You can enroll in Medicare before you’re 65 if you have a disability and meet certain other conditions. You can choose Medicare or a Medicare Advantage plan. For many people under 65, an Advantage plan is the most cost-effective option.
What Disabilities Qualify for Medicare Under 65?
When you’re under 65, you become eligible for Medicare if:
- You’ve received Social Security Disability Insurance (SSDI) checks for at least 24 months. At the end of the 24 months, you’ll automatically enroll in Parts A and B.
- You have End-Stage Renal Disease (ESRD) and need dialysis or a kidney transplant. You can get benefits with no waiting period by applying at your local Social Security office.
- Also, if you have Lou Gehrig’s Disease, you’ll automatically be enrolled when you begin receiving disability benefits.
If you’re under 65 and Medicare-eligible you can sign up for an Advantage plan.
Medicare Advantage Plans for Disabled Under 65
Most Social Security Disability Advantage plans combine Medicare coverage with other benefits like prescription drugs, vision, and dental coverage. Medicare Advantage can be either HMOs or PPOs.
You may have to pay a monthly premium, an annual deductible, and copays or coinsurance for each healthcare visit. Your costs will vary depending on your insurance company and the plan you choose.
You may also be eligible for a Medicare Advantage Special Needs Plan. These plans are only available to people who meet specific criteria, such as having a particular chronic and disabling health condition or being eligible for both Medicare and Medicaid.
A Special Needs Plan fits the healthcare needs of the people in the policy. The availability of this type of policy can vary by location.
Many people on Social Security Disability also qualify for their state’s Medicaid program. If you’re on Medicare and Medicaid, you can still sign up for an Advantage plan. The two programs together will usually cover almost all your healthcare costs. But, it’s important to note, Medicare isn’t free.
If you’re under 65, here’s when you can enroll in Advantage Plans:
- During your Initial Enrollment Period, which begins three months before you enroll in Medicare and ends three months after the month, your benefits start.
- During the Annual Enrollment Period from October 15th-December 7th each year
You can also switch from one Advantage plan to another or drop Advantage coverage during the Medicare Advantage Open Enrollment Period from January 1st to March 31st.
Medicare Supplement Plans for Disabled Under 65
Medicare pays a large portion of the cost, but not all of it. Medigap can help cover what Medicare doesn’t cover. But if you’re under 65, it can be hard to find an affordable Medigap plan.
While some states require companies to offer at least one Medigap plan to people under age 65, others do not. In some states, Medigap plans are only available to certain types of beneficiaries, such as people with end-stage renal disease.
In several states, you can’t buy a Medigap plan at all if you’re under 65. And rates tend to go up from one year to the next. So, Medigap can be both hard to get and expensive if you’re under 65. Often, the best solution is an Advantage plan.
When you turn 65, you’ll qualify for the Medicare Supplement Open Enrollment Period. Then, you can get a policy without having to answer any questions about your health.
Medicare Part D for Disabled Under 65
If you choose Medicare, you’ll need a Part D drug plan. You’ll pay a premium, and a copay or coinsurance. Many people on Social Security Disability qualify for Extra Help with Part D costs. Eligibility for Extra Help is based on income and assets. If you’re on Medicaid, you automatically qualify for Extra Help.
Medicare for Disabled Youth
Children under the age of 20 with ESRD can qualify for Medicare if they need regular dialysis treatment and at least one of their parents is eligible for or receives Social Security retirement benefits.
If your child is over the age of 20, they qualify for Medicare after receiving SSDI benefits for at least 24 months. In the case that your child was disabled before turning 22, is unmarried, and one parent receives Social Security retirement benefits, no work history is required for SSDI.
Children 19 years of age or older who don’t qualify for Medicare may qualify for Medicaid. Lastly, children under the age of 18 who don’t qualify for Medicare could qualify for a state Children’s Health Insurance Program (S-CHIP) if their family has a lower income.
FAQs
How to Get Help with Medicare if You're Disabled and Under 65
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I have had Parkinson disease since 2015 and try to work (construction) as much as possible. Can I apply for disability under Medicare? If so, how do I apply
Hi Kat! You’re eligible for Medicare if you’re 65+ OR if you’ve been collecting Social Security Disability Income for at least 24 months. If you don’t meet one of these two criteria, you won’t be eligible for Medicare.
what are the eligibility requirements for Medicare Advantage for under age 65?
Hi Angela! You’re considered eligible for an Advantage plan if you’re under 65 as long as you’ve been receiving SSDI for 24 months OR you’ve been diagnosed with ESRD.
I’m 61 and have to take a Medicare Advantage plan. It has it’s pros and cons and nothing is perfect. My biggest complaint is the high co oys for everything. I have refused surgeries, tests and therapies because I just can’t afford the cost pays. I make $8 a month too much to be duel eligable. I know there has to be a cut off somewhere but I’m drowning in debt from the medical bills.
Hi Nina! That’s the biggest complaint we hear regarding Medicare Advantage Plans. You have to weigh out the pros and cons… is it better to have a Medigap plan with a higher monthly premium and no copays or out of pocket costs, or is it better to have lower monthly premiums with higher out of pocket costs. Since your on disability, Medigap plans are expensive. However, when you turn 65 you’ll get another Open Enrollment Period that allows you to enroll in a Medigap plan with Guaranteed Issue, and the monthly premium will be significantly lower than it is when you’re under 65. Hopefully, in a few more years you can switch back to Original Medicare and pick up a Medigap plan that won’t have copays and other out of pocket costs.
Please contact me to see if I’m qualified. I will be 63 in July and have COPD and recent surgery for carpal tunnel which may put me out of work.
Hi John! You can find information on Medicare coverage for COPD here, as well as an FAQ regarding Medicare coverage for carpal tunnel here. To give you a quote, please complete our rate form with the required information so we can contact you!