What Disabilities Qualify You for Medicare?
If you fall into one of the following disability categories, you may be eligible for Medicare even if you are younger than 65 years old.
You have amyotrophic lateral sclerosis (ALS), also known as Lou Gehrig’s disease. You have end-stage kidney disease (ESRD) that requires dialysis or a kidney transplant. You receive disability benefits through the Railroad Retirement Board (RRB). You receive Social Security Disability Insurance (SSDI).
Paying Into the System
People who qualify for Medicare have paid for that benefit. The number of years you or your spouse pay the federal government in payroll taxes determines not only your eligibility for the healthcare program but how much you will pay. These tax dollars are intended to safeguard entitlement benefits for you when you need them in the future.
The Cost of Medicare
While Medicare offers health care to the disabled, it is not free. You have to pay premiums for the different parts.
Premiums must be paid for Part A if someone (or their spouse) has not worked at least 40 quarters (10 years) of taxed employment. Everyone pays premiums for Part B, an amount determined by your income. If you want prescription drug coverage, you will pay premiums for Part D as well.
In lieu of these options, you may pick a Medicare Advantage plan. Medicare Advantage plans include everything that Part A and Part B cover and may include Part D coverage if you choose. Like the other parts of Medicare, these plans will cost you a monthly premium.
Other health plan costs include deductibles, coinsurance, and copayments too.
When Other Insurance Plans Cost Less Than Medicare
You may find that other insurance options are less expensive for you than Medicare.
Affordable Care Act plans are an appealing but you are not allowed to have any part of Medicare while on an Obamacare plan. You could sign up for health coverage through your spouse’s health plan if that option is available. Better still, you may be eligible for health care based on your military experience, whether through the VA or TRICARE.
In these cases, you may be tempted to decline Medicare in favor of another insurance. After all, no one wants to pay two premiums if they don’t have to. However, you need to understand that declining Medicare can have serious repercussions.
Declining Part A Coverage
If you decline Part A coverage, you could lose your Social Security benefits. This could include your retirement benefits or even benefits from SSDI. Not only will you lose the future income from Social Security but you will have to pay back any Social Security benefits you received up to the time you declined Part A.
A ruling by a U.S. District Court in 2001 addressed this very issue. Three federal employees sued the government because they wanted to discontinue Part A in favor of coverage under the Federal Employees Health Benefit (FEHB) program. At the same time, they wanted to keep their Social Security benefits.
The 1965 law that created both Social Security and Medicare provided the answer. Judge Rosemary Collyer stated that “requiring a mechanism for Plaintiffs and others in their situation to ‘dis-enroll’ would be contrary to congressional intent, which was to provide ‘mandatory’ benefits under Medicare Part A for those receiving Social Security Retirement benefits.” Translated, the ruling states people cannot disenroll from Medicare Part A without also losing their Social Security benefits.
Declining Part B Coverage
If you decline Part B coverage, you may be faced with late penalties when you sign up at a later time. Unlike with Part A, this will not cause you to lose your Social Security benefits. This is because you do not pay taxes for Medicare Part B.
Summary
No one would fault you for trying to keep your health costs down. That said, you should not decline Medicare Part A if you are on SSDI. The two programs are linked together by law and declining one automatically declines the other. You would not only your Medicare coverage, you would lose your disability income!
You can decide whether or not Medicare Part B is right for you but be aware that you could potentially face late penalties down the line.
A Word from VeryWell
Most people get Part A for free. If this is the case, it is usually in your best interest to enroll and continue Medicare coverage to secure your Social Security benefits. Be very careful about waiving your Part A coverage. It could literally cost you!
