How to Apply for Social Security Disability Insurance to Get Medicare

Qualifying for Medicare Regardless of Age

Not everyone who goes on Medicare is 65 years or older. The program is available to people who are younger if they have a medical disability. People who have amyotrophic lateral sclerosis (ALS), also known as Lou Gehrig's disease, automatically qualify, and people who have end-stage renal disease, meaning that they need dialysis or a kidney transplant, are eligible if they paid enough in taxes. Most people with disabilities, however, qualify for Medicare based on Social Security Disability Insurance (SSDI). How does the SSDI program work and how can you apply?

1
Find Out if You Qualify for Social Security Disability

Disability
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Make sure you meet these four requirements to qualify for the Social Security Disability Insurance (SSDI) program.

1. Earn Enough Work Credits

The Social Security Administration (SSA) then uses work credits to decide if you meet criteria. For 2017, one work credit equals $1,300 in taxed earnings for the year and four credits equal $5,200. You cannot earn more than four credits per year.

The number of work credits you need to qualify for SSDI is divided up into three age categories:

  • Age 24 and younger: You need six work credits in the three years immediately preceding your disability.
  • Age 24 to 31: You need one work credit for each year between 21 and the year your disability began.
  • Age 31 and older: You need at least 20 work credits (for those 31 to 42 years old) in the 10 years immediately preceding your disability and up to 40 credits (for those 62 and older) with 20 of those work credits earned in the 10 years before your disability began.

Helpful tip: Keep in mind that any job where you worked "under the table" is not going to count towards your SSA work credit requirement since taxes were not paid.

2. Meet Income Limits

You must earn less than a certain amount of money each month. Earning more implies that you can perform "substantial gainful activity" and are not disabled in the eyes of the SSA. In 2017, the monthly earning limit is $1,170 ($1,950 if you are blind). 

3. Prove You Have a Medical Disability

You must have a medical disability, mental or physical, that is expected to last for at least one year. The Social Security Administration will request medical records in addition to supportive documentation from your doctor as proof of disability.

4. Show Your Disability is Severe

The medical disability must be severe enough to affect your ability to work in your current or past jobs. The ability to work in some capacity based on your age, education and skill level will likely result in a denied claim for SSDI.

2
Gather Information to Support Your Disability Claim

Application
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Before you apply for SSDI, you need to gather information. This will help you to accurately complete your application. Here is what you need on hand.

  1. Copies of your medical records relating to the disability
  2. Copies of Worker's Compensation documents, if applicable
  3. List of your medical conditions
  4. List of your medications
  5. List of medical tests relating to the disability with dates of service
  6. List of doctors and other healthcare professionals who have treated you over the past 12 months with dates of service, office addresses, and office phone numbers
  7. Signed medical release form to allow your medical records to be sent to the Social Security Administration
  8. Job history over the past 15 years with description of job duties
  9. Names and birth dates of your spouse(s), past and present
  10. Names and birth dates of minor children
  11. Dates of marriages and divorces
  12. Bank information for your future Social Security checks, if approved for disability
  13. Contact information including name, address and phone number for someone who knows and supports you as a reference

Helpful tip: You may want to ask your doctor for a copy of your records to review yourself before you submit an application. If you feel more there is not enough information describing your medical condition, you can request an office visit. You will want the doctor to add the needed information as part of a face-to-face visit rather than in response to a phone call. A detailed physical examination is often what is needed to strengthen an SSDI claim.

3
Complete Your SSDI Application

SSDI
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Once you gather up your information, you can officially apply for SSDI benefits. This can be done in three ways.

  1. In person. Visit your local Social Security office and fill out an application face to face with a Social Security representative.
  2. On the phone. Complete your application on the phone at 1-800-772-1213. Social Security representatives are available Monday through Friday 7 a.m. to 7 p.m. Eastern Standard Time to assist you.
  3. Online. Applications are available on the Social Security website. You can save your application as you go and complete it at your convenience.

Helpful tip: The application process takes time, averaging one to two hours depending on the complexity of your case. Be sure to set aside enough time to complete your application properly.

4
Make an Appeal if Your SSDI Case is Denied

Appeals
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It may take the Social Security Administration (SSA) three to five months to approve or deny your application, shorter if your medical condition is listed on the list of Compassionate Allowance Conditions. Conditions on this list are generally expected to have a shorter life expectancy and higher medical needs.

If your application was denied for any reason, you may choose to appeal the decision. In 2016, more than 2.3 million people applied for SSDI, but only 32 percent of cases were approved that year.

There are four levels of appeal. If at any level your case is approved, the appeals process stops there.

  1. Reconsideration. In this case, your application will be reviewed a second time by a new set of individuals at the state agency.
  2. Hearing with an administrative law judge. A judge who was not involved in your prior case reviews will examine your case. You may bring witnesses to the hearing to add testimony on your behalf. Hearings are usually in person but can also be conducted on the phone if necessary.
  3. Review by the Social Security Appeals Council. The Appeals Council decides whether or not to hear your case after reviewing results from your hearing. They may review the case themselves or send it back for a hearing with a second administrative law judge.
  4. Federal court review. The last resort is to file a lawsuit with the federal district court.

Helpful tip: If your case is denied at any level, you may need to strengthen your case. The SSA has very strict requirements, and oftentimes, more medical documentation is needed to demonstrate your impairment. You may want to consider an independent medical examination, i.e. evaluation by a physician who is experienced in the appeals process and who can make functional assessments that address the SSA requirements.

5
How and When to Get Started on Medicare

SSDI and Medicare eligibility
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Once you are approved for SSDI, you are on the path to Medicare coverage. As long as your SSDI is not taken away for any reason, you will automatically be enrolled in Medicare Part A and Part B on your 25th month of consecutive SSDI benefits. Your premiums will be directly deducted from your SSDI benefit check.

You will have to apply for a Medicare Part D plan, i.e. a prescription drug plan, on your own.

Think carefully before you make any decisions to decline Medicare when you are on SSDI. Even if you think another health plan will cost you less in annual deductibles or monthly premiums, this will never work in your favor because:

  1. If you refuse Medicare Part A, you will lose all Social Security benefits, including your SSDI.
  2. If you keep Medicare Part A but decline Medicare Part B, you are not eligible for other health insurance coverage, i.e. from the Health Insurance Marketplace or a private insurance company. It is against the law for these plans to market or sell to Medicare-covered beneficiaries.

Helpful tip: Not only could you lose your SSDI disability benefits and future income if you decline Medicare, but you would lose access to affordable health care. The long-term financial ramifications are considerable.

A Word from Verywell

Not every medical disability qualifies you for Social Security Disability Insurance (SSDI), but SSDI qualifies you for Medicare. Applying for SSDI can be time-consuming, but it could be well worth the effort if you are in need. Learn how to go through the process step by step and avoid any missteps.
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