Medicare & Disability

Person in wheelchair

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Factors to Consider

When you are entitled to Social Security disability benefits for 24 months, you are eligible for Medicare beginning the 25th month. An exception applies if you have been diagnosed with Amyotrophic Lateral Sclerosis (ALS) also known as Lou Gehrig’s disease. If you have ALS, Medicare begins the first month you are entitled to Social Security disability benefits.  
 
If you have questions about your Medicare eligibility and enrollment, you should contact your local Social Security Office. 

Provide them with this information:

  • When your disability benefits began.
  • Whether you or a family member is working for an employer with 100 or more employees, and whether you are covered by the employer group health plan. 

Ask these questions:

  • Will Medicare pay first or will other insurance I have pay first?
  • Should I sign up for Medicare Part B?
  • If I do not sign up for Medicare Part B, will I have to pay a penalty later?
  • Document the name, date, exact question asked and the response provided for future reference. 

Enrolling in Medicare

Automatic for Most People

Generally, enrollment in Medicare Part A and Part B is automatic. If you are receiving disability benefits, you will receive a Medicare card showing the date your Medicare benefits begin.

You receive Medicare Part A premium-free, and you will pay a monthly premium for Medicare Part B. You need both Medicare Part A and Part B for the best coverage. If you don’t enroll in Part B when you should, you may pay a higher premium later. If you are covered under an employer group health plan, you may be able to delay enrollment in Medicare Part B (see below). 

If you are paying a higher premium because you enrolled late in Medicare Part B, the penalty will end when you turn 65. 

Enrollment When Covered by an Employer Plan

Employers with 100 or more employees are required to continue your health insurance coverage. You must be currently employed or covered under an employer group health plan of a family member who is currently employed.  

As long as employment continues and the employer has 100 or more employees, the employer group plan will pay first for your health care. Medicare will be a second payer. You can wait to enroll in Part B until you or your working family member is no longer actively employed. You have up to eight months to enroll in Part B after you or your family member quits working.