- June 11, 2020
Today we’re going to dive into the topic of disability and Medicare. We’ll briefly look at how to qualify for Medicare, then explore what your options are if you’re approaching 65 and are currently enrolled in Medicare due to a disability. Let’s get started.
How to Qualify for Medicare
There are three different ways you can qualify for Medicare benefits. The most common way people qualify for Medicare is by turning 65. As long as you’ve paid into the Medicare tax system for at least 40 quarters (or 10 years’ worth of work), you automatically qualify for Medicare at 65.
The second way people qualify for Medicare is by being diagnosed with a certain health issue. For example, if you've been diagnosed with Lou Gehrig's disease or with permanent kidney failure, you're eligible to enroll in Medicare at any age because of your health issues.
The third and final way people qualify for Medicare is that they’ve received Social Security disability benefits for 24 months. If you've been receiving SS disability checks for 24 months, you are automatically enrolled in Medicare on the 25th month, no matter your age.
Disability and Medicare
If you came into Medicare because of a disability, you were issued a Medicare card. That card has a Part A and B effective date, signifying the day you started Medicare.
Now you're turning 65. Since you already started Medicare, you will not be issued a new card at 65. However, thanks to the fact that you’re now turning 65, you have a second open enrollment period. This gives you a great opportunity to make changes to your plan.
Why would you want to change your plan? When you first went on Medicare because of a disability, you made certain decisions. Maybe you stayed on original Medicare and purchased a Supplemental plan, or maybe you went with an Advantage plan. Now that you’re turning 65, the plan you originally went with may not be a good fit anymore. And thanks to the open enrollment period, if you don’t like the plan you initially went with, you can change it.
Let’s look at what your options are.
Currently on an Advantage Plan
If you started on Medicare because of a disability and enrolled in an Advantage plan, you have two different options when you turn 65.
Switch Advantage Plans
First, you can switch Advantage plans. Maybe there’s something about your plan that you're no longer happy with. If you’re turning 65, you can get off your Advantage plan and switch to a different one. Keep in mind, everything is tied to your birth month. So if you're turning 65 in the month of July, you have three months before and after July to switch to a different Advantage plan.
Switch to Supplemental Plan (Medigap)
The other thing you can do is switch to a Supplemental plan (also called Medigap policies). If you decide to move off of an Advantage plan and switch to a Supplemental plan, you will have a seven month period (again, beginning three months before your birth month). During this seven-month period, you can enroll in any Supplemental plan you want, no health questions asked. In other words, even if you have preexisting conditions, the insurance company has to take you. If you miss this seven-month window, you will have to go through medical underwriting to qualify for a Supplemental plan.
Currently on a Supplemental Plan
For those you who are on Medicare because of disability and chose to go with a Supplemental plan, you can also make changes during the open enrollment period.
Switch to an Advantage Plan
First, you can switch from your Supplemental plan to an Advantage plan. Again, everything is going to be tied to your 65th birth month, so you have three months before and after your birth month to make that switch.
If you switch from a Supplemental plan to an Advantage plan during this time, any Advantage company is going to take you.
Switch to New Supplemental Plan (Medigap)
The other option you have is to switch to a new Supplemental plan. More than likely, if you got a Supplemental plan through disability, you're paying higher rates. Once you turn 65, you’ll be charged the same rate as anyone else coming into Medicare at 65, meaning your rates should go down significantly.
Again, during this seven month period, there will be no health questions asked whatsoever, so you can get any Medigap policy you want. During this time, you’re also able to add any prescription drug plan to your coverage, regardless of pre-existing health conditions.
If you qualified for Medicare because of a disability and are now turning 65, you have a great opportunity to make changes to your plans. If you’re currently on an Advantage plan, you can either switch to a new Advantage plan or enroll in a Supplemental (Medigap) plan. If you’re currently enrolled in a Supplemental plan, you can either switch to an Advantage plan or get a new Supplemental plan. During this 7-month period, you can enroll in any plan you’d like, no health questions asked.
We understand how difficult making the right Medicare decisions can be. To take the next step, watch our full course here, or schedule a free one-on-one call with a certified Medicare School Guide who can answer your questions, compare plans options, and even help you enroll. Click here to get started.
MedicareSchool.com started in 2009 to provide an unbiased and education-focused service to individuals approaching Medicare enrollment. Since then, MedicareSchool.com has helped over 100,000 people find and enroll in the best Medicare plans that fit their budget.