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Medicare Coverage for Americans Under Age 65

A Disability and a Long Wait Are Required Before You Can Enroll in Medicare Early

By David Fisher

Updated January 21, 2009

(LifeWire) - Medicare won't be available to most of us until we turn 65, but for a select few -- those with long-term disabilities or those who have been diagnosed with specific diseases -- Medicare is available at any age. It just isn't easy to get.

Medicare Coverage for Persons with Long-Term Disabilities

People who can establish that they suffer from long-term disabilities that prevent them from working can qualify for monthly Social Security disability insurance (SSDI) payments and for Medicare. It can be a long process, though, and those who succeed don't always qualify for the full benefits that people older than 65 enjoy.

A request for benefits starts with an online application. You must have worked enough hours to qualify for Social Security benefits to have a chance at success, be a  spouse of someone who has or be a dependent .

Your application is likely to move more quickly if you select one doctor as the lead contact for your case. It's best to go with one who has experience with disability cases, responds promptly to requests for information and is familiar with your overall health situation. It's also a good idea to keep a detailed log of your experiences with everyday activities to document, for example, any difficulties you have with mobility or any side-effects you are experiencing from medications.

The Social Security Administration says most applications are processed within three to five months. For most, though, the wait for Medicare benefits is just beginning, even if their application is approved.

Waiting Periods for Medicare Coverage

The law requires a five-month waiting period before any monthly SSDI benefits are paid on an approved claim, and most SSDI recipients must wait a full two years after that period passes to qualify for Medicare -- a minimum total delay of 29 months from the date of SSDI approval before any Medicare coverage begins.

Even then, only the most basic Medicare coverage -- Part A, or hospitalization and nursing home coverage -- is guaranteed. Federal law does not require private insurers to sell Part B Medicare -- the type of coverage that pays for prescription drugs and nonhospital medical care -- to people under 65, even if they are disabled.

Some states do require that such coverage be offered during limited open-enrollment periods; contact your state insurance commission to determine the rules that apply to you.

More than 7 million Americans younger than 65 qualified for early disability payments and Medicare by the middle of this decade, according to the 2006 Medicare Trustee Report, but a report by the Commonwealth Fund, a healthcare research foundation, estimated that 1.3 million are stuck at any given time in the lengthy Medicare waiting period. Of those, nearly 77% are poor or nearly poor by the time their Medicare comes through, and 12% die while they are in the waiting period.

Medicare Coverage for Persons with Lou Gehrig's Disease or End-Stage Renal Failure

People younger than 65 who are diagnosed with amyotrophic lateral sclerosis, which is also known as Lou Gehrig's disease, or those who are undergoing dialysis for end-stage kidney failure are allowed to skip the waiting periods for Medicare.

They are eligible as soon as their disability payments begin.

Sources:

Medicarerights.org

http://www.medicarerights.org/maincontentpolicytopic_disabilities.html

Medicare.gov

http://www.medicare.gov/medigap/under65.asp

Medicare faqs

http://questions.medicare.gov/cgi-bin/medicare.cfg/php/enduser/std_alp.p...

ehow.com

http://www.ehow.com/how_2179353_apply-for-disability.html

ehow.com http://www.ehow.com/how_4473093_qualify-medicare-under-65.html

Social Security Administration

http://ssa-custhelp.ssa.gov/cgi-bin/ssa.cfg/php/enduser/std_adp.php?p_fa...

Social Security Administration

http://ssa-custhelp.ssa.gov/cgi-bin/ssa.cfg/php/enduser/prnt_adp.php?p_f...

Social Security Administration

http://ssa-custhelp.ssa.gov/cgi-bin/ssa.cfg/php/enduser/popup_adp.php?p_...

listing of contacts for state insurance commissioners

http://www.naic.org/state_web_map.htm


LifeWire, a part of The New York Times Company, provides original and syndicated online lifestyle content. David Fisher is a freelance writer based in Bend, Ore. He has worked as an editor, a writer and a financial adviser and has held insurance licenses in two states.

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