Medicare enrollment rules for Social Security Disability

Dear Toni,

My sister Sally has been qualified for Social Security Disability for the past 24 months, due to having heart issues, and is receiving her Social Security check. Last week, she received a letter saying that she will be enrolled in Medicare Parts A and B beginning Nov. 1. She is 64 and her individual health insurance plan ends when her Medicare begins.

Sally does not turn 65 until next May and is not sure what she should do regarding picking a Medicare plan to begin in November. Should she enroll in a Medicare Advantage plan or a Medicare Supplement? My concern is regarding her expensive prescriptions, and I am not able to find any help online. Please advise what Sally’s options are. Thanks, Toni.

--Karen from Dallas

Hi Karen:

Enrolling in the correct Medicare plan, either Original Medicare with a Supplement and stand-alone Medicare Part D plan or Medicare Advantage plan with Part D included, when someone has a serious health condition can be extremely complicated. Your sister’s current specialists and prescriptions are what the Toni Says Medicare team would focus on during a Medicare consultation.

Since Sally’s Medicare will begin Nov. 1 and Medicare’s 2025 prescription drug plan information won’t be released until Tuesday, Oct. 1 on the Medicare.gov site, I would advise you to start searching for the best plan with prescriptions after Oct. 1 at www.medicare.gov to know which Medicare Advantage Prescription Drug or Part D plan covers all of Sally’s prescriptions.

Since Sally is reaching her 25th month on Social Security Disability (SSD) and qualifying for Medicare Parts A and B, let’s discuss the two Medicare enrollment times for those with SSD:

1. Enrolling in Medicare under 65: When one’s 24th month on Social Security Disability passes, the individual is automatically enrolled in Medicare Parts A and B to begin on the 1st day of the 25th month. This is the case with Sally’s Medicare. Even though she will not turn 65 until May, Sally’s Medicare will begin Nov. 1. Each state has different Medicare Supplement plans available to those under 65. In Texas, only Medicare Supplement Plan A is available to those under 65.

If you are under 65, on SSD, and enrolling in Medicare for the first time, during a Toni Says Medicare consultation, we advise you to discuss with your medical professionals and facilities which Medicare Advantage plan they accept.

Medicare Advantage Prescription Drug (MAPD) plans help to cover the Medicare costs that Medicare does not pay for. The MAPD plan will have deductibles, co-pays, and out-of-pocket costs (up to a maximum) that the Medicare enrollee will have to pay. This type of plan includes a prescription drug plan. Again, always verify that your health care professionals and facilities accept and will bill the MAPD plan you’ve picked.

2. Turning 65 and on Social Security Disability: Karen, I have good news for you and Sally because when she turns 65 next May, she will have a second Medicare Supplement enrollment time which is called the Medigap/Medicare Supplement Open Enrollment period. She will not have to answer any health questions because she will have just turned 65, the same as anyone who is just turning 65 and is enrolling in both Medicare Parts A and B. Those on Social Security Disability will qualify during a 6-month period that begins the month one turns 65 for Medicare Supplement Plans A-N.

I’ve had my own SSD experience because my sister was on a MAPD plan until she turned 65. During her Medigap/Medicare Supplement Open Enrollment period, I signed her up for a Medicare Supplement Plan G, and she had eye surgery with a physician that we could choose.

Readers, always explore your Medicare options when turning 65, because what you don’t know WILL hurt you.

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Toni King is an author and columnist on Medicare and health insurance issues. She has spent nearly 30 years as a top sales leader in the field. For a Medicare checkup, call the Toni Says call center at (832) 519-8664 or email info@tonisays.com regarding your Medicare plans and options. Toni Says Medicare Survival Guide Advanced edition is available at www.tonisays.com. Toni’s Medicare Moments articles have just been released: https://familytalktoday.com/medicare-moments.