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Medicare Advantage Plans for Disabled People Under 65

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By Daniel Petkevich
Mar 24, 2023

See if Medicare Advantage is the right choice for you

Are you under 65 and living with a disability? Medicare is not just for seniors looking for healthcare. Medicare Advantage plans are available for disabled people under the age of 65 who are struggling to find affordable coverage. Knowing your options can save you money on your healthcare. So let’s dive deep into Medicare Advantage plans for disabled people under 65 years old. 

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Eligibility for Medicare Advantage plan for disabled under 65

There are several criteria that qualify you for Medicare under the age of 65. 
Similarly, if you have kidney failure, also known as end-stage renal disease (

ESRD

), have undergone a kidney transplant, or need continuous dialysis, you might be eligible for Medicare before you turn 65 and be able to get benefits immediately.
Note: If you are a railroad worker with ESRD, contact Social Security, not the Railroad Retirement Board, to see if you are eligible for Medicare.
Also, if you have amyotrophic lateral sclerosis (

ALS/Lou Gehrig’s disease

), you'll be enrolled to receive Medicare as soon as your disability benefits begin.
Social Security Disability Insurance (SSDI) and Supplemental Security Income (SSI) programs offer assistance to people and families who meet the

Social Security Administration’s

requirements for disability. You can receive benefits for at least one month up to a lifetime. 
The programs are separate but have the same medical requirements. If you are trying to apply for SSDI or SSI, you can do so at the

link here

. They will process your application and move it along to your state’s Disability Determination Services office. For more information about what might qualify you, check out the SSA’s

definition of disability

.
Once you qualify for Original Medicare, you can sign up for a Medicare Advantage plan.

Benefits of Medicare Advantage plans

Medicare Advantage plans, also known as Part C of Medicare, are a way for you to get more coverage than what Original Medicare has to offer. These are insurance plans offered by private companies that, by law, have to meet the same standard of coverage as Original Medicare. You are likely to have a plan premium in addition to the Part B premium and a specific copay amount for your in-network services. You will be responsible for your copay until you hit your yearly Out-of-Pocket maximum. Most Medicare Advantage plans include a Part D prescription drug plan as well. 
One of the major benefits of a Medicare Advantage plan is that some of the plans include a series of extra benefits that are not typically covered by Original Medicare. This might include dental, vision, and hearing, depending on your plan. 
One of the drawbacks of Medicare Advantage plans is the potential for network restrictions. Medicare Advantage plans are either HMO or PPO. With HMO plans, you might be limited to in-network providers only, and you have to pay entirely out-of-pocket to seek care outside of your network. PPO plans allow you to go outside your network, but you still have to pay more for out-of-network providers. 

Special Needs Plans

Special Needs Plans are different kinds of Medicare Advantage plans that are more selective with who can enroll. SNPs offer a variety of benefits that are tailored to the specific needs of the plan members, including personalized care plans, coordinated care management, and access to specialists and care providers who specialize in treating their particular health conditions.
According to the

Medicare.gov website

, there are three types of SNPs that limit membership to those with specific diseases or characteristics: 
  1. Chronic Condition SNP (C-SNP) - you might qualify if you have one or more of the following conditions: chronic alcohol and other dependence, autoimmune disorders, cancer (excluding pre-cancer conditions), cardiovascular disorders, chronic heart failure, diabetes mellitus, end-stage liver disease, HIV/AIDS, chronic lung disorders, chronic and disabling mental health conditions, neurologic disorders, stroke, and more.
  2. Institutional SNP (I-SNP) - you might qualify if you are expected to live for at least 90 days in one of the following institutions: nursing home, intermediate care facility, skilled nursing facility, rehab hospital, and more. 
  3. Dual Eligible SNP (D-SNP) - you might qualify if you have both Medicaid and Medicare. 
Since these are special types of Medicare Advantage plans, your prescription drug plan (Part D) is still included. However, your monthly premiums and out-of-pocket costs will be determined by your specific choice of plan. 

Enrolling in a Medicare Advantage plan for disabled under 65

The enrollment periods of Medicare are similar for those who are eligible due to age and those eligible due to their disability. 
  • Initial Enrollment Period - this is a seven-month window that begins three months before your 25th month on Social Security benefits and ends three months after your 25th month on Social Security benefits. If you enroll during the three months before, you receive coverage starting the 25th month. If you enroll after your 25th month, then your coverage begins the following month. 
  • Annual Enrollment Period

    - this period, which occurs from October 15 to December 7 each year, allows you to apply to enroll in a Medicare Advantage plan. You might also use this time to switch plans if you are looking for a new plan.
  • Special Enrollment Period - there are various life circumstances that would necessitate a change in your insurance plan. Check out

    Medicare.gov’s list of special circumstances.

When it’s time for you to enroll in Medicare, the best practice is to speak with a licensed Medicare advisor at Fair Square. 

