“My 42 year old client is physically and cognitively disabled and has very expensive health insurance. He qualifies for Medicaid for his nursing home placement needs. He should have Medicare due to his disabilities. I know it is open enrollment for Medicare until December 7th, I can just sign him up now, right?” Social Worker, GA

Thank you so much for you question. The brief answer to this question is, “No, the Annual enrollment period is for those already established on Medicare to make changes to certain Medicare products – not for someone to initiate Medicare coverage, especially for someone under 65. This is an entirely different process through Social Security.”

Medicare coverage for those under age 65 is only available through a disability “declaration” by Social Security. Your client must meet the strict Social Security definition of total disability and apply for the program for Social Security Disability Insurance. Additional information regarding Social Security Disability, the application process, and required supporting documentation is available on their website, www.ssa.gov/disability.

Once your client has received approval for Disability benefits through Social Security, they will automatically receive Medicare Part A and Part B on the 25th month of disability. Social Security will set the timeline for when a person will be eligible to receive Medicare benefits  – as it is not, typically, from the approval date of the application but, yet, a date prior when the person was declared to be “disabled”.

Your client will also want to assess, at that time, what other Medicare based products will be helpful to also cover the costs beyond original Medicare. There is a very brief window surrounding the date of eligibility to select additional products options once approved – so, it is critically important to be aware of the date of eligibility and seek education from a trusted Medicare products insurance broker or Medicare.gov for available options.

Best wishes to you and yours!

0 replies

Leave a Reply

Want to join the discussion?
Feel free to contribute!

Leave a Reply

Your email address will not be published. Required fields are marked *