It’s common knowledge that Medicare is available to people 65 and older, but you might be surprised to learn that about 10% of Medicare beneficiaries, or nearly 7 million people, are under 65.
Medicare was founded in 1965, as a program to provide health insurance for the elderly. In 1972, Medicare coverage was expanded to include people with disabilities under 65 years of age, as well as people with end-stage renal disease (ESRD) who require dialysis or a kidney transplant.
Disabilities covered by Medicare for people under 65 years of age
Medicare coverage for people with disabilities under 65 is tied to Social Security Disability Insurance (SSDI) benefits.
“To get Medicare coverage under age 65 for people with disabilities, you must have collected SSDI payments for 24 months, and then by the twenty-fifth month, you are eligible for Medicare,” said Emily Whereloe, 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 one year or more or could result in death,” according to the Social Security Administration (SSA).
SSDI beneficiaries are typically older, with serious physical and mental challenges, according to the Center on Budget and Policy Priorities. The most common causes of disability for SSDI beneficiaries aged 50 and over are musculoskeletal conditions such as osteoarthritis and scoliosis. The leading causes of disability for SSDI beneficiaries under age 50 are mental disorders such as schizophrenia and bipolar disorder.
The second requirement for qualification is limited income. If you are able to work, your condition must prevent you from earning above an amount that is considered “substantially gainful activity” or (SGA). In 2024, SGA is $1,550 per month, or $2,590 if you are considered blind under SSA rules.
The third requirement for qualification is having sufficient work history. Typically you must have worked for at least five of the last 10 years, unless you are under 24, as different rules apply.
“If you haven’t worked enough or earned enough, you may still be able to get Medicare,” Huberty said. You only have to pay premiums for Parts A and B. If you’ve worked enough, you can get Part A premium-free, but you still have to pay Part B premiums no matter how much you’ve worked, Huberty says.
Once you meet these requirements, there is a time lag between SSDI approval and when you start receiving payments.
“There is a five-month waiting period between SSDI approval and receipt of SSDI payments, said Christine Huberty, Attorney at the Center for Medicare Advocacy. However, it’s five months since the SSA determined your disability began, which means it can be retroactive, Huberty said.
Bottom line: instead of having to wait 24 months, you can wait up to 29 months to get Medicare under 65 for people with disabilities.
“There are some exceptions to the 24-month waiting period,” Huberty said. For those diagnosed with ALS (Lou Gehrig’s disease), Medicare is available immediately upon receipt of SSDI approval. For those approved for SSDI after an ESRD diagnosis, Medicare is available after a three-month waiting period (after transplant or starting dialysis treatment), or a one-month waiting period to start home dialysis, Huberty said.
Huberty also said that the wait time for SSDI approval may be faster for certain serious conditions, which are on the Social Security Administration’s list of Compassionate Benefit Provisions.
You can apply for SSDI online or by talking to a representative.
If you need health insurance while waiting for Medicare to take effect, you can get it through your old employer, your spouse’s employer, or the marketplace.
Medicare Part D and Medigap plan eligibility for people under 65 for Medicare
Although you automatically qualify for traditional Medicare Part A (hospital insurance) and Medicare Part B (health 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 qualify for Medicare,” Whereeloe said.
Medigap policies, also known as supplemental insurance, do not cover copayments and deductibles
covered by other Medicare insurance. However, this coverage may be more difficult to obtain, Whereloe said.
“Under federal regulations, Medigap policies are only required to be sold to people over age 65,” Whereloe said. “However, states can expand Medigap enrollment protections to cover people with disabilities under 65.” For example, in New York, Medigap is available to anyone on Medicare, regardless of age, Whereloe said.
Disabilities covered by Medicare Advantage and Medicaid plans for people under 65 years of age
“If you are under 65 and qualify for original Medicare because of a disability, you are also eligible for a Medicare Advantage plan,” Huberty said.
Some Medicare Advantage plans, called Chronic Condition Special Needs Plans (C-SNPs), are available to those with certain chronic conditions, such as cancer, heart failure and severe mental illness, Huberty said. C-SNP may offer additional and/or specific protection for chronic conditions, Huberty said.
Medicaid health coverage, which is based on low monthly income and assets, covers more than 10 million children and adults with disabilities, making up about 15% of all Medicaid recipients.
Medicaid provides coverage for a variety of 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 after you finish the waiting period
I’m well! You don’t need to do anything! You will automatically be enrolled in Medicare Part A and Part B. Three months before your Part A and B coverage begins, you will receive a welcome package that includes your Medicare card.
One caveat: If you have to pay premiums for Part A because of limited employment history, you should contact the SSA and proactively enroll in Medicare, Huberty says.
Additional program to provide financial assistance for people with disabilities under 65 years of age
If you have difficulty paying Medicare costs, you may also qualify for special government programs. These include:
- Extra Help: This program helps cover prescription drug deductibles and copayments for people on Medicare Part D. This program is administered federally by the SSA.
- Medicare Savings Program (MSP): this helps cover Medicare Parts A and B premiums, and can also cover Parts A and B deductibles, coinsurance, and copayments. MSP is available at the state level.
Contact your State Health Insurance Assistance Program (SHIP) for assistance in applying for both programs.
More about Medicare:
