Some individuals may qualify for Medicare before turning 65 if they have a disability. Once you turn 65, however, you’ll need to understand the topic of disability and Medicare. In this article, we’ll look at how to qualify for Medicare and explore what options are available as you approach 65.
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 Disability at any age because of your health issues.
The third and final way people qualify for Medicare is if they’ve received Social Security disability benefits for 24 months. If this is the case, then you are automatically enrolled in Medicare on the 25th month, no matter your age.
What Coverage Options Are Available With 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. 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.
You may consider changing your Medicare plan from what you previously had when you first applied. Maybe you initially 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 chose may not be a good fit anymore. Thanks to the open enrollment period, you can change it if you don’t like it.
Let’s look at what your options are.
Currently on an Advantage Plan
If you started on Medicare Disability and enrolled in an Advantage plan, you have two different options when you turn 65.
Option 1: 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 that everything is tied to your birth month. For example, 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.
Option 2: Switch to a Supplemental Plan (Medigap)
The other option you have is to 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 with 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 need to undergo medical underwriting to qualify for a Supplemental plan.
Currently on a Supplemental Plan
For those who are on Medicare Disability and chose to go with a Supplemental plan, you can also make changes during the open enrollment period.
Option 1: 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.
Option 2: Switch to a 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.
During this enrollment period, there will be no health questions asked whatsoever, so you can get any Medigap policy you want. You can also add any prescription drug plan to your coverage, regardless of pre-existing health conditions.
Learn More About Medicare Disability With Medicare School
At Medicare School, 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 plan options, and even help you enroll.