Understanding Medicare Coverage for People with Disabilities

According to the Centers for Disease Control and Prevention, about 1 in 3 American adults with disabilities have healthcare needs they cannot address due to the cost barrier. There are 61 million adults in the US living with disabilities, and among them, approximately 20 million cannot access the resources they need to improve their health and quality of life.

It is therefore vital for individuals with disabilities to be made aware of all the healthcare programs they can realistically access. One such program that aims to reduce out-of-pocket medical spending is Medicare, a federal insurance program that subsidizes the healthcare costs for certain demographics in the United States.

Who is eligible for Medicare?

Medicare is usually only available to adults aged 65 and older. However, adults under the age of 65 can also qualify for Medicare if they have been approved for Social Security Disability Insurance (SSDI) benefits. Only individuals with at least 40 Social Security work credits within the past 10 years are eligible for an SSDI.

What does Medicare cover?

Medicare has three parts, with each of them covering different healthcare services. These include Medicare Parts A, B, and D. Medicare Part A is hospital insurance and covers care services in different healthcare institutions, including hospitals, nursing facilities, hospice cares, and certain home care services. Meanwhile, Medicare Part B acts as medical insurance and covers outpatient care, including doctor’s services, medical equipment, testing, and ambulance and emergency services. Lastly, Medicare Part D covers prescription drugs.

If you want all three plans under a single package, you can opt for Medicare Part C, which is a Medicare bundle offered by private insurance companies. It is also known as Medicare Advantage. Kelsey Care Advantage outlines what a Medicare Advantage plan covers — on top of Parts A, B, and D, Advantage plans also include value-added benefits, such as vision, dental, and hearing coverage. Medicare Advantage plans can also provide transportation to medical appointments and facilities, which can be convenient for individuals with limited mobility.

How much does Medicare cost?

Adults under the age of 65 are not required to pay monthly premiums for Medicare Part A if they have Social Security or Railroad Retirement benefits. On the off chance that an individual does not qualify for free premiums, Part A costs $259 or $471 per month. The amount depends on how long their spouse has been paying Medicare taxes. For hospital stays, a $1,484 deductible will be charged per benefit period. Meanwhile, Medicare Part B costs an annual deductible of $203. After which, individuals are required to share 20% of the cost for the following services: doctor’s services, medical equipment, and outpatient therapy.

For Medicare Part D, the cost of one’s monthly premium depends on their income and IRS tax returns. For instance, individuals with a yearly income under $88,000 pay nothing on top of their plan premium, while individuals with a yearly income above $500,000 are required to pay $77.10 monthly on top of their plan premium.

The Kaiser Family Foundation explains that the cost of Medicare Advantage plans can vary depending on your insurer as well. Their reports show that the average Medicare monthly premium costs $25, though many can go for as low as $0. Plans with more value-added benefits can cost as high as $100 per month.

How do I apply for Medicare?

Individuals will automatically be enrolled in Medicare Parts A and B 24-months after getting approved for SSDI. However, there are exceptions for certain disabilities. Individuals with amyotrophic lateral sclerosis get enrolled after the first month on SSDI. On the other hand, individuals with the end-stage renal disease get enrolled into Medicare after three months of dialysis.

Individuals who want the added coverage of Medicare Advantage will have to apply to a private insurer after being enrolled into Medicare Parts A and B. To join a Medicare Advantage Plan, simply research the plans available in your area. Then fill out the necessary application forms. On top of your basic information, most insurers will also ask for your Medicare number and the date your coverage took effect.

What are my other options?

If you lack the work credits necessary to qualify for SSDI approval, you can consider applying for Supplemental Security Income. As stated in our article, ‘Preparing to Live Independently with Disability‘, an SSI is a government-sponsored monthly stipend given to limited-income individuals with disabilities. Individuals who earn a certain amount of income will not qualify for SSIs.

The Social Security Administration also notes that certain states also sponsor Medicaid medical assistance programs for individuals on SSI Benefits. Like Medicare, Medicaid covers hospital bills, physician costs, prescription drugs, and other health expenses.

Living with a disability can be very demanding financially, especially when it comes to healthcare costs. Enrolling in Medicare can help reduce out-of-pocket costs and give you access to the resources that can address your healthcare needs.

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