Young woman pushing an older women in a wheelchair down a path in a park -Medicare if You Have ALS or ESRD

More than 60 million people are currently enrolled in Medicare. Most people think you have to be at least 65 to qualify for Medicare, but there are some exceptions. If you have Amyotrophic Lateral Sclerosis (ALS), also known as Lou Gehrig’s disease, or end-stage renal disease (ESRD), you can still get traditional Medicare coverage as long as you meet the other requirements. Let’s take a look at just what Medicare is and what the eligibility requirements are.

What is Original Medicare?

Original Medicare refers to Medicare Parts A and B. Part A covers hospital stays, hospice care, and skilled nursing care typically needed after being hospitalized after a broken hip, a stroke, etc. Part B covers doctor’s visits, medical equipment, diagnostic screenings, lab tests, ambulance transportation, and other outpatient services.

Most people get Medicare once they reach age 65. Some people have to pay a premium for part A, but most don’t. As long as you or your spouse paid taxes into Medicare while you were working, you won’t have to. If you didn’t, you’ll have to pay a premium. Part B’s costs depend on your income. The Social Security Administration uses tax information to determine what your costs will be. The majority of people will pay either $104.90 per month or $121.80 per month for the Part B premium. Some people opt to have it taken directly out of their Social Security checks each month.

Who is Eligible for Medicare?

If you have ALS or ESRD, you can qualify for coverage with Medicare. If you meet one of the following criteria, you’re most likely eligible for Medicare Parts A and B:

  • You’ve been diagnosed with ALS (Amyotrophic Lateral Sclerosis), or Lou Gehrig’s Disease
  • You’re age 65 or older and eligible for Social Security
  • You’ve been diagnosed with end-stage renal disease (ESRD)
  • You’re under age 65, permanently disabled, and you get disability benefits from the Railroad Retirement Board or Social Security

In order to qualify, you also have to be a U.S. citizen or you must have been a legal permanent resident for at least five consecutive years.

What You Need to Know if You Have ALS or ESRD and How to Apply

As mentioned above, if you’ve been diagnosed with ALS or ERSD, you don’t have to be 65 to qualify for Medicare. You also don’t have to wait 25 months to be eligible. If you have ALS, you’re eligible for Medicare the moment your SSDI benefits start. If you have ESRD, you’re eligible to apply for Medicare on the first day of the fourth month of dialysis (or right away if you do dialysis at home) or when you enter the hospital for a kidney transplant.

Medicare Advantage plans are not currently available to ESRD patients, but they will become available in 2021, according to CMS.gov. If you’re under age 65 and you have ALS or ESRD, the availability of Medigap plans varies from state to state so you’ll have to check your state’s requirements to see if you can get it in your area. Once you know that you’re eligible, you can apply for Medicare through Social Security’s online portal, by phone, or at your local Social Security office.

Starting the Process

Living with ALS or ESRD is hard enough — you shouldn’t have to worry about having adequate medical insurance to cover your healthcare costs. With the above information, you can determine whether you qualify for Medicare based on the rest of the criteria so you can bridge the gap and cover most, if not all, of your medical costs. Check your eligibility today so you can start reaping the benefits of Original Medicare.

 

What to Know About Medicare if You Have ALS or ESRD

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