ALS in a Medicare plan when they start paying Social Security benefits.
According to a 2017 review in Amyotrophic Lateral Sclerosis and Frontotemporal Degeneration, a person’s monthly costs with ALS under Medicare can total $10,398 during the month of their diagnosis.
A person should contact the SSA with any questions about their work history and eligibility for Medicare by visiting the “Contact Us” section of their site or calling 1-800-772-1213 (TTY: 1-800-325-0778).
If a person receives benefits from the RRB, they can call 1-877-772-5772 to find out more about qualifying for Medicare.
Extra Help is a Social Security program that provides additional financial assistance for people of limited means who need prescription drug coverage through Medicare.
To qualify for Extra Help, an individual must have less than $14,610 in resources. Married couples who live together must have less than $29,160 in combined resources.
The SSA defines resources to include the following:
•bank accounts
•bonds
•mutual funds
People with ESRD, ALS, and certain disabilities may qualify early for Medicare.
Those with ESRD qualify after 2 months of dialysis or after taking a home dialysis training course. People who live with disabilities can apply after 2 years of receiving Social Security benefits.
Individuals with ALS, however, become eligible for Medicare at the same time they can start receiving Medicare coverage.
It is best for individuals to contact Medicare directly to discuss eligibility for their circumstances.
- Rachel Nall, MSN, CRNA
You’ll sign up for Medicare Part A and Part B through Social Security, so you can make both retirement and Medicare choices and withhold any premiums from your benefit payments. If you’re under age 65, you may be eligible for Medicare if you have permanent kidney failure or if you receive Disability benefits.
If you are under 65, you may be eligible to get Medicare earlier if you have a disability, End-Stage Renal Disease (ESRD), or ALS (Lou Gehrig’s Disease). Medicare is divided into four parts: Medicare Part A is insurance for hospitalization, home or skilled nursing, and hospice.
You can enroll in Medicare at anytime during this seven-month period, which includes the three months before, the month of, and the three months following your 65th birthday. The date when your Medicare coverage begins depends on when you sign up.
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