How to Qualify for Medicare If You’re Under 65

Who Qualifies for Medicare Under Age 65?

To qualify for Medicare before age 65, you must meet one of three criteria:

1. You Have a Qualifying Disability and Receive Social Security Disability Insurance (SSDI)
If you’ve been approved for SSDI, you will automatically become eligible for Medicare after 24 months of receiving benefits.

Key points:

• You don’t have to apply separately for Medicare—it’s automatic after two years of SSDI.

• This applies regardless of your age. You could be in your 30s or 50s and qualify.

• You’ll be enrolled in Part A (hospital insurance) and Part B (medical insurance) automatically.

2. You Have End-Stage Renal Disease (ESRD)
People with ESRD—a permanent kidney failure condition requiring dialysis or a kidney transplant—can qualify for Medicare without waiting 24 months.

Eligibility rules:

• You must have worked long enough (or be the spouse/dependent of someone who has) to qualify for Social Security or Railroad Retirement benefits.

• Coverage typically starts the first day of the fourth month of dialysis treatment.

• If you’re doing home dialysis, coverage may begin sooner.

3. You Have Amyotrophic Lateral Sclerosis (ALS)
If you have ALS (also known as Lou Gehrig’s disease), you become eligible for Medicare immediately upon receiving your first SSDI check—there’s no 24-month waiting period.

This fast-track benefit recognizes the progressive nature and severity of the disease.

What Does Medicare Cover If You’re Under 65?

Once you qualify, you get access to the same Medicare benefits as those over 65:

• Part A: Inpatient hospital stays, skilled nursing facilities, hospice, and some home health care

• Part B: Doctor visits, outpatient services, mental health care, durable medical equipment (DME), and preventive services

• Part D: Optional prescription drug coverage (available through private insurers)

• Medicare Advantage (Part C): An alternative to Original Medicare, often with extra benefits like dental, vision, and hearing

The scope of coverage is the same—but the experience may differ based on disability status and provider access, especially in rural areas or regions with limited Medicare Advantage options.

Do You Have to Pay for Medicare If You’re Under 65?

Yes, in most cases:

• Part A is free if you (or your spouse) worked and paid Medicare taxes for at least 10 years.

• Part B has a monthly premium—$174.70 in 2025 for most people, though it may be lower for those with Medicaid.

• Part D and Medicare Advantage premiums vary by plan.

If your income is limited, you may qualify for help through programs like:

• Medicare Savings Programs (MSPs) to help pay Part B premiums and out-of-pocket costs

• Extra Help (also known as the Low-Income Subsidy) to reduce Part D prescription costs

• State Medicaid programs, if you are dual-eligible

Learn more here: Medicare Savings Programs – Medicare.gov

How to Enroll in Medicare If You’re Under 65

If you’re receiving SSDI, enrollment in Medicare is automatic after 24 months. You’ll receive a “Welcome to Medicare” packet in the mail around your 22nd month of benefits.

You can also:

• Decline Part B (though it’s not recommended unless you have other coverage)

• Choose and enroll in a Part D or Medicare Advantage plan during your Initial Enrollment Period (3 months before and after your eligibility date)

If you have ESRD or ALS, you’ll need to apply directly—either through the Social Security Administration or your healthcare provider.

Start here: Apply for Medicare – SSA.gov

Can You Get Medigap If You’re Under 65?

This is where it gets tricky. Medicare Supplement Insurance (Medigap) policies help cover out-of-pocket costs under Original Medicare—but federal law does not require insurers to sell Medigap plans to people under 65.

Here’s what to know:

• Some states do require insurers to offer at least one Medigap plan to people under 65 with disabilities (e.g., California, New York, Texas, Florida).

• Premiums may be higher for those under 65.

• You’ll get a new six-month Medigap enrollment window when you turn 65, regardless of past eligibility.

If you can’t get a Medigap plan, you may consider Medicare Advantage as an alternative with capped out-of-pocket costs.

See your state rules: Medigap Policies by State – Medicare.gov

Should You Stay on Employer or ACA Coverage Instead?

Some people who qualify for Medicare under 65 also have access to:

• Employer-based insurance (through their job or a spouse)

• ACA marketplace plans (if they’re not yet enrolled in Medicare)

However:

• Once you enroll in Medicare, you’re no longer eligible for ACA subsidies.

• You can delay Medicare Part B without penalty if you have active employer coverage (not COBRA or retiree insurance).

If you’re unsure which route is better, compare:

• Monthly premiums

• Out-of-pocket costs

• Drug and provider coverage

• Network access

A SHIP counselor can help you compare options for free: Find Help – SHIP Locator

What If You Recover from a Disability?

If you were on Medicare due to a disability but later no longer qualify for SSDI, you may lose Medicare eligibility after a grace period (typically 8.5 years after SSDI ends).

However:

• If you return to work but still have a disabling condition, you may be eligible for continued Medicare coverage under the “Trial Work Period” program.

• If your disability returns, you can reapply for SSDI and Medicare.

Always consult SSA if your work or disability status changes.

Bottom Line

Medicare isn’t just for seniors—if you’re under 65 and living with a disability, ESRD, or ALS, you may be eligible for coverage. While some rules vary depending on your condition and state, Medicare can be a vital source of affordable healthcare when other insurance options are limited.

Understanding your rights, benefits, and coverage options is the first step to protecting your health—and your finances.

For more information, visit:

• Medicare Coverage for People Under 65 – Medicare.gov

• SSA – Medicare and Disability

• Medigap Rights for Under 65 – Medicare Interactive