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Individuals under the age of 65 may be eligible for Medicare benefits due to certain disabilities. Medicare is the federal health insurance program that consists of:
All persons age 65 and older, whether disabled or not, who are entitled to receive Social Security benefits are eligible to enroll in Medicare. You will be enrolled at age 65 automatically if you are already receiving Social Security benefits. Medicare eligibility is income-blind. You can continue to receive Medicare benefits even if you work after you begin receiving Social Security benefits.
If you have been receiving (or have been entitled to receive) Social Security disability benefits for at least 24 months (not necessarily consecutively), you may be eligible to enroll in Medicare. To enroll, you must be entitled to benefits in one of the following categories:
Anyone with End Stage Renal Disease (ESRD) is eligible for Medicare. A person who is disabled as a result of chronic kidney failure, who requires dialysis or a kidney transplant, and who is fully or currently insured or entitled to payments either under Social Security or the Railroad Retirement Board is entitled to enroll in Medicare. His or her spouse and dependent children are also entitled to enroll in Medicare.
A person disabled by Amyotrophic Lateral Sclerosis (ALS) automatically gets Medicare Parts A and B the month the disability begins.
If you are no longer entitled to receive Social Security disability benefits because you have returned to work, you may have your Medicare coverage continued for 93 months after the trial work period. However, this coverage extension applies only if your disabling condition continues, even if it doesn't prevent you from working and you meet other eligibility requirements. After that period, you will no longer be able to obtain Medicare Part A premium free, but if your disabling condition continues, you can purchase Medicare Part A coverage by paying premiums.
If you are a qualified low-income person who is working, your premiums for Medicare Part A may be paid by your state Medicaid agency.
If you become re-entitled to receive Social Security disability benefits after the end of a previous period of entitlement, you are automatically eligible for Medicare coverage and no waiting period applies. However, this rule applies only to workers who become re-entitled within five years after the end of their previous period of entitlement (seven years for widows, widowers, and dependent children). The five- or seven-year requirement will be waived if the previous period of disability ended after February 20, 1988, and the current disability is the same as or related to the previous disability.
Medicare is the only medical insurance some disabled people have. However, you may also be entitled to receive benefits from another health insurance policy as well as Medicare. So which insurance will pay your claim? In most situations, you will submit your claims to Medicare first, but there are exceptions: If you are covered by an employer-sponsored group policy or another type of social insurance, Medicare will be the secondary payer.
If you are disabled and covered under a group health plan, either through your own employer or the employer of a spouse or family member, you must apply for benefits from your group health plan first. If your group health plan rejects the claim because the services are not covered by the plan, Medicare will then pay if Medicare covers those services. This applies if the plan is sponsored by an employer who has at least 100 employees. If you are over 65 and working, this rule applies if your employer has 20 or more employees.
After he was released from the hospital, Claude submitted a claim to his group health insurance company. His claim was paid except for one item--occupational therapy he received while he was in the hospital. His insurance contract did not cover this type of therapy. However, since Medicare covers occupational therapy, Medicare paid the remainder of Claude's medical bill as second payer.
If you are entitled to medical workers' compensation benefits, veterans benefits, or black-lung benefits, Medicare will be the second payer.
Group health plans may not discriminate against Medicare beneficiaries who are disabled. They cannot refuse to insure you because you are also covered under Medicare for a disability.
Enrollment in Medicare is automatic if you have already been receiving Social Security disability benefits at the time you become eligible for Medicare. Enrollment in Medicare Part A is compulsory, but you can decline to enroll in Medicare Part B by filling out a form that will be sent to you, and you will not have to pay the premium for Medicare Part B. If you change your mind, you can still enroll later during a special open enrollment period. Your enrollment in Medicare Part A, however, will not cost you anything, and since Medicare Part A will be the secondary payer to your group health insurance plan anyway, think twice before declining coverage.
Your Medicare coverage can begin with the first day of the third month after the month your dialysis treatments began. However, if you are expecting a transplant soon, a different rule may apply. Your Medicare coverage will begin either with the month of the transplant, or if you are hospitalized before the transplant to undergo procedures related to the transplant, in that month, as long as it was within two months of the transplant.
MULTIPLAN_GHHK3T9EN_AcceptedMedicare.org is a non-government site and is operated by HealthCompare Insurance Services, a licensed health insurance agency certified to sell Medicare products. It contains information about and access to insurance plans for Medicare beneficiaries, individuals soon eligible for Medicare and those advising on behalf of Medicare beneficiaries. Medicare.org is not endorsed by the Centers for Medicare & Medicaid Services (CMS), the Department of Health and Human Services (DHHS), or any other government agency.
If you're looking for the government's Medicare site, please navigate to www.medicare.gov.
HealthCompare Insurance Services, Inc. is a licensed and certified representative of Medicare Advantage HMO, PPO and PFFS organizations and Medicare Prescription Drug plans with a Medicare contract. Enrollment in any plan depends on contract renewal.
The purpose of this communication is the solicitation of insurance. Contact will be made by an insurance agent/producer or insurance company.
Limitations, copayments, and restrictions may apply. Benefits, premium and/or copayments/coinsurance may change on January 1, of each year.
The plans we represent do not discriminate on the basis of race, color, national origin, age, disability, or sex. To learn more about a plan’s nondiscrimination policy, please click on the carrier’s link below.
Blue Cross Blue Shield - Illinois
Blue Cross Blue Shield - Montana
Blue Cross Blue Shield - New Mexico
Blue Cross Blue Shield - Oklahoma
Blue Cross Blue Shield - Texas
Blue Shield of California
Capital Blue Cross
Cigna Health Spring
Premera Blue Cross
Scott & White
Vibra Health Plan
Last Revised 11/15/2017