Medicare Challenges for Nonelderly Disabled Americans

Medicare is typically thought of as a program for elderly Americans, and it works very well for their purposes. However, Medicare is also utilized by eight million Americas under age 65 who live with permanent disabilities. Research indicates there are certain challenges faced by this younger population in getting the care they need that elderly enrollees do not deal with.

Americans receiving Social Security Disability benefits for 24 months are automatically eligible to enroll in the Medicare program. Because of this waiting period many disabled people under age 65 who end up on Medicare are uninsured for all or part of that two year time frame. One of the requirements to qualify for Social Security Disability is that you are completely unable to work. If you had insurance coverage through your job chances are it would not continue to cover you once you end your employment. Sometimes COBRA is an option to extend your insurance coverage, but COBRA is very expensive. You must be able to pay both your portion of the premium and the portion your employer used to cover to keep that policy active. That's incredibly burdensome for people who are not able to work.

According to a Kaiser Family Foundation survey of Medicare beneficiaries, half of nonelderly disabled people had difficulty paying for their health care in the past year. By contrast only 18% of the elderly population reported this trouble. Nonelderly disabled Medicare beneficiaries were also more likely to report they went without needed medication because they could not afford to buy it. The nonelderly disabled population was also less likely to have a supplemental policy to help cover the out of pocket costs associated with Medicare. Finally, the nonelderly disabled population was more likely to face challenges with prior authorizations and insurance refusing to cover medications prescribed by their doctors.

Luckily the 2010 Patient Protection & Affordable Care Act (PPACA) offers some solutions to the challenges disabled people on Medicare have been facing.The Medicare donut hole, which is a gap in prescription drug coverage for patients who have Part D prescription coverage, has already been improved. In 2011 patients whose prescription drug costs put them in the Medicare donut hole will only have to pay 50% of the cost of their medications out of pocket. In the next few years the donut hole will eventually be phased out completely. This change alone stands to make a huge improvement in the ability of disabled people to take their medications as directed by their doctors without having to choose between food and medicine or medicine and electricity.

The 2010 law also helps people in the waiting period for Medicare benefits by giving them access to the Pre-existing Conditions Insurance Programs with only a six month wait (read more about the Pre-existing Conditions Insurance Program here: Pre-Existing Conditions Insurance Program: Information for Uninsured Migraine Patients). This temporary program has been devised as a bridge to help vulnerable populations who cannot get insurance on their own because of pre-exiting heath conditions. In 2014 insurance companies will no longer be allowed to refuse to cover people who live with pre-existing conditions and this program will no longer be necessary.

The health care needs and resources of the elderly and disabled can be vastly different. Hopefully additional changes to better meet the needs of the disabled Medicare population will follow in the years to come.

By providing your email address, you are agreeing to our privacy policy. We never sell or share your email address.

This article represents the opinions, thoughts, and experiences of the author; none of this content has been paid for by any advertiser. The team does not recommend or endorse any products or treatments discussed herein. Learn more about how we maintain editorial integrity here.

Join the conversation

or create an account to comment.