Understanding health insurance coverage rules can be complicated. If you are disabled or have qualified for disability, it can be even more so because the rules are different. There are two basic standards, and learning which applies to your situation will help determine your options.
There are two standards that affect your access to health insurance if you are disabled. If you are not eligible for Medicare, you will have different options than individuals who are disabled and Medicare eligible. The type of health care coverage available to you in such a case is based on three qualifiers: the cause of your disability, your income and the private insurance options available in your county of residence.
To become eligible for Medicare health care coverage, you need to have received Social Security or Railroad Retirement Act disability benefits or payments for at 24 months. Once you have met this criteria, you will become Medicare eligible in your twenty-fifth month of disability. There are two exceptions to this rule, and you will still need to apply for Medicare coverage, as benefits are not automatically provided.
If you are disabled due to amyotrophic lateral sclerosis, better known as Lou Gehrig's disease or ALS, you are eligible to enroll in Medicare the same month your disability benefits begin -- you are not required to wait 24 months for eligibility. The second exception is made for individuals whose disability is cased by end stage renal disease, or ESRD. You will be Medicare eligible if you have permanent kidney failure, regularly scheduled and attended dialysis treatments, or a kidney transplant, and you are receiving Social Security disability payments. Your dialysis center's financial staff can answer your specific questions, and the Renal Support Network website can help as well (see Resources).
Private Health Care Coverage
You may have access to private health care coverage through your employer or through your spouse or parent's job while you are waiting to become eligible for Medicare. If you are not eligible for Medicare, discuss your disability health care coverage options with your Human Resources liaison at the company that is providing access to your health insurance. If you are Medicare eligible, your private insurance will be considered your primary coverage. If you are not covered under an employer plan, Medicare will be your primary insurance coverage once you have met the waiting period requirement.
Government Health Care Coverage
Most states offer access to low-cost coverage for specific diagnoses, including HIV, breast and cervical cancer, and TB. Call your state's health department for more information. Another reliable source of help are social workers at your local hospital. They are familiar with the type of special health care coverage plans in your state. Each state offers access to Medicaid coverage for low-income individuals and families, and people on disability. The Centers for Medicare and Medicaid have extensive information available at their website. If you are a veteran, contact your local VA medical facility for information (see Resources). You can also call 1-877-222-VETS for help. To apply for Medicare benefits via the Social Security Administration, or SSA, make a toll-free call to 1-800-772-1213.
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