Cost of Medicare Advantage plan for disabled under 65

The cost of your specific Medicare Advantage plan will vary based on where you live, which plan provider you choose, and your plan-specific details.

Schedule a call with a licensed Medicare Advisor

to get more information today.  

Medicare Advantage plans are not inherently bad

, but they can be misunderstood. Medicare Advantage plans are often characterized as having fewer up-front costs than Medicare Supplement plans but more room for out-of-pocket costs as you go. These typically come in the form of deductibles, copays, and coinsurance.
Deductibles—The amount you pay before your insurance coverage begins.
Coinsurance— The amount you pay as your share of the cost for services after you pay any deductibles, usually a percentage.
Copays—The amount you pay as your share of the cost for a medical service you use.
You’ll have an Out-of-Pocket maximum with your Medicare Advantage plan. Different plans can offer different yearly Max. OOP, but the maximum for 2023 across Medicare Advantage plans is $8,300.
Luckily, there are Medicaid and Medicare Savings Programs available through federal and state governments. These can help cover some of the out-of-pocket costs outlined above. If you are interested in applying for low-income subsidy programs,

you can apply here

.

Frequently asked questions about Medicare Advantage plan for disabled under 65

1. Who is eligible for a Medicare Advantage plan for disabled individuals under 65?
To be eligible, you must be under the age of 65 and have a qualifying disability. You must also be enrolled in either Social Security Disability Insurance (SSDI) or Supplemental Security Income (SSI) for at least 24 months.
2. What benefits do Medicare Advantage plans for disabled individuals under 65 cover?
These plans cover all the benefits that Original Medicare (Part A and Part B) covers, such as hospitalization, doctor visits, and medical equipment. In addition, Medicare Advantage plans may offer additional benefits such as prescription drug coverage, dental, vision, and hearing care, and wellness programs.
3. How do I enroll in a Medicare Advantage plan for disabled individuals under 65?
You can enroll during your Initial Enrollment Period (IEP), which is the seven-month period that starts three months before the month of your 25th month of disability payments and ends three months after. You can also enroll during the Annual Enrollment Period (AEP) from October 15 to December 7 each year or during a Special Enrollment Period (SEP) if you experience certain life events such as moving or losing other health coverage.
4. How much does a Medicare Advantage plan for disabled individuals under 65 cost?
Costs vary depending on the plan you choose, your location, and your specific healthcare needs. You may have to pay a monthly premium in addition to your Part B premium, as well as co-pays, deductibles, and other out-of-pocket costs.
5. Can I change my Medicare Advantage plan for disabled individuals under 65?
Yes, you can change your plan during the Annual Enrollment Period (AEP) or during a Special Enrollment Period (SEP) if you experience certain life events.
6. Can I have both a Medicare Advantage plan and Medicaid?
Yes, you may be eligible for both Medicare and Medicaid and may enroll in a Medicare Advantage plan that is designed for individuals who are eligible for both programs. These plans are called Dual Eligible Special Needs Plans (D-SNPs).
It's important to understand the details of Medicare Advantage plans for disabled individuals under 65, so you can choose the best plan for your healthcare needs and budget. If you have additional questions, you can contact Medicare directly or consult with a licensed insurance agent.

Conclusion

For those who are looking for a Medicare Advantage Plan before the age of 65 due to a disability, you have options. Your eligibility is reliant upon receiving at least 24 months of SSDI or SSI, and your enrollment windows are similar to those of age-eligible beneficiaries. The cost of your Medicare Advantage plan will depend on your unique situation. If you need a plan, look no further than the Medicare experts at

Fair Square

. Give us a call at (888) 376-2028. We are here to help.

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Join the Fair Square Medicare Newsletter to stay informed on cost savings, changes to Medicare, and other valuable healthcare information.

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Virgil Insurance Agency, LLC (DBA Fair Square Medicare) and www.fairsquaremedicare.com are privately owned and operated by Help Button Inc. Medicare supplement insurance plans are not connected with or endorsed by the U.S. government or the federal Medicare program. This is a solicitation of insurance. A licensed agent/producer may contact you. Medicare Supplement insurance is available to those age 65 and older enrolled in Medicare Parts A and B and, in some states, to those under age 65 eligible for Medicare due to disability or End-Stage Renal disease. Virgil Insurance Agency is a licensed and certified representative of Medicare Advantage HMO, HMO SNP, PPO, PPO SNP and PFFS organizations and stand-alone PDP prescription drug plans. Each of the organizations we represent has a Medicare contract. Enrollment in any plan depends on contract renewal. The plans we represent do not discriminate on the basis of race, color, national origin, age, disability, or sex. Plan availability varies by region and state. For a complete list of available plans please contact 1-800-MEDICARE (TTY users should call 1-877-486-2048), 24 hours a day/7 days a week or consult www.medicare.gov. © 2024 Help Button Inc

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