Medicare for Family Members with Special Needs


Young girl standing in a field wearing a rain jacket

Medicare is the nation's largest health insurance program, covering 40 million Americans. It provides coverage for individuals 65 years of age and older, some disabled individuals younger than 65 years and individuals with end-stage renal disease (permanent kidney failure treated with dialysis or a transplant). For military families with family members with disabilities, Medicare can help provide health care coverage and save you money in the process.

What services does Medicare provide?

Learn

about Medicaid through Military OneSource's Medicaid for Family Members With Special Needs

People qualify for Medicare based on the Medicare tax they paid through their work. Workers' spouses, minor children and adult children with disabilities may also be covered. There are different parts of Medicare that help cover specific medical services:

  • Medicare Part A (hospital insurance) covers inpatient hospital stays, care in a skilled nursing facility, hospice care and some home health care.
  • Medicare Part B (medical insurance) covers certain doctors' services, outpatient care, medical supplies and preventive services.
  • Medicare Part C (also known as Medicare Advantage) offers health plan options run by Medicare-approved private insurance companies that provide similar benefits and services covered under Part A and Part B and often cover Part D as well.
  • Medicare Part D (Medicare Prescription Drug Coverage) helps cover the cost of prescription drugs and helps protect against higher costs in the future.

When are family members with disabilities eligible for Medicare?

Service members' children with disabilities qualify for Medicare Parts A and B automatically after receiving disability benefits from Social Security for 24 months. A Medicare card will be mailed approximately three months before the 25th month of disability benefits. Medicare Part B is optional. If you do not want Part B, you must follow the instructions that come with the Medicare card and send the card back. If you keep the card, you keep Part B coverage and may have to pay Part B premiums.

When TRICARE beneficiaries are entitled to Medicare Parts A and B, they are also eligible for TRICARE for Life. If you decline Medicare Part B coverage for your child, your child will lose his or her TRICARE eligibility unless you are on active duty. To maintain eligibility for TRICARE for Life for your child, you must enroll in Medicare Part B prior to your retirement to keep TRICARE without a break in coverage.

How much does Medicare cost?

Visit

TRICARE to learn more about TRICARE beneficiaries who are eligible for both TRICARE and Medicare.

The monthly cost of Medicare depends on the level of coverage you want to have:

  • Medicare Part A: Typically, you do not pay a monthly premium for Part A coverage. Individuals with disabilities who have received Social Security benefits for 24 months qualify for "premium-free Part A'" coverage.
  • Medicare Part B: The monthly premium for Part B coverage varies depending on your income.
  • Medigap policy: If Medicare does not cover all your child's medical needs, you can look into purchasing a Medigap policy. A Medigap policy is a health insurance policy sold by private insurance companies to fill gaps in Medicare coverage. The Medicare website provides an online Medigap Policy Search to help identify potential policies in your area.

If you have questions on Medicare coverage, contact your installation Exceptional Family Member Program office or a Military OneSource special needs consultant. They can help answer questions on a wealth of topics including insurance, Supplemental Security Income, Medicare and Medicaid.


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