How to Insure Your Income: Medicare Claims

Medicare eligibility based on disability means that you are totally disabled and collecting Social Security disability income benefits or have a major kidney problem requiring dialysis. Specifically, you must have been collecting Social Security disability income benefits for at least 24 months in order to attain Medicare eligibility. (This means 24 months of compensable disability, plus the five-month waiting period. So, after 29 months of disability, you are eligible for Medicare.)

(There's one exception: Eligibility due to kidney failure or transplant requiring dialysis is effective with the first day of the third month following the month in which dialysis began. In essence, this means there is a three-month waiting period.)

Finally, Medicare benefits are influenced greatly by whether or not your doctor is a participating physician. A participating physician is one who has been approved to receive payment directly from the Social Security Administration. He or she has agreed to accept the amounts paid by Medicare. A nonparticipating physician is not approved by Medicare for direct payment and may charge more for services. Medicare will cover these charges only up to its predetermined limit.

A caveat: A disabled person on Medicare may have to pay excess charges if his or her doctor is a nonparticipating physician.