The answer to this question depends on what makes you eligible for Medicare. The majority of people who qualify for Medicare due to a disability have a two-year waiting period before they can receive Medicare benefits. Those with End-Stage Renal Disease also have a waiting period before they can receive Medicare benefits, determined by the length of time they have been receiving dialysis.
There are also set delays in coverage taking effect. During your Initial Enrollment Period, if you sign up in the three months before your turn 65, your coverage will start the first day of your birthday month. For those with birthdays on the first of the month, coverage begins on the first of the previous month. If you sign up for a different plan during Open Enrollment from October 15 to December 7, your new coverage will begin on January 1. If you sign up during General Enrollment from January 1 to March 31, your coverage begins on July 1.
Medicare with Disability
To qualify for Medicare under the age of 65, you must have a disability or chronic medical condition. Once you become disabled, contact Social Security to apply for disability benefits. You will not be able to receive Medicare coverage right away. There is a 24 month waiting period.
You will receive Medicare benefits after 24 months of receiving Social Security Disability Insurance (SSDI). In the 25th month, you will automatically receive your red, white, and blue Medicare card in the mail. Your Part A and Part B coverage begin in the 25th month of receiving SSDI. You receive premium-free Part A, meaning you pay nothing in premiums for Part A.
Medicare with End-Stage Renal Disease
End-Stage Renal Disease (ESRD) is advanced kidney failure. People with ESRD are not automatically enrolled in Medicare but can choose to enroll in Part A and Part B. To receive full coverage for dialysis and outpatient medicine, it is recommended that these people sign up for both parts.
Those with ESRD are granted retroactive coverage from when they sign up for Medicare back up to 12 months after they became eligible due to ESRD. The 12 months take the waiting period into account, with coverage only beginning with Medicare eligibility.
There is a four-month waiting period for those with dialysis treatments to receive Medicare coverage. Coverage starts on the first day of the fourth month of dialysis treatments. During those first three months, your other health insurance can pay for the cost of your dialysis.
You can avoid this waiting period by pursuing home dialysis treatments. This will involve participating in a home dialysis training program offered by a Medicare-certified training facility during the first three months of your course of dialysis. Your doctor must also expect you to finish training and be able to perform the dialysis treatments successfully on your own. In this case, Medicare will start to cover you in the first month of your regular course of dialysis treatments.
If you’re getting a kidney transplant, your coverage begins the month you’re admitted to a Medicare-certified hospital for your kidney transplant. Coverage can begin two months before your transplant, so if your transplant is delayed by two months your stay will still be covered.
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Understanding Medicare and its many benefits can be difficult, so it’s best to use an agency like The Fussell Group Insurance Advisors. Give us a call today to get your coverage started!