If you're younger than 65 and have been on Social Security
disability benefits for a while, you may have already navigated the process of using
Medicare as your health insurance provider.
Mid age woman using her laptop in dining room for
remote work.
But what happens when you celebrate your 65th birthday? Do you
start the sometimes laborious process all over again? Let's walk through how the
system works and what to expect.
What Is Medicare?
Medicare, the
federal health insurance program established in 1965, was designed to provide
coverage for American adults over age 65. At the time, most Americans retired at
about that age, so Medicare was meant to kick in when coverage from an
employer-based insurance plan ended.
In 1972, Medicare was expanded to cover people younger
than 65 – if they receive Social Security disability benefits. Since then,
qualifying for such benefits has meant meeting several requirements and completing a
24-month waiting period before coverage kicks in.
Two specific conditions are exempt from the 24-month
waiting period: Those with end-stage kidney disease and those with Lou Gehrig’s
disease, which is more formally called amyotrophic lateral sclerosis, or ALS.
Individuals with these diseases can qualify for Medicare no matter their age and
without having to fulfill the two-year waiting period.
No matter which disability you have, once you meet the
outlined requirements, you can access federally subsidized health insurance coverage
via Medicare. This way, you can help you get the care you need when you're unable to
secure health insurance through an employer.
Read: Your Guide to Medicare
Coverage.
Medicare Parts and
Programs
Medicare is broken into four parts, explains Dr. Meena
Seshamani, deputy administrator and director of the Center for Medicare at the
Centers for Medicare & Medicaid Services in Washington, D.C.
Part A, the so-called hospital portion, covers
inpatient care in hospitals, skilled nursing facilities and some types of in-home
health care or hospice care.
Part B, on the other hand, covers services from doctors
and other health care providers, Seshamani says. These services include physical
therapy, preventive care, outpatient care and some medical devices, such as
wheelchairs.
Parts A and B together are considered “Original Medicare” and have
been around since the beginning.
In 2003, Medicare Part C, also called Medicare
Advantage, rolled out. This part includes health plans offered by private companies
approved by Medicare. This coverage is optional and intended to supplement the
coverage offered by Parts A and B.
Part D is the prescription medication piece of
Medicare.
Another program, Medigap, includes both Original Medicare
and a supplemental plan to pay for coinsurance deductibles, explains Kathleen Holt,
a Connecticut-based attorney and associate director for the Center for Medicare
Advocacy. Medigap plans help reduce out-of-pocket expenses for individuals who opt
for this additional coverage.
Aging Up
So, what happens
when individuals with qualifying disabilities turn 65 and become eligible for
Medicare because of their age? In short, nothing.
“Your Medicare coverage will remain the same because
you’ve already met the eligibility requirements for premium-free Part A and Part B
coverage by receiving disability benefits for at least 24 months,” explains Javier
Sanchez, executive director of Medicare programs for CalOptima Health, a
community-based health insurance plan serving low-income residents in Orange County,
California.
He adds that “your 65th birthday doesn’t bring any new
requirements or things to do. You don’t need to re-enroll or complete any paperwork
to continue getting Medicare benefits for a disability.”
However, if you want to make changes to your
enrollments, your 65th birthday would be the time to do it, says Bob Rees, vice
president of Medicare sales and member loyalty with eHealth Inc., a health insurance
broker and online resource provider headquartered in Santa Clara, California.
"If you’re already enrolled in Medicare pre-65 due to
disability, turning 65 essentially gives you a second enrollment opportunity,” he
explains.
More specifically, aging up means you can take another look at the
coverage you’ve been getting and make changes or additions to better suit your needs
going forward. For example, if you declined Medicare Part B when you first enrolled
in Medicare, “you will be automatically enrolled in Part B now,” Rees explains. You
can enroll in Medicare Advantage, Part D or a Medicare supplement plan as well, he
points out.
Seeking Help With
Selections
Medicare can seem complicated, and the dizzying array of
options and parts can make you wonder if you’re getting the coverage you need.
“It may be beneficial to seek advice from a Medicare
consultant or counselor to make sure you're taking full advantage of the programs
and benefits available to you as an age-based Medicare recipient,” Rees says.
A free resource for such consultation is the State
Health Insurance Assistance Program, or SHIP, a grant-based program in every state,
D.C., Puerto Rico, Guam and the U.S. Virgin Islands. SHIP programs are staffed by
experts who are trained in working one-on-one with individuals to match them with
the appropriate Medicare options for their specific needs. You can find your local
program and set up an appointment at the SHIP website.
Medicare.gov is also a great resource for learning more
about the options and navigating the process of enrollment or changing your
selections. CMS also staffs a 24/7 call center at 1-800-Medicare where you can check
your eligibility and get help getting oriented around Medicare, Seshamani notes.
Helping people figure out the best options for them “is really a top priority for
us,” she says.
Source: https://health.usnews.com/senior-care/articles/will-disability-benefits-change-after-65
