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Social Security Disability Benefits and Medicare Coverage

how to get medicare disability

Disabled individuals who receive Social Security benefits can qualify for Medicare before age 65. You may also be eligible for Medicare benefits if you get disability benefits from the Railroad Retirement Board.

Eligibility for disability benefits

The Social Security disability program provides benefits if you have a condition that prevents you from working for at least a year or is expected to result in death.

To be eligible for benefits, you need to have worked enough calendar quarters and paid Social Security or Railroad Retirement Board taxes during that time. The required number of quarters will depend on your age at the time you got disabled. For example, if you were disabled before age 28, you’ll usually need one and a half years of work. The older you were when you got disabled, the longer you’ll need to have worked to qualify for benefits.

For more information on work requirements for disability benefits, see this Social Security publication . 

Social Security uses five questions to determine if you’re disabled.

  • Are you currently employed? Applicants who make above a certain amount aren’t considered disabled.
  • Is your health condition “severe?” A condition is considered severe if it hinders your ability to do simple work-related tasks for at least a year, such as sitting, walking, or understanding instructions.
  • Does the List of Impairments include your health condition? Medical conditions included on the Social Security’s List of Impairments are considered extremely debilitating. If you have one of these conditions, you’ll automatically meet the legal definition of disabled. If your condition isn’t on this list, you’ll be evaluated on whether your condition is as severe as a listed condition.
  • Can you do the work you used to do? You’re not considered disabled if you can still work in the job you used to have.
  • Are you able to do other work? If you’re not able to do the work you did previously, you’ll be evaluated on your ability to do other types of work. 

The amount of your monthly disability benefit will depend on your lifetime average earnings. If your claim is approved, your Social Security disability benefits will start in the sixth full month from when your disability began.

How to apply for disability benefits

You should apply for disability benefits as soon as you get disabled, since it can take three to five months for your application to be reviewed, processed, and approved.

You can apply for Social Security disability benefits:

  • Online at the Social Security website.
  • By calling Social Security at 1-800-772-1213, Monday through Friday, from 7AM to 7PM. TTY users can call 1-800-325-0778.
  • In person at a Social Security office. 

If you worked for a railroad, you

can apply for disability benefits through the Railroad Retirement Board by calling 1-877-772-5772, Monday through Friday, from 9AM to 3:30PM. TTY users can call 1-312-751-4701.

During the application process, you will need to provide medical documentation that shows how your condition prevents you from working or performing work-related functions, like sitting, walking, or lifting. Your doctors and providers will be asked to verify your medical condition.

Eligibility for Medicare coverage

Receiving disability benefits from Social Security or the Railroad Retirement Board is one way to qualify for Medicare before 65. You’re automatically enrolled in Medicare Part A and Part B after getting disability benefits for 24 months, regardless of age.

If you have amyotrophic lateral sclerosis (ALS, or Lou Gehrig’s disease), you’d automatically get Medicare Part A and Part B the first month that your disability benefits start. There’s no waiting period for Medicare if you have Lou Gehrig’s disease. 

Social Security work incentives

The Social Security disability program provides incentives for you to return to work. Disabled individuals who return to work may still be eligible for disability benefits for a certain amount of time. It’s important to let Social Security know if you start working again. You will need to report your earnings and the number of hours worked.

Here’s an overview of how your disability benefits would be affected if you return to work:

  • Trial work period: Social Security gives you a nine-month trial period to see if you’re able to return to work; during this time, you’ll continue to receive full disability benefits no matter how much you make, as long as your disability is still an impairment. Your trial period begins in any month that you make above $770 and continues until you’ve reached nine months over a 60-month period.
  • Extended period of eligibility: After the trial work period, you can get disability benefits in any month that your income is below a certain limit. This extended period of eligibility lasts for 36 months after the trial work period.
  • Expedited reinstatement: If you stop being eligible for disability benefits because you make above a certain limit, you have a five-year period where you can get your benefits reinstated immediately if you’re unable to work because of your disability. You wouldn’t need to reapply or have your disability status verified again.

If you stop getting Social Security disability benefits because you’ve returned to work, you’ll still be eligible for Medicare benefits for 93 months after the trial work period, as long as you still meet the definition of disability. After that, you will need to pay a monthly premium for Medicare Part A and/or Part B if you want to continue your coverage.

Medicare has neither reviewed nor endorsed this information.

Category: Insurance

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