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Medicare and Special Needs

One of the great things about America is that as a society we try and give extra help to those people who are most in need of extra help. In following that creed, Medicare sees to it that there is extra help within Medicare Advantage programs for particular need situations.

Medicare Through Disability

Medicare is for people who are 65 years old and over. The exception to this rule is those people with a disability, who are eligible for Medicare at any age. To qualify for Medicare through disability, someone needs to have drawn disability benefits from Social Security for 24 months. Once they’ve done so that person will automatically be registered for Part A and Part B.

The exception to this 24-month waiting rule is those who are on Social Security disability because of ALS, also known as Lou Gehrig’s disease. For those people, there is no waiting period at all.

There is a cost though. Those on disability will still be required to pay their Part B in the usual amount; for most people, it’s $148.50 a month in 2021. Those on disability can also choose to delay their Part B by turning it in and then only have Part A which does not have any cost involved.

There are reasons why someone might do so; for instance, if they are getting healthcare coverage through another source such as VA benefits or through a spouse’s group health coverage. If this is the case someone will want to weigh which is a better deal, the cost of group coverage or the $148.50 they’ll be paying Medicare for their Part B.

Note: If you lose your disability status and benefits then you will no longer be eligible for Medicare as well. You will then have to wait until you are 65 to get Medicare back. Make sure to make an appointment with a Medicare agent before you turn 65 because if you had Medicare through disability and lost it your new application for Medicare in turning 65will be much more complicated.

A common mistake many people make when they get Medicare through disability is just having their Part A and Part B benefits but not signing up for a Medicare Advantage plan as they are entitled to do. The problem with this is that Medicare itself provides only 80% coverage. This could leave some rather large copayments to meet. Secondly, if someone is signed up for Medicare but does not have prescription drug coverage they’re subject to Medicare penalties.

Note: You are not able to sign up for most Medigap supplements because carriers usually don’t enroll people who are younger than 65. You can, however, sign up for any Medicare Advantage plan, most of many of which have zero in premiums beyond what you are already paying for your Part B. It only makes incredible sense to do so.

There is some more good news, too: For those who have been on disability and are now turning 65 you will get a new Initial Enrollment Period (IEP) much as everyone turning 65 does. You will now be able to get a Medigap supplement with Guaranteed Issue if you choose to. Or use your new IEP to sign up for a different Medicare Advantage plan. I will be happy to go over your options with you.  

Special Needs Plan for Diabetes and Chronic Care

Some counties offer special Medicare Advantage programs called Chronic-Condition Special needs Plans or CSNPs. These CSNPs are available for people with severe and chronic qualifying conditions such as heart failure, cancer, or diabetes. These plans may offer additional benefits tailored to people in the group who have the condition they are designed for.

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