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Medicare Coverage for Disabled Under 65

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.

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Disabilities That Qualify for Early Medicare

When you’re under 65, you become eligible for Medicