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Health Care Reform:

Health Insurance & Affordable Care Act

Medicare Eligibility and Enrollment

For People With Disabilities and Illnesses

No matter how old you are, if you have Lou Gehrig's disease, kidney failure, or certain other disabilities, you are eligible for Medicare. But you might have a waiting period before you can get Medicare benefits. Here are the details.

Lou Gehrig's disease (ALS). As soon as you get Social Security Disability benefits for ALS, you should be automatically enrolled in Medicare. There is no waiting period.

Kidney failure. To qualify, you must have end-stage renal disease and need dialysis or a kidney transplant. Usually, you can't get Medicare until three months after you start dialysis. Once you've been diagnosed with kidney failure, call the Social Security administration at (800) 772-1213 to enroll in Medicare.

Other disabilities for which you get Social Security Disability benefits. You can't get Medicare until two years after you qualify for Social Security Disability. At that point, the Social Security Administration should sign you up automatically.

If you are not getting Medicare coverage and feel that you should, call the Social Security Administration at (800) 772-1213.

Medicare Enrollment Periods

Medicare limits your ability to add or drop coverage after official enrollment periods. So pay close attention to Medicare enrollment deadlines. Here are some details:

Initial Enrollment Period. If you are not automatically enrolled, you must sign up during your "initial enrollment period" for Part A with or without Part B. This initial sign-up lasts 7 months, starting 3 months before the month of your 65th birthday and ending 3 months after. During this time, you can sign up for any Medicare coverage you would like. However, if you wait to sign up the month of your birthday or the 3 months that follow, you will have to wait 1 to 3 months for coverage to begin.

Other enrollment periods. If you did not enroll in Parts A and B during the initial enrollment period, you may do so between Jan. 1 and March 31, with coverage beginning in July of that year. You may have to pay a higher monthly premium for coverage. There are some exceptions. If you are covered under a group health insurance plan through your job or your spouse's job, or if your employment ends after the initial enrollment period, you may enroll in Medicare during a Special Enrollment Period without having to pay a late-enrollment penalty.

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