Medicare eventually opened its eligibility requirements to include more than elderly residents. Representatives expanded Medicare eligibility requirements to include individuals younger than 65 who have certain terminal conditions. Applicants younger than 65 years of age can qualify if any of the below items are true:
- Receive or qualify to receive disability income from Social Security or the Railroad Retirement Board (RRB)
- Diagnosed with End-Stage Renal Disease (ESRD)
- Diagnosed with Lou Gehrig’s Disease or amyotrophic lateral sclerosis (ALS)
- They have a disability that qualifies for Social Security benefits
Individuals with certain diagnoses will have waiting periods before they can qualify to enroll in coverage. For example, you will need to wait until your 25th month of receiving Social Security disability payments for fibromyalgia, dementia, or schizophrenia.
As someone younger than 65 years of age, you qualify for Medicare Part A at no cost if:
- The RRB sends you a disability pension.
- You have received at least 24 months of Social Security disability benefits.
- You receive Social Security benefits due to your ALS diagnosis.
- You meet the requirements of the Social Security disability program and have adequate work credits.
- You are the spouse or dependent child of a worker who qualifies, older than 50, and meets the Social Security disability program requirements.
If you qualify for Social Security disability benefits, the program will automatically enroll you in Original Medicare (Medicare Part B and A) in your 25th month of receiving benefits. Even if you qualify for free Part A, you will need to cover the cost of Part B premiums.
Likewise, Social Security will automatically enroll you in Original Medicare the first month you receive Social Security disability benefits due to ALS. Medicare Part B is optional whether you have ALS or another qualifying disability that automatically signs you up for Medicare. The coverage is voluntary since you may be responsible for paying the monthly premiums.
Younger individuals who qualify for both Medicare and Medicaid may have partial- or full-dual coverage. The programs will pay for Part A and Part B premiums, coinsurances, copayments, and deductibles with full-dual coverage. With partial-dual coverage, the beneficiary will be responsible for some of the costs.
If you have ESRD, Medicare coverage begins when you become able to qualify. Coverage typically starts on the first day of receiving dialysis for the fourth month. Your coverage can begin retroactively, up to 12 months before you apply.
If the Social Security Administration does not automatically register you, you will need to wait for the Medicare enrollment dates. Your eligibility period will determine when you can sign up for the federal health care insurance plan.