If you have been awarded disability payments, or if you are disabled and are in the process of appealing a denial of coverage, it is important that you know how this will impact your healthcare coverage under Medicare.
Your coverage options depend on if you are under 65 or are 65 years old or older.
If you are under 65, you must meet specific criteria to get Medicare based on a disability. You must no longer be able to do your previous work or any other type of comparable work. Eligibility will be based upon your age, education and work experience.
Regardless of age, if you are already receiving benefits you automatically get Part A and Part B.
If you are more than 65 years old, you were automatically enrolled in Medicare hospital insurance, Part A, when you applied for Social Security benefits.
Medicare comes in four Parts: A, B, C and D. Part A covers hospital expenses such as room, board, inpatient services, skilled nursing facility for limited time, and can also cover hospice care and home-health care.
Part B covers medical expenses, such as doctor’s services, outpatient services and some medical supplies. It helps pay for some services Part A doesn’t cover, like certain occupational and physical therapy services and some home-health care.
It also covers some preventive services. The premium you pay for Part B is deducted from your Social Security benefits.
However, Medicare does not cover all healthcare costs. For example, patients must typically pay a deductible for each hospital stay and coinsurance anytime they use the services of a physician or surgeon. Also, very little drug coverage is provided. Because Original Medicare doesn’t cover everything, private insurance companies offer Parts C and D which provide coverage for services Part A and B do not cover.
Regardless of age, people who are already receiving Social Security disability benefits will automatically be enrolled in Medicare Parts A and B, but can decide not to take Part B, C or D that requires paying a premium each month
If you have a disability and get Part A only, or if you are getting disability benefits when you turn 65, you won’t have to apply for Part B. Medicare will enroll you in Part B automatically.
If you have any questions about how to get Medicare will impact a disability, you should go to www.medicare.gov, or call 1-800-772-1213. TTY users should call 1-800-325-0778.
If you have problems wading through the government red tape, a qualified and experienced attorney can assist you in receiving the help you need.