Medicare Disability and Under 65

You are eligible to enroll in Medicare under the age of 65 if you meet certain guidelines. You can choose Original Medicare or a Medicare Advantage plan that can include your Part D Prescription Drug coverage and additional benefits such as Dental, Vision, Hearing, and OTC benefits.

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Requirements for Medicare Under age 65

You will be eligible for Medicare if you meet one of the situations below:

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- On your 25th month of disability you will be automatically enrolled in Medicare Parts A and B. This qualifies you for a Special Election Period to choose a Medicare Advantage Plan

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- You have End-Stage Renal Disease (ESRD) and need dialysis or a kidney transplant. You can get benefits with no waiting period by applying at your local      Social Security office.

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- If you have Lou Gehrig’s Disease, you’ll automatically be enrolled when you begin receiving disability benefits.

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Medicare Part B Costs

The Medicare Part B premium is $148.50 per month. You will need to continue to pay this premium if you choose to enroll into a Medicare Advantage Plan. Many on Social Security Disability also qualify for Medicaid benefits. If you qualify for Medicare and Medicaid the state may cover the costs of the Medicare Part B and any Part D premiums.

Medicare Advantage Plans (MA or MAPD)

​These plans combine all the benefits of Medicare Parts A and B and can include Medicare Part D. (MA) You must live within the service area of the plan. They are offered by private insurance companies and offer low or zero premiums plans in addition to the Medicare Part B premium.

Medicare Advantage plans have copays or coinsurance for services as well as a maximum out of pocket (MOOP) for the plan year. Many also include vision, dental, hearing, gym discounts or memberships and OTC benefits.

​Dual Eligible Special Needs Plan (DSNP)

​These are Medicare Advantage Plans specifically designed to serve individuals that are entitled to Medicare Part A and enrolled in Medicare Part B you must live within the plan’s service area and receive certain levels of Medicaid to be enrolled.

DSNP plans include prescription drug coverage and feature $0 copays for services. Many include vision, dental, hearing, over the counter (OTC) allowances, transportation services, and meal allowances. They are available as an HMO or PPO.

When Can I Enroll ?

Initial Enrollment Period (IEP) – This begins 3 months before your Medicare effective date and ends 3 months after your Medicare Part A and B effective date.

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The Medicare Annual Election Period (AEP) - runs October 15th to December 7th and is the time you can make changes to your plans that become effective January 1st of the following year.

The Medicare Advantage Open Enrollment Period (OEP) - runs January 1st to March 31st and is the time you can also switch from one Medicare Advantage plan to another or drop Medicare Advantage coverage during this time.

You may also qualify for Special Election Periods (SEP) during the year.

Contact a Perfiniti Agent for more details.