Medicare Advantage for Disabled Persons Under 65

In this article...
  • Learn about the Medicare Advantage (Medicare Part C) plan options for beneficiaries under the age of 65 who have qualified for Medicare coverage because of a disability. People who have end-stage renal disease (ESRD), Lou Gehrig’s Disease (ALS) and other qualifying disabilities may qualify before 65.

Around 15% of all Medicare enrollees are under the age of 65 and have qualified for Medicare because of a disability.

If you’re under 65 and are eligible for Original Medicare (Part A and Part B), then you are most likely also eligible to enroll in a Medicare Advantage (Part C) plan, which covers everything Original Medicare covers and can also cover additional things like vision, hearing, dental and prescription drugs. 

What Are Medicare Advantage Plans?

Medicare Advantage plans are sold by private insurance companies and are required by law to provide all of the same benefits as Original Medicare (Part A and Part B). On top of those basic benefits, these plans typically offer additional coverage not found in Original Medicare for things like prescription drugs and other benefits.

Some extra Medicare Advantage plan benefits can also include things like:

  • Non-emergency transportation for trips to places like your doctor’s office or the pharmacy
  • Over-the-counter (OTC) allowances for non-prescription medications and products
  • Home meal delivery
  • Modifications to your home such as bathroom grab bars
  • Free memberships to fitness programs like SilverSneakers

Whether or not you’re 65 years old, you can compare Medicare Advantage plans online for free, and you can call to speak with a licensed insurance agent to learn more and find out if you’re eligible.

Eligibility for Medicare Advantage for Disabled Under 65

To become eligible for a Medicare Advantage plan before turning 65 years old, you’ll first need to qualify for and enroll in Original Medicare. 

If you have collected disability benefits from Social Security or the Railroad Retirement Board for 24 months, you will become eligible for Medicare enrollment beginning with your 25th month of receiving benefits.

The Social Security Administration uses the following definition of a disability in order to determine who is and isn’t eligible for disability benefits (and thus Medicare before age 65):

“The inability to engage in any substantial gainful activity by reason of any medically determinable physical or mental impairments which can be expected to result in death or which has lasted or can be expected to last for a continuous period of not less than 12 months.” 

A “medically determinable physical or mental impairment” is defined as:

“An impairment that results from anatomical, physiological, or psychological abnormalities that can be shown by medically acceptable clinical and laboratory diagnostic techniques. The medical evidence must establish that an individual has a physical or mental impairment; a statement about the individual’s symptoms is not enough.” 

Individuals with ALS (Lou Gehrig’s disease) and ESRD (end-stage renal disease) can also qualify you for Medicare under age 65 and do not require the 24-month waiting period. People with ALS become eligible for Medicare as soon as disability benefits begin, and those with ESRD become eligible after three months of dialysis treatments (or immediately if conducting home dialysis) or when hospitalized for a kidney transplant.

Once you are enrolled in both Medicare Part A and Part B, you are then eligible to join a Medicare Advantage plan. The only real requirement beyond that is that you must live in the service area covered by the plan. 

Medicare Special Needs Plans (SNPs)

A Special Needs Plan (SNP) is a particular type of Medicare Advantage that is built to better serve the needs of a beneficiary with a specific health or living condition. Many under-65 Medicare beneficiaries choose to enroll in these plans because of the customized benefits they can offer.

For example, a Special Needs Plan designed for beneficiaries who have liver disease might:

  • Include a network of liver specialists
  • Cover medications commonly prescribed to treat liver disease
  • Offer free fitness and nutrition programs designed to improve the health of those with liver problems
  • Other benefits specifically catered to the needs of someone with liver disease

Under a previous law, beneficiaries under 65 who qualified for Medicare because of ESRD were only allowed to enroll in a Medicare Advantage plan if it was a Special Needs Plan. But a 2020 rule change granted these beneficiaries the same freedom as other under-65 beneficiaries to enroll in any type of Medicare Advantage plan. And additional 2020 legislation promotes more use of home dialysis and other coverage improvements for those with ESRD.

When to Enroll in Medicare Advantage Under 65

After receiving disability benefits for 24 months, you will be automatically enrolled in Medicare Part A and Part B beginning with your 25th month. (If you have ALS, you will be automatically enrolled in Part A and Part B during your first month of disability benefit collection.)

During your 22nd month of collecting disability benefits you will begin your Initial Enrollment Period (IEP). Your IEP lasts for seven consecutive months and marks the time at which you may enroll in Medicare Advantage if you so choose. Although you may enroll as early as your 22nd month of disability collection, your Medicare or Medicare Advantage benefits will not begin until your 25th month. 

Beneficiaries under the age of 65 may also enroll in a Medicare Advantage plan during the Annual Enrollment Period (AEP), which takes place from Oct. 15 to Dec. 7 each year. 

How to Enroll in Medicare Advantage Under 65

The easiest way to enroll in a Medicare Advantage plan before the age of 65 is to connect with a licensed insurance agent who can help you review all of the plan options available in your area, answer any questions you may have and walk you through the enrollment process. 

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