Given what we see projected on the news, it’s easy to assume that the majority of Medicare recipients are senior citizens, but that’s not always the case. Indeed, many Americans under the age of 65 are eligible for and currently using the benefits from Medicare, either because of a particular medical condition or a preexisting, permanent disability.
In this article, we’ll give you some valuable information about how to make the most of your Medicare benefits and find the plan that best suits your personal needs. For more information about Medicare or insurance in general, please contact AV Towers Insurance today. Nosotros hablamos español!
Eligibility Overview
If you are under 65 years of age, there are two primary ways you’ll be eligible for Medicare. If you’ve been receiving Social Security Disability Insurance checks for at least 2 years, or 24 months, you are eligible. The other way you may be eligible is if you’ve been diagnosed with End-Stage Renal Disease. If you have this condition, you’ll generally only need to wait three months before obtaining eligibility for benefits.
Although these are the primary eligibility criteria for Medicare under age 65, there are exceptions. For instance, if you have Amyotrophic Lateral Sclerosis (ALS), you do not have to worry about the 2-year waiting period before receiving Medicare benefits; from the time you get your first SSDI check, you’ll also receive access to the medical insurance program.
Know the Parts of Medicare
Unless you or someone you know relies on Medicare, you may have been unaware that the insurance has multiple parts. Medicare is broken down into Part A and Part B. What’s the difference between these?
Medicare Part A is a financial aid for inpatient hospital visits and stays, whereas Part B is a more generalized form of coverage that assists in payments for doctor’s appointments, lab analyses, medical supplies and equipment, and more. Essentially, Medicare Part A is hospital insurance; Part B is medical insurance.
It is possible to receive both parts of Medicare — for example, to pay for doctor’s visits while staying in an inpatient facility — but in general, most people will use one variety more frequently than the other.
How to Make The Most of Your Benefits
Those under 65 in need of Medicare benefits are one of the most vulnerable populations when it comes to unethical insurance practices. They are also likely to experience difficulty with paying their medical bills and meeting their deductibles.
To mitigate struggles in paying for insurance, Medicare Supplement Insurance (a.k.a. Medigap) is a tool you may consider. Simply put, this supplemental insurance can help cover “gaps” in your Medicare costs that would otherwise have to be paid out of pocket.
Although Medigap is an excellent resource, there are exceptions that may disqualify you from receiving it depending on where you live and what conditions you have been diagnosed with.
Know Your Rights
Consumer protection laws require insurance companies to adhere to certain business practices. This federal legislation helps protect vulnerable individuals that are receiving Medicare, but only if they are 65 or older. Some states have opted to extend these consumer protection rights to Medicare recipients under the age of 65, but they are not federally or legally required to do so.
Currently, 31 states offer some level of protection for Medicare recipients under 65, but even these states have varying criteria of what qualifies an individual for coverage and protection, such as the type of disability they have or how long they have been dealing with a given disease.
The 19 states that do not offer protections to young Medicare beneficiaries have been known to grant coverage to some disabled individuals or persons suffering from ESRD. However, they are still legally free to discriminate against those under 65 based on age, sex, health status, condition prognosis, and virtually any other criteria they deem to be relevant justification for denial of coverage.
You can figure out where your state stands on consumer protection laws for those under 65 by visiting this resource.
Conclusion
Insurance coverage is a complex industry to navigate, and Medicare for those under 65 is a crowning example of this intricacy. From hyper-specific stipulations on eligibility criteria to discriminatory behavior by insurance companies, there is no shortage of hurdles to overcome in the journey to obtain coverage.
If you want to learn more about your eligibility for Medicare benefits or get information about insurance in general, please reach out to AV Towers Insurance today.
