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How Can I Qualify for Medicare Before I’m 65?

Question: I was just denied Social Security disability benefits because I didn’t have enough work credits. I was mainly applying to qualify early for Medicare (I’m 60), because I have high medical costs due to kidney problems and other conditions. Now I’m worried I won’t qualify for Medicare even when I turn 65. What can I do?

Answer:  You have some options. There are several parts to Medicare, with different rules for qualifying for each. Part A, Hospital Insurance, is the Medicare coverage that’s premium-free for those who are fully insured with Social Security. Individuals over 65 who aren’t insured with Social Security can pay a premium to get Part A. Anyone over 65 can also get Part B, Medical Insurance (mainly for doctors’ visits), simply by paying a premium.

Here are the various ways to qualify for Medicare.

Premium-free Medicare for those age 65 or older. If you are 65 or older and you OR your spouse worked for long enough in a job covered by Social Security, for a railroad, or for a federal, state, or local government in a Medicare-covered job, you qualify for free Medicare Part A. Generally you need 40 work credits (each representing one calendar quarter of work) to be fully insured by Social Security. That represents about ten years’ worth of work.

To qualify based on your spouse’s work record (or your ex-spouse’s work record), your spouse must be at least 62. Do you have a spouse who will have enough work credits by the time you turn 65?  Check with Social Security to see if your spouse (or ex-spouse) will have enough credits.

Paid-premium Medicare for those over 65 and older. Those over 65 who don’t qualify through one of the above methods can get Part A or Part B by paying a premium. Note though, if you want to get Part A by paying a premium, you also have to pay for Part B. On the other hand, you can just get Part B if you want, by paying the Part B premium. Also, anyone who is entitled to Medicare Part A or enrolled in Part B can get Part D prescription drug coverage by paying a monthly premium.

How much are you looking at having to pay for Part A if you’re not fully insured for Social Security? If you, or your spouse, has 30 to 39 work credits (instead of the 40 required to be fully insured by Social Security), the monthly premium for Part A is currently $225 per month. If not, the monthly premium would be $441 per month (in 2013 numbers). If you have income below a certain level, however, you can get help paying your premiums through one of the Medicare Savings Programs.

Those younger than 65. Unfortunately, there are limited ways to get Medicare if you’re under 65. You can qualify for Medicare if you are approved for disability benefits from Social Security or the Railroad Retirement Board. However, there is a 24-month waiting period after you become entitled to disability benefits before you can get Medicare. You can also get Medicare coverage if you have end-state kidney/renal disease (ESRD). (For ESRD, you or your spouse need only be “currently insured” with Social Security. If you or your spouse earned six credits in the three years before turning before turning 65 or dying, you are currently insured.)

If your income and assets aren’t too high (and you may not need to count money you spend on your medical expenses), you might want to look into applying for Medicaid, especially if your state has opted for Medicaid expansion. Or, check out the new health care marketplaces.

Ways to get more credits. If you are close to the amount of credits you need (at age 60, you need 38 credits to qualify for disability benefits; at age 62 or older, you need 40 credits to qualify for disability or retirement benefits), you might consider going back to work on a very part-time basis. You need to earn only $1,160 to get one credit, and you can earn four credits per year. Getting to 40 credits (or 30, even), can save you thousands of dollars in Medicare Part A costs over the years. Or, if your spouse is close to being fully insured for Social Security, he or she might be able to earn a few more work credits.

Lastly, you can always appeal a Social Security denial. If you can get approved for disability benefits, you’ll automatically be eligible for Medicare two years later or when you turn 65, whichever is earlier.

How Obamacare Will Affect Social Security and People With Disabilities

One way that Obama’s health care reform will help make health insurance accessible to more people is by eliminating preexisting condition exclusions.  This will be a big benefit to those with disabilities, because many will now be able to purchase their own insurance. Having more people eligible for private health insurance will have an effect on Social Security, Medicare, and Medicaid.

Thanks to Obama’s health care reform law, as of January 1, 2014, insurance companies can no longer deny coverage to individuals with preexisting conditions, or charge them higher rates. (See Nolo’s recent article on the ban against preexisting condition limitations.) At the same time, individuals without group health insurance can purchase insurance through the Health Insurance Marketplace; applications can be submitted starting October 1, 2013. Those with low income (less than 400% of the federal poverty level) are eligible for lower premiums, and those with even lower income (250% of the federal poverty level) can qualify for lower out-of-pocket costs like deductibles and copays. (See Nolo’s federal poverty guidelines for exact figures.)

These two provisions of the new health care reform law (called the Patient Protection and Affordable Care Act of 2010) should lower the number of people on Medicare and Social Security disability.  Why? Historically, many folks with preexisting conditions who lost their prior work-based health coverage apply for disability benefits just so they can get health care benefits. They know that an approval for Social Security disability will mean they can either qualify early for Medicare, or, if they have very low income (or somewhat low income and very high medical expenses), they may be eligible for Medicaid. Some of these folks will now decide not to file for disability benefits since they don’t need a disability approval to get health care, now that insurance companies can’t turn down people with disabling medical conditions and disabled individuals have an opportunity to buy affordable health care, more flexibility in choosing a health care plan, and the potential for out-of-pocket savings on their health care needs.

Not only that, but now that more persons with disabilities or chronic medical conditions will have good health care and access to reasonable priced medications, more of them will be able to work despite having physical or mental impairments, and fewer of them will need to apply for disability benefits.

What’s more, those who can’t work for a while due to a temporary disability will be less likely to need to be off work indefinitely, thanks to better health care and access to medications. In fact, fewer people many now qualify for Social Security disability since only those whose medical conditions prevent them from working for at least 12 months are eligible for SSDI or SSI disability benefits. Now, some disability applicants who would have been eligible to receive Social Security while they recuperate from injuries or mental illnesses may recover sooner because of regular doctors’ visits plus the proper medication.

On the other hand, some other folks who would have previously been denied disability benefits or Medicaid benefits are now more likely to be approved. Often disability applicants are denied because they haven’t been seeing a doctor for treatment and don’t have test results to prove their disability. Now that health care is more accessible, more folks who apply for disability will have been seeing doctors regularly and have the proper diagnoses, lab results, and x-rays in their records. This should help eliminate the need for Social Security to send applicants to consultative medical exams and should reduce the number of disability appeals – with the proper medical records, fewer claims will be incorrectly denied disability benefits in the first place. This represents significant potential cost savings for Social Security.

Similarly, despite fewer people applying for disability benefits, Medicaid roles will increase, of course, because in some states Obamacare’s Medicaid expansion will now allow adults with incomes of up to 133%-138% of the federal poverty level to qualify for Medicaid.

But overall, health care reform appears to be a great deal for persons with disabilities.

Welcome to Nolo’s Disability Blog

Welcome to the latest addition to Nolo’s legal blogs: the Disability Blog. I’ll be blogging mostly about Social Security disability and SSI, with some information on veterans benefits, Medicare, Medicaid, and workers’ compensation thrown in from time to time. Send me your question about disability, and if it hasn’t already been answered on our site, I’ll answer it. Please don’t send questions that you don’t want published, and know that we can’t guarantee an answer to all questions. Ask a question.