What are Medicare’s 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 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. — Karen, Dallas

Dear Karen: Enrolling in the correct Medicare plan, either original Medicare with a supplement and stand-alone Medicare Part D drug plan or Medicare Advantage plan with Part D included, when someone has a serious health condition, can be extremely complicated. Your sister’s specialists and prescriptions are what the Toni Says 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, I would advise you to start searching for the best plan with prescriptions after Tuesday at Medicare.gov.

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

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 first day of the 25th month. Even though Sally will not turn 65 until May, her 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.

If you are under 65, on Social Security disability and enrolling in Medicare for the first time, we advise you to ask which Medicare Advantage plans your medical professionals and facilities accept.

Medicare Advantage prescription drug plans help cover the costs that Medicare does not pay for. The plan will have deductibles, copays and out-of-pocket costs (up to a maximum) that the Medicare enrollee pays. This type of plan includes a prescription drug plan.

Turning 65 and on Social Security disability: When Sally turns 65, she will have a second Medicare supplement enrollment window — 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 for supplement Plans A through N during this six-month period that begins the month they turn 65.

Toni King is an author and columnist on Medicare and health insurance issues. If you have a Medicare question, email info@tonisays.com or call 832-519-8664.