Did you know that your Medicare coverage can change if you qualified due to a disability—but are later deemed no longer disabled?
For individuals under 65, qualifying for Original Medicare (Parts A and B) through a disability is a crucial benefit. But what happens when the Social Security Administration (SSA) reviews your case and decides you’re no longer eligible based on disability status?
Here’s what agents and beneficiaries need to know about how Medicare works when disability status changes.
Loss of Disability Status
If the SSA determines that you are no longer disabled, you may lose your eligibility for Medicare under disability rules. However, that doesn’t mean coverage stops right away.
Many people in this situation still maintain coverage for several years—or may be eligible again later based on age.
Extended Medicare Coverage Period
The good news? You typically won’t lose Medicare the moment your disability benefits end.
In most cases, beneficiaries who are no longer considered disabled can keep their Medicare coverage for 93 months(about 7 years and 9 months) after their Social Security Disability Insurance (SSDI) benefits end.
This extension gives individuals time to plan their next steps for healthcare coverage, whether that’s transitioning to employer coverage or preparing for Medicare eligibility at age 65.
Purchasing Medicare After Loss of Premium-Free Part A
If you lose access to premium-free Part A, you may still be able to purchase Part A coverage.
Here’s how that works:
- You’ll pay a monthly premium for Part A, based on how many work quarters you or your spouse have earned.
- You can continue Part B coverage, but you’ll still be responsible for paying the Part B monthly premium.
This option is helpful for individuals who are ineligible for other affordable insurance and want to maintain consistent coverage.
Exploring Alternative Health Coverage
If Medicare is no longer an option, it’s important to act quickly and explore alternative insurance solutions, such as:
- Employer-sponsored health insurance (if returning to work)
- Medicaid (if income and resource limits are met)
- Health Insurance Marketplace plans (may qualify for subsidies based on income)
⚠️ Losing Medicare due to a change in disability status may trigger a Special Enrollment Period, allowing you to sign up for other coverage without waiting for the annual open enrollment window.
Final Thoughts
Losing disability status doesn’t have to mean losing access to quality healthcare. Understanding the options available—and how long your coverage continues—is critical for maintaining peace of mind and avoiding gaps in care.
At National Insurance Markets, we help agents and clients navigate complex transitions like this one. Whether you need help evaluating options or exploring the best next steps, we’re here to guide you.
📞 Have questions about Medicare and disability coverage?
Reach out to National Insurance Markets today for expert advice and personalized support.
