Understanding Medicare for Disability

By James O'Neal

Despite our age or our experience, we all seem to carry a charming naivete with us wherever we go. We see terrible, unfortunate things happen to everyone around us, but think it couldn’t possibly happen to us.

We’ll never contract a debilitating disease or get into a disastrous car wreck. We’ll never have an accident on the job. “It can’t happen to me.”

The odds aren’t against you, but unfortunately, they aren’t great either. 1 in 8 people will become disabled for five or more years during their career. That gives you a 12.5% chance of developing a major disability in your lifetime.

To safeguard your health and financial security against this, you need disability insurance. If you’re already disabled, you most likely qualify for Medicare for disability coverage. Below, we’ll break down all of your options.

Workplace Disability Insurance Plans

If you currently have insurance through your employer, you may be able to get disability insurance through them. Workplace plans typically include long-term and short-term disability plans.

The short-term plan covers you for up to 3 months and usually covers 60-70% of your salary with a cap of $1,000 a week. The long-term plan kicks in after those 3 months and usually pays 60-67% of your salary with a cap of $5,000-10,000 per month.

If you make commissions or bonuses, these plans generally exclude those and only give you payouts based on your base salary. Clearly, these plans don’t provide you full coverage, so you may need additional insurance.

If you’re already disabled, this ship has sailed, unfortunately. There is still assistance available, however, like Medicare for disability coverage.

Qualifying For Medicare For Disability Coverage

Medicare is one of our nation’s most beloved government programs. A recent Pew study found that 95% of Americans think that Medicare should continue to exist or expand to more recipients. The reasons for its revered status can be found in its simplicity. Once you turn 65 years old, you automatically qualify for Medicare.

If you are looking to receive Medicare for disability coverage, however, it can be more tricky. Of course, if you’re over 65, you qualify for Medicare with or without a disability.

But if you’re under 65, there are few hoops you have to jump through.

Getting Social Security Disability Insurance (SSDI)

In order to receive Medicare benefits for your disability, you first need to qualify for SSDI. In order to get Social Security benefits you first need to meet certain criteria.

The first is that you have to have worked in jobs covered by Social Security. Almost every job is covered these days, so you shouldn’t be concerned here.

The second is that you have to meet the Social Security Office’s definition of disabled. This is how they define it:

  • You cannot do the work that you did before
  • You cannot adjust to other work because of your medical condition(s)
  • Your disability has lasted or is expected to last for longer than one year or result in death

To apply for your SSDI benefits, you can complete their online application or visit your local Social Security office. These applications can take 3-5 months to process, so they recommend that you apply immediately upon becoming disabled.

The application process requires taking a look at all of your medical and work history, so make sure that you compile all of the documentation you can.

What Next?

Once you receive your SSDI you will be subject to a 24-month waiting period before you can receive Medicare for disability coverage. During this period, you may qualify for health insurance through a former employer, so contact them to see what offers are available.

After the 24-month waiting period, you then become automatically eligible for Medicare Part A & B. Part A is hospital insurance that most people do not have to pay for. Part B is a medical insurance, and if you opt into this plan, you may be required to pay a certain amount of money in premiums. You can also enroll in a Medicare supplement plan if you need more coverage.

If you still have your disability but decide to return to work in some capacity, you can still keep your SSDI and Medicare coverage for up to 8.5 years after securing a job.

Your Rights With Medicare

With Medicare, you have certain rights when you return to the workplace. The biggest is that you are protected from discrimination. Any employer that works with Medicare is not allowed to treat you different because of your disability or any other distinguishing factor.

You also have a right to keep your healthcare and personal information private. You do not have to disclose any information about your medical treatments to your employer.

You are also entitled to clear information regarding your coverage, how much you have to pay for it, and how much Medicare covers. Even if you do not speak English, you are entitled to learning about your Medicare benefits in a language that you understand. You are also entitled to receive treatment in your preferred language.

You can appeal any decisions the Medicare office makes regarding your health care coverage – whether they revoke, deny, or charge more for healthcare coverage than anticipated.

Need Help Deciding On Coverage?

The American healthcare system can be a labyrinthian, bureaucratic nightmare. There are so many rules, stipulations and guidelines to follow. Sorting out what you need from your healthcare provider, nevermind how to get it can be prohibitively confusing.

Hopefully, this guide on how to acquire Medicare for disability coverage was useful.

If you’re still in the dark and need assistance sorting through this mess, try contacting us for help. We’re a team of qualified health insurance professionals that can make sure you get all the coverage you need at an affordable cost.