Do You Qualify for Medicare With a Disability?

In this article...
  • Your out-of-pocket medical bills could be lower if you have a disability. Learn how qualifying for Medicare could broaden your health insurance options.

If you're age 65 or older, you will qualify for Medicare automatically. But you can also qualify for Medicare if you have a disability as determined by the Social Security Administration (SSA) if you're at least 20 years old. Learn what the SSA considers a disability and what additional benefits you may be entitled to. 

How Does Social Security Define Disability? 

The SSA defines disability as the inability to participate in gainful activity due to physical or mental impairments. Additionally, the disability has had to occur for a minimum of 12 continuous months. Disability benefits through SSA can be granted at any age. Once a disability beneficiary is at least 20 years old and has been declared disabled for 24 continuous months, they can qualify for Medicare. Only a child diagnosed with End-Stage Renal Disease (ESRD) will qualify for Medicare before turning 20 years old. 

Primary Disability Categories and Requirements

The SSA determines disability eligibility through the examination of medical records, expert consults and a claimant's self-report of activity limitations. The scope and severity of health issues that lead to disability determinations are different for each individual. The SSA categorizes disabilities into the following groups

  • Sensory and speech disorders
  • Musculoskeletal conditions
  • Cardiovascular and respiratory illnesses
  • Neurological disorders
  • Cancer and immune system disorders
  • Mental health conditions
  • Congenital disorders
  • Endocrine and digestive conditions
  • Skin disorders

Can Disability Benefits Stop? What Happens to Health Insurance? 

If it is determined that you have recovered from your disability and can sustain gainful activities, such as holding a full-time job, the SSA may discontinue your benefits. It's a good idea to communicate with the Social Security Administration about your work status, as changes in the law have allowed beneficiaries to continue Medicare benefits after losing disability benefits. 

Types of Social Security Disability Benefits: SSI vs. SSDI

Most people are awarded either Supplemental Security Income (SSI) or Social Security Disability Insurance (SSDI) benefits. SSI is based on financial need, and SSDI is awarded if you have a minimum work history. Individuals with SSI may qualify for Medicaid in their home state. In certain instances, one person may have both SSI and SSDI. Regardless of which disability benefit you receive, you will not become eligible for Medicare until you've been disabled for 24 months. 

How Does Having a Disability Affect Insurance Options? 

Whether you're already age 65 or exploring Medicare options as a disabled adult, it's important to know that the number of insurance options increases once you qualify for Medicare. You may choose to stay with traditional Medicare, purchase a supplement policy or enroll in a Medicare Advantage plan. Depending on your financial need, you may qualify for Medicare and Medicaid, which is commonly called dual eligible. Medicare Advantage plans are available in a variety of plan types for people who are dual-eligible, in long-term care facilities or have chronic special needs. 

Special Needs Plans With Medicare

If you or a loved one has a specific chronic illness, requires nursing care, or becomes eligible for Medicaid, there are Medicare plans designed to meet your needs. Medicare plans for individuals with special needs offer coverage for services typically covered by traditional Medicare with the addition of enhanced benefits, such as vision, dental, transportation assistance and meal delivery. Furthermore, you can transition to a special needs plan as soon as you meet the criteria. There is no need to wait for Annual Open Enrollment.