It’s common knowledge that Medicare is available for people 65 and over, but you may be surprised to learn that about 10% of Medicare beneficiaries, or nearly 7 million people, are under age 65.
Medicare was established in 1965, as a program to provide health insurance for older adults. In 1972, Medicare coverage was expanded to cover those under 65 who were disabled, as well as people with end-stage renal disease (ESRD) requiring dialysis or kidney transplant.
Disabilities covered under Medicare for people under 65
Medicare coverage for people under 65 with disabilities is tied to Social Security Disability Insurance (SSDI) benefits.
“To get Medicare coverage under age 65 for a disability, you need to have been collecting SSDI payments for 24 months, and then in the twenty-fifth month, you become eligible for Medicare,” says Emily Whicheloe, Director of Education at the Medicare Rights Center.
To qualify for SSDI payments, you must first have a disability or blindness that “affects your ability to work for a year or more or will result in death,” according to the Social Security Administration (SSA).
SSDI beneficiaries are typically older, with serious physical or mental challenges, according to the Center on Budget and Policy Priorities. The most common cause of disability for SSDI beneficiaries 50 and older are musculoskeletal conditions such as osteoarthritis and scoliosis. The primary cause of disability for SSDI beneficiaries under 50 include mental disorders such as schizophrenia and bipolar disorder.
A second requirement for qualification is limited income. If you can work, your condition must prevent you from earning income above an amount considered “substantial gainful activity” or (SGA). In 2024, SGA is $1,550 per month, or $2,590 if you’re considered blind under SSA rules.
The third requirement for qualification is having enough work history. You typically need to have worked for at least five of the last 10 years, unless you’re under 24, where different rules apply.
“If you haven’t worked enough or paid in enough quarters, you may still be able to get Medicare,” says Christine Huberty, attorney at the Center for Medicare Advocacy. You will just have to pay a premium for Parts A and B. If you’ve worked enough, you can get premium-free Part A, but you still have to pay a Part B premium no matter how much you’ve worked, says Huberty.
Once you meet these requirements, there is a time lag between SSDI approval and when you begin getting payments.
“There is a five-month waiting period between SSDI approval and receipt of SSDI payment, says Huberty. However, it’s five months from when SSA determines your disability began, which means it could be retroactive, says Huberty.
The bottom line: instead of the 24-month waiting period, you may wait up to 29 months to get Medicare under 65 with a disability.
“There are some exceptions to the 24-month waiting period,” says Huberty. For those diagnosed with ALS (Lou Gehrig’s disease), Medicare is available immediately upon receiving SSDI approval. For those approved for SSDI after a diagnosis of ESRD, Medicare is available after a three-month waiting period (after a transplant or starting dialysis treatments), or a one-month waiting period for starting in-home dialysis, says Huberty.
Huberty also says that waiting times for SSDI approval may be quicker for specific serious conditions, which are included in the list of the Social Security Administration’s Compassionate Allowances Conditions.
You can apply for SSDI online or by speaking with a representative.
If you need health insurance while you’re waiting for Medicare to kick in, you can get it through a former employer, your spouse’s employer, or the marketplace.
Medicare Part D and Medigap plan eligibility for people under 65 on Medicare
While you will automatically be eligible for traditional Medicare Part A (hospital insurance) and Medicare Part B (medical insurance) after the SSDI waiting period, you may also consider additional health insurance coverage.
“Medicare Part D, or prescription drug coverage, is available to people under 65 who are eligible for Medicare,” says Whicheloe.
Medigap policies, also known as supplemental insurance, cover co-pays and deductibles not
covered by other Medicare insurance. However, this coverage may be trickier to get, says Whicheloe.
“Under federal rules, Medigap policies are only required to be sold to people over 65,” says Whicheloe. “However, states can expand the Medigap enrollment protections to include people under 65 with disabilities.” For example, in New York, Medigap is available to anybody on Medicare, regardless of their age, Whicheloe says.
Disabilities covered under Medicare Advantage plans and Medicaid for people under 65
“If you are under 65 and qualify for original Medicare because of a disability, you are also eligible for Medicare Advantage plans,” says Huberty.
Some Medicare Advantage plans, called Chronic Condition Special Needs Plans (C-SNPs), are available to those with specific chronic conditions, such as cancer, heart failure, and severe mental illness, says Huberty. C-SNPs may offer additional and/or specific coverage for chronic conditions, says Huberty.
Medicaid health coverage, which is based on a low monthly income and assets, covers over 10 million children and adults with disabilities, which is roughly 15% of all Medicaid recipients.
Medicaid provides coverage for various disabilities, such as mental and behavioral health disorders, physical limitations and injuries, intellectual and developmental challenges, and other health conditions.
As always, Medicaid coverage varies by state, so check with your state office.
How to sign up for Medicare once you’re done with the waiting period
Good news! You don’t have to do a thing! You’ll automatically be enrolled in Medicare Part A and Part B. Three months before your Parts A and B coverage starts, you’ll receive a welcome package that includes your Medicare card.
One caveat: If you have to pay a premium for Part A due to a limited work history, you should contact SSA and proactively enroll in Medicare, says Huberty.
Additional programs to provide cost assistance for people with disabilities under 65
If you’re having trouble paying Medicare costs, you may also qualify for special government programs. These include:
- Extra Help: This program helps cover prescription drug deductibles and co-pays for people on Medicare Part D. It’s administered federally by the SSA.
- Medicare Savings Programs (MSPs): this helps cover Medicare Part A and B premiums, and may also cover Part A and B deductibles, coinsurance, and copayments. MSPs are available at the state level.
Contact your State Health Insurance Assistance Program (SHIP) for help applying for both programs.
More on Medicare:
- 3 big changes coming to Medicare in 2025. Here’s what they'll mean for you
- What Medicare beneficiaries need to know about generic medications
- Medicare has a new pilot program to help people with dementia. Here's how it works
- If you are denied coverage by Medicare, you have the right to appeal the decision. Here's how
