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securing medicare disability

Medicare, a pillar of federal health insurance, caters to older adults and individuals with disabilities or chronic health issues. Data from the Center for Medicare Advocacy reveals that over 65 million people were enrolled in Medicare as of March 2023. While the eligibility age for benefits is 65, certain circumstances exist for securing Medicare disability coverage before then.


While Medicare typically supports those 65 and older, a significant number of enrollees are younger individuals with long-term disabilities. According to insights from the Kaiser Family Foundation, approximately 12% of Medicare beneficiaries qualify due to disability rather than age.

Individuals who enroll in Medicare for a disability receive the same benefits available to older enrollees. They have the option to select fundamental coverage through Medicare Parts A and B, or explore additional benefits through Part D covering prescription drug coverage and Medicare Advantage plans.

Traditional Medicare is structured to include various components for different healthcare needs. Medicare Part A encompasses critical aspects such as inpatient hospital care, skilled nursing, and home health services. Part B, on the other hand, mainly addresses outpatient services. Individuals with disabilities can supplement their coverage with Part D prescription drug benefits, as well.

Medicare Advantage plans, denoted as Medicare Part C, provide an alternative to traditional Medicare. These plans, designed by private companies in collaboration with Medicare, often extend beyond basic coverage to include vision, hearing, and dental services. Medicare premiums are usually deducted from monthly Social Security Disability Insurance (SSDI) payments, administered by the Social Security Administration (SSA).

For younger SSDI recipients securing Medicare disability coverage, a mandatory 24-month waiting period is required for eligibility. Current estimates suggest that around 1.6 million Americans find themselves in this interim period. However, Congress has made exceptions for certain health conditions, such as amyotrophic lateral sclerosis (ALS). Patients diagnosed with ALS, also known as Lou Gehrig’s disease, immediately qualify for Medicare benefits upon meeting SSDI criteria.

Understanding the Two-Year Waiting Period

The 24-month waiting period originated in the early 1970s when it was implemented as a cost-saving measure. Yet in contemporary times, the two-year wait often poses significant challenges. Many individuals find themselves uninsured during this interim period. Some are unable to afford essential medications or necessary medical treatments, while others may not survive the wait.

During this holding period, individuals with disabilities may explore alternative health insurance options. Coverage through a former employer or private plans are two options, however, private plans can be difficult to afford. For those with limited financial resources, Medicaid offers a viable solution for healthcare coverage.

Efforts to modify or eliminate the waiting period have been ongoing for years, with lawmakers and disability advocates calling for change. Despite bipartisan support for proposed bills as recent as 2023, concrete progress toward addressing this issue remains elusive. On a positive note, exceptions are allowed for certain conditions; individuals who have ALS, end-stage renal disease (ESRD) post-kidney transplant, or who have undergone several months of dialysis treatment are immediately eligible for benefits.


For individuals facing disabilities that hinder their ability to work, Social Security Disability Insurance (SSDI) provides vital financial support. SSDI offers monthly income to disabled workers and their families, aiding them during challenging times. Anyone under 65 who qualifies for Social Security disability benefits can receive Medicare coverage. Yet eligibility still hinges on having sufficient work credits and meeting the Social Security Administration’s (SSA) criteria for disability.

The SSA maintains strict guidelines for what constitutes a disability. This includes being unable to work or participate in gainful activity due to a physical or mental impairment. The impairment must be severe enough to cease previous work activities or hinder adapting to new ones. Additionally, this must last for a year or longer, or be deemed terminal. When evaluating disability claims, the SSA references a designated list of impairments. Individuals with other conditions must demonstrate disability equal to those listed before securing Medicare disability coverage.

14 categories of conditions are recognized by the SSA, including:

  • Nervous system disorders (ALS, epilepsy, multiple sclerosis, Parkinson’s disease, and traumatic brain injuries)
  • Cancer
  • Diseases of the immune system (HIV, lupus, and rheumatoid arthritis)
  • Heart diseases (arrhythmia, congenital heart disease, and heart failure)
  • Illnesses hindering respiration (asthma, chronic obstructive pulmonary disease (COPD), and cystic fibrosis)
  • Kidney disease
  • Mental and cognitive illnesses (bipolar disorder, depression, and dementia)
  • Sense and speech conditions (blindness, deafness, and speech impairments)
  • Endocrine disorders (diabetes and thyroid problems)
  • Disorders affecting the bones, joints, and muscles (amputation, chronic joint pain, and spinal disorders)
  • Congenital disorders affecting multiple body systems (Down syndrome)
  • Blood disorders (sickle cell disease and bone marrow failure)
  • Problems with the digestive system
  • Skin conditions (burns and ichthyosis)

Additional SSDI Resources

Only a small minority of SSDI applicants are approved for securing Medicare disability coverage. To improve your chances of qualifying, explore these articles for more information:


If your disability prevents you from working, you may be eligible for Medicare coverage through SSDI. Speak with a reputable special needs planner for support in seeking the right benefits for your situation. Additionally, an elder law attorney can provide further guidance on navigating disability benefits and securing Medicare disability coverage.

Bromlow Law, PLLC and Laura L. Bromlow, are dedicated to the practice of Elder Law and Estate Planning. Our practice focuses solely on working with clients in these and closely related legal fields. Laura L. Bromlow is a Certified Elder Law Attorney with the National Elder Law Foundation. Bromlow Law, PLLC strives to enhance communication among family members and loved ones and to keep them all out of conflict so they can stay out of court. We want to help you keep your close circle safe!

Please contact our office today at (281) 665-3807 to schedule a free consultation to discuss your legal matters. We look forward to the opportunity to work with you.

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