Am I Eligible for Medicare if I Get Disability Benefits?

When an individual is unable to work due to a disabling condition, their income is not the only thing that disappears – their medical insurance disappears as well. This is why so many disability applicants wonder whether or not they will be eligible to receive Medicare benefits and social security. So are Social Security Disability recipients able to receive Medicare benefits to help cover medical expenses? The answer is yes, but not right away.

When Can I Begin Receiving Medicare Benefits?

If you have been entitled to Social Security Disability benefits for a period of 24 months then you will become eligible to begin receiving Medicare benefits on the 25th month.

What Does Medicare Cover?

The type of coverage you are provided through Medicare depends on the type of Medicare you decide to accept. Medicare Part A is hospital insurance. In most circumstances, there is no charge for Medicare Part A coverage. This type of Medicare pays for inpatient hospital care, skilled nursing facilities, long-term hospital care, inpatient rehabilitation, hospice care, home health care, inpatient psychiatric care and obesity bariatric surgery.

Medicare Part B is different from Medicare Part A. Medicare Part B is more like a traditional medical insurance plan. In most cases, you will need to pay a premium in order to receive Medicare Part B. You can choose to refuse Medicare Part B coverage, but if you do so you will need to pay a surcharge if you wish to receive Medicare Part B in the future. Medicare Part B covers any services or supplies that are needed to diagnose or treat your medical condition as long as they meet the accepted standards of medical practice. Medicare Part B also covers preventative services such as vaccinations and routine physical exams.

Medicare Part D is another type of Medicare that you may opt to pay for. Medicare is a prescription drug coverage that will help you pay for your prescription medications. Some of the people who receive Medicare Part D have something that is referred to as a “gap”. These Medicare recipients fall into this “gap” when Medicare has paid for a certain amount of their prescription drugs. Once a Medicare recipient falls into this “gap”, they must pay for their own medications until they have paid their way out of it. In some cases, however, people who are eligible to receive extra help from Medicare will not experience this gap in coverage.

When Will I Fall Into the Part D Gap?

When Medicare has paid approximately $2,930 towards your medications you will enter the gap. At this time, you will have to pay for 50 percent of your prescription drugs rather than the amount Medicare normally covers. Once you have spent approximately $4,700 out of your own pocket for prescription medications, you will be taken out of the gap and Medicare Part D will go into full effect once again. If you receive extra help from Medicare due to financial circumstances, you will not need to worry about the gap as the gap policy will not apply to you.

How Much Does it Cost for Medicare Part D Coverage?

The amount that Medicare recipients pay for prescription coverage under the Medicare Part D plan varies, but the average premium is approximately $31 per month. The annual deductible also varies. If you receive extra help you will have no deductible. If you do not receive extra help, your deductible will be $65 per year. 

Additional Resources 

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