Who Can Receive Medicare Benefits?

Medicare is a health care insurance program provided by the federal government. Usually, Medicare benefits are received by people age 65 or older. Therefore, if you are under age 65, you will not be able to sign up for Medicare, except in two situations.

  1. If you are under 65 and have certain disabilities you may be eligible for Medicare coverage.
  2. If you are under 65 and have End-Stage Renal Disease (ESRD) and need frequent kidney dialysis or a kidney transplant.

Keep reading to learn more about the requirements for Medicare eligibility for people under age 65.

Requirements for People with Disabilities under age 65

In order for someone to enroll in Medicare under 65, they must have a disability that qualifies for Social Security Disability Insurance (SSDI). Additionally, before your application is accepted, you must have been receiving social security payments for a period of 24 months or more.

Once the 24 months have passed, an Original Medicare red, white, and blue card will be sent to you by mail. You should receive this card within 3 months of the 25th month of disability payments. While this means you now have Medicare Part A and Part B, if you need prescription drug coverage you will still need to pay a premium for Part D.

Additional Benefits Coverage

If you have received disability benefits from the Railroad Retirement Board (RRB) for 24 months, you will qualify for Original Medicare.

As you may have guessed, Medicare for short term disability under 65 does not exist. Medicare for disabled people under 65 applies only for long-term disabilities. For the most part, the condition in question has to impair someone’s ability to work. These disabilities include the following:

Heart conditions

  • High blood pressure
  • Blood Clots
  • Heart Failure or Heart Attacks
  • Digestive Disorders
  • Crohn’s disease
  • Short bowel syndrome
  • Chronic liver disease

Endocrine System Disorders

  • Diabetes
  • Hyperglycemia
  • Adrenal gland problems
  • Thyroid and parathyroid disorders

Blood Disease

  • Chronic anemia
  • Sickle cell disease
  • Low platelet counts
  • Hemophilia
  • Deep Vein Thrombosis

Immune Disease

  • HIV
  • AIDS
  • Lupus
  • Multiple Sclerosis (MS)

Types of Cancer

  • Breast Cancer
  • Lung Cancer
  • Pancreas Cancer
  • Stomach Cancer

Mental Health Disorders

  • Post Traumatic Stress Disorder (PTSD)
  • Anxiety
  • Autism
  • Multiple or dissociative personalities disorder
  • Substance Addiction
  • Schizophrenia

Muscle/Skeletal Disorders

  • Osteoporosis
  • Amputations
  • Arthritis
  • Herniated Disks
  • Scoliosis
  • Whiplash
  • Spinal Fusion

Neurologic or Brain Dysfunctions

  • Cerebral Palsy
  • Stroke
  • Epilepsy
  • Parkinsons disease

Respiratory Dysfunctions

  • Asthma
  • Lung transplants
  • Bronchiectasis
  • Pneumonia
  • Cystic Fibrosis
  • Sleep Apnea

Skin disorders

  • Burns
  • Cellulitis
  • Dermatitis

Hearing or Vision Disabilities

  • Hearing loss
  • Sight loss
  • Vertigo

This list represents only a portion of the disabilities that may be covered under SSDI. In order for you to qualify for SSDI for one of these conditions, you will have to be evaluated for coverage by the Social Security Administration (SSA). They use a manual filled with the qualifying criteria, which is commonly called the “Blue Book.”

When applying for SSDI, you may want to work with an attorney as you prepare for an SSA evaluation. A personal injury lawyer, in particular, can be a powerful ally in helping you get compensation or coverage if your disability was caused by an injury such as a traumatic brain injury.

If you need Medicare coverage and you're under 65, there may be some options available to you. Especially if you have a disability.

End-Stage Renal Disease for People Under Age 65

What is End-Stage Renal Disorder?

This is the final stage of chronic kidney disease (CKD). At this point, CKD has reduced overall kidney function to around 10 or 15 percent. This is a critical point for the body and it means the patient will require regular dialysis treatments to make up for the reduced kidney functionality.

Why does ERSD qualify for disability and Medicare Coverage?

The kidneys are essential organs to the body’s health. Specifically, they regulate fluid levels, manage electrolytes, as well as produce hormones and enzymes that activate vital body functions.

Human beings can usually live comfortably with one healthy kidney, however, trouble begins when both kidneys start failing.

In particular, one of the kidney’s primary functions is removing waste from the blood and reducing excess fluid through urine production. When kidneys fail or become unhealthy, blood waste levels rise in addition to fluid levels. Conditions such as uremia or edema tend to develop as a result. Furthermore, patients with critical kidney disease (CKD) may also experience high blood pressure.

Kidney disease is also linked to cardiac arrest, parathyroid dysfunction, and anemia.

If you need Medicare and you're under 65, usually you can only get coverage if you have a disability.

What treatments are available for ESRD?

In order to make up for the loss of healthy kidney function, the only treatment is dialysis. This medical treatment uses a machine that operates as an artificial kidney. During dialysis, an artificial artery is linked to the patient’s own artery or vein, typically in the forearm. Next, the blood is sent to the machine which uses dialysate to clean the blood. Besides this, dialysate also restores electrolytes and minerals to normal levels.

Dialysis patients usually visit dialysis centers and may receive treatment multiple times a week depending on their needs. Typically, the whole process takes about four hours. As you can see, dialysis is a demanding and time-consuming treatment. With this in mind, it becomes clear that people with ESRD can benefit from Medicare coverage especially a Special Needs Plan.

Are there other types of dialysis treatments?

Because this treatment is so involved and crucial to a patient’s life, home hemodialysis machines are available. Other types of dialysis available include nocturnal dialysis, peritoneal dialysis, and continuous renal replacement therapy.

Nocturnal dialysis is simply dialysis performed at night, whereas peritoneal dialysis involves a surgical implant that filters the blood.

For more answers about getting started with health insurance, visit our In the Media page for videos answering some frequently asked questions.

If you are in need of a Medicare or Medicare Advantage plan and are under 65, give us a call. Or, if you need insurance but don’t qualify for Medicare and you’re under the age of 65, we can help you find the right plan. Or if you need temporary health insurance, we can help you examine your options.

We know that applying for coverage is confusing and stressful, but we will work for you to get you the care that you need.

Set up a FREE consultation over the phone or face-to-face in our office. The coverage you need is just around the corner.

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