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Can my spouse, who was diagnosed with ALS but isn’t 65 yet, get Medicare?


Yes. Because amyotrophic lateral sclerosis (ALS), also known as Lou Gehrig’s disease, is progressive and has no known cure, people who are diagnosed with it can receive Medicare before age 65. ALS affects nerve cells in the brain and spinal cord, causing muscle weakness that can worsen quickly.

People with disabilities who are younger than 65 typically qualify for Medicare after they’ve been eligible for Social Security Disability Insurance (SSDI) benefits for 24 months. But ALS is one of two conditions that bypass the 24-month waiting period; the other eligible condition is permanent kidney failure, also called end-stage renal disease (ESRD).

Because of ALS’s fast-moving effects, two important changes occurred. Congress passed legislation in July 2001 that eliminated the 24-month waiting period for Medicare. And the ALS Disability Insurance Access Act of 2019 eliminated SSDI-approved applicants’ five-month waiting period before receiving benefits. People with ALS automatically start Medicare the month their SSDI or Railroad Retirement Board disability benefits begin.

The mean survival time for people diagnosed with ALS is two to five years, though some people live with ALS a decade or longer. Physicist Stephen Hawking lived with the disease for 55 years. About 5,000 people are diagnosed in the United States each year, and more than 30,000 are estimated to be living with ALS.

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How do you apply for SSDI?

Many SSDI applications can take a while to get through the claims and appeals process, but the Social Security Administration says its online application process can approve ALS patients in as little as two days. In addition to applying for SSDI online, you can also go to your local Social Security office or apply by phone at 800-772-1213.

One way to ensure speedy approval is by providing ample medical records to back up the diagnosis and any other documentation SSA requires.

After starting disability benefits, your spouse with ALS will be enrolled automatically in Medicare. From there, just like Medicare beneficiaries who are age 65 or older, they’ll need to make the same decisions about original Medicare, a Medigap Medicare supplement policy and a Part D prescription drug plan versus a private Medicare Advantage plan.

How do you qualify for Medicare?

Workers who pay FICA taxes receive one benefit credit for every $1,730 in earnings in 2024 (the amount changes annually), earning a maximum of four credits a year. People diagnosed with ALS don’t always need 40 quarters of work to be eligible for Medicare benefits. If a person with ALS doesn’t have enough Social Security work credits to qualify alone, and not through a spouse’s earnings history, then the patient can’t receive Medicare benefits.

However, a younger person who becomes disabled requires fewer work credits for SSDI eligibility — as few as six in the three years before the ALS diagnosis if younger than 24. A person 62 or older must have 40 credits, the equivalent of 10 years of work.

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Keep in mind

Even though you can buy a Medigap policy within six months of signing up for Medicare Part B at age 65, regardless of preexisting conditions, rules for younger people vary by state. These plans can help pay out-of-pocket costs for parts A and B of original Medicare.

Some states don’t have guaranteed issue rights for Medigap if a Medicare beneficiary is younger than 65, which makes it difficult to qualify for coverage with a preexisting condition such as ALS. Contact the State Health Insurance Assistance Program (SHIP) in your area to learn more about your state’s rules. Representatives there also can help with Medicare enrollment and coverage questions.

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