If you’re younger than 65 and have been on Social Security disability benefits for a while, you may have already navigated the process of using Medicare as your health insurance provider.
But what happens when you celebrate your 65th birthday? Do you start the sometimes laborious process all over again? Let’s walk through how the system works and what to expect.
What Is Medicare?
Medicare, the federal health insurance program established in 1965, was designed to provide coverage for American adults over age 65. At the time, most Americans retired at about that age, so Medicare was meant to kick in when coverage from an employer-based insurance plan ended.
In 1972, Medicare was expanded to cover people younger than 65 — if they receive Social Security disability benefits. Since then, qualifying for such benefits has meant meeting several requirements and completing a 24-month waiting period before coverage kicks in.
Two specific conditions are exempt from the 24-month waiting period: end-stage kidney disease and Lou Gehrig’s disease, which is more formally called amyotrophic lateral sclerosis, or ALS. Individuals with these diseases can qualify for Medicare no matter their age and without having to fulfill the two-year waiting period.
No matter which disability you have, once you meet the outlined requirements, you can access federally subsidized health insurance coverage via Medicare. This way, you can get the care you need when you’re unable to secure health insurance through an employer.
[Read: Your Guide to Medicare Coverage.]
Medicare Parts and Programs
Medicare is broken into four parts, explains Dr. Meena Seshamani, deputy administrator and director of the Center for Medicare at the Centers for Medicare & Medicaid Services, or CMS, in Washington, D.C.
Part A, the so-called hospital portion, covers inpatient care in hospitals, skilled nursing facilities and some types of in-home health care or hospice care.
Part B, on the other hand, covers services from doctors and other health care providers, Seshamani says. These services include physical therapy, preventive care, outpatient care and some medical devices, such as wheelchairs.
Parts A and B together are considered “Original Medicare” and have been around since Medicare’s inception.
In 2003, Medicare Part C, also called Medicare Advantage, rolled out. This part includes health plans offered by private companies approved by Medicare. This coverage is optional and intended to replace the coverage offered by Parts A and B.
Part D is the prescription medication piece of Medicare.
Another program, Medigap, includes both Original Medicare and a supplemental plan to pay for coinsurance deductibles, explains Kathleen Holt, a Connecticut-based attorney and associate director for the Center for Medicare Advocacy. Medigap plans help reduce out-of-pocket expenses for individuals who opt for this additional coverage.
[Read: Medicare vs. Medicare Advantage: How to Choose.]
Aging Up
So, what happens when individuals with qualifying disabilities turn 65 and become eligible for Medicare because of their age? In short, nothing.
“Your Medicare coverage will remain the same because you’ve already met the eligibility requirements for premium-free Part A and Part B coverage by receiving disability benefits for at least 24 months,” explains Javier Sanchez, executive director of Medicare programs for CalOptima Health, a community-based health insurance plan serving low-income residents in Orange County, California.
He adds that “your 65th birthday doesn’t bring any new requirements or things to do. You don’t need to re-enroll or complete any paperwork to continue getting Medicare benefits for a disability.”
However, if you want to make changes to your enrollments, your 65th birthday would be the time to do it, says Bob Rees, vice president of Medicare sales and member loyalty with eHealth Inc., a health insurance broker and online resource provider headquartered in Santa Clara, California.
“If you’re already enrolled in Medicare pre-65 due to disability, turning 65 essentially gives you a second enrollment opportunity,” he explains.
More specifically, aging up means you can take another look at the coverage you’ve been getting and make changes or additions to better suit your needs going forward. For example, if you declined Medicare Part B when you first enrolled in Medicare, “you will be automatically enrolled in Part B now,” Rees explains. You can enroll in Medicare Advantage, Part D or a Medicare supplement plan as well, he points out.
[READ: Medicare Mistakes to Avoid.]
Seeking Help With Selections
Medicare can seem complicated, and the dizzying array of options and parts can make you wonder if you’re getting the coverage you need.
“It may be beneficial to seek advice from a Medicare consultant or counselor to make sure you’re taking full advantage of the programs and benefits available to you as an age-based Medicare recipient,” Rees says.
A free resource for such consultation is the State Health Insurance Assistance Program, or SHIP, a grant-based program in every state, Washington, D.C., Puerto Rico, Guam and the U.S. Virgin Islands.
SHIP programs are staffed by experts who are trained to work one-on-one with individuals and match them with the appropriate Medicare options for their specific needs. You can find your local program and set up an appointment at the SHIP website.
Medicare.gov is also a great resource for learning more about the options and navigating the process of enrollment or changing your selections. CMS also staffs a 24/7 call center at 1-800-Medicare where you can check your eligibility and get help getting oriented around Medicare, Seshamani notes. Helping people figure out the best options for them “is really a top priority for us,” she says.
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Will My Disability Benefits Change When I Turn 65? originally appeared on usnews.com
Update 09/22/23: This story was previously published at an earlier date and has been updated with new information.
