Page 18 - CF Roundtable - Winter/Spring 2026

ASK THE ATTORNEY: READERS’ QUESTIONS ANSWERED
By: Beth Sufian, J.D. ©2025 Beth Sufian, All Rights Reserved.
MEDICARE COVERAGE:
OVERVIEW OF ELIGIBILITY
QUESTION
Do I have the ability to obtain Medicare benefits by just
proving I have cystic fibrosis? What are the ways a person
with CF can become eligible for Medicare?
ANSWER
Some people with CF are incorrectly told that they can
obtain Medicare benefits simply because they have a CF
diagnosis but this is not correct.
Typically, there are three ways a person usually becomes
eligible for Medicare benefits. The first way to obtain
Medicare coverage is by reaching the age of 65 and
meeting other eligibility criteria related to citizenship and
work history. The largest number of Medicare recipients
receive Medicare because they are 65 years of age or
older.
The second way to obtain Medicare benefits if a person
is not yet 65 years old is based on the receipt of Social
Security Disability Insurance (SSDI) benefits. More people
with CF are becoming eligible for Medicare after they
stop work and the person has received SSDI benefits for
24 months and continues to receive SSDI benefits. If a
person loses SSDI benefits before 24 months of benefit
payments have occurred then the person will not receive
Medicare unless they become eligible for SSDI in the
future and meet the 24-month waiting period for Medicare
eligibility.
Third, a person over the age of 18 who receives a Social
Security Disability benefit based on a deceased, retired,
or disabled parent’s work record will become eligible for
Medicare after 24 months of receiving the Social Security
benefit. Some Social Security offices will approve
eligibility for Medicare if a person was receiving another
type of Social Security Disability benefit for more than 24
months and then became eligible for the parent benefit.
There are two medical conditions that result in eligibility
for Medicare benefits based on diagnosis with the
condition even if a person has not yet received SSDI
benefits for more than 24 months. One condition is
Amyotrophic Lateral Sclerosis (ALS). The other condition
is end-stage renal disease, which is permanent kidney
failure that requires dialysis or a transplant.
A person must also meet the following conditions:
•
•
The person’s kidneys no longer work,
AND
The person needs regular dialysis or has a
transplanted kidney.
However, if a person has Medicare because of permanent
kidney failure then Medicare coverage will end either
12 months after the month the person stops dialysis
treatments or 36 months after the month the person has a
kidney transplant. However, if a person is receiving Social
Security Disability Insurance (SSDI) benefits for more
than 24 months, Medicare will continue for as long as the
person receives SSDI benefits in most circumstances.
In addition, if a person starts dialysis again or gets a
kidney transplant within 12 months after the month the
person stopped dialysis, Medicare resumes. If a person
starts dialysis or gets another kidney transplant within
36 months after the month the person received their first
kidney transplant then Medicare coverage would restart.
Lastly, if a person only receives Supplemental Security
Income (SSI) benefits then the person would only be
eligible for SSI benefits and Medicaid coverage. A person
is not eligible for Medicare if the person only receives SSI
benefits.
QUESTION
Does Medicare provide coverage for vision benefits and
eyeglasses?
ANSWER
Traditional Medicare coverage does not provide coverage
for eyeglasses or general eye appointments. Medicare
Advantage plans may provide such coverage.
18 CF Roundtable Winter/Spring 2026