By Vicki Gottlich, Director of the Center for Policy and Evaluation, Administration for Community Living
Medicare Open Enrollment season is a time when Medicare beneficiaries can review their policies to make sure their medical care—fee-for-service or managed care—and their pharmacy plans are meeting their needs. While much media attention is given to urging adults over the age of 65 to review their Medicare options, many people overlook the fact that Medicare also covers millions of younger people with disabilities. All Medicare beneficiaries—regardless of age—should use Medicare Open Enrollment season to think about whether last year’s health plan choices still work for them.
Medicare has undergone many changes since July 1965 when it became law. At that time, Medicare was designed to provide health insurance to people aged 65 and older who were entitled to Social Security benefits. However, in 1972, the law was amended to provide health insurance coverage to younger people who were eligible for Social Security disability (SSDI) benefits. Most of the people who are eligible for Medicare based on disability must receive SSDI for 24 months before their Medicare coverage starts. Those who receive SSDI because they have amyotrophic lateral sclerosis (ALS, also known as Lou Gehrig’s disease) become eligible for Medicare right away, without any waiting period. Medicare also covers people with end stage renal disease (ESRD) who are younger than age 65 without the 24-month waiting period. Today, about 54 million people get their health coverage through Medicare. Of these, about 16%, or almost 9 million people, are younger people with disabilities.
All people with Medicare, regardless of their age, have the same choices as to how they receive their Medicare coverage. They may choose the traditional Medicare program and a Medicare Part D prescription drug plan, or they may choose a Medicare Advantage plan. The traditional Medicare program provides the same coverage to all beneficiaries; there is no distinction between beneficiaries who are eligible based on age and those who are eligible based on disability. Medicare Advantage plans and Medicare Part D plans cannot discriminate or deny enrollment to someone because of age, health status, disability, or the reason for receiving Medicare. There is one exception to this rule: most Medicare Advantage plans do not have to enroll people with ESRD, unless they were specifically created to serve people with ESRD.
The Medicare Open Enrollment period affords every Medicare beneficiary—those who are eligible based on age and those who are eligible based on disability—the opportunity to think carefully about their Medicare choices and make changes. Medicare Open Enrollment ends December 7, 2014. Beneficiaries who change their plans will be covered under their new plan starting January 1, 2015.
For more information, visit www.medicare.gov. Find out more information about the characteristics of people with Medicare at kff.org/medicare/fact-sheet/medicare-at-a-glance-fact-sheet/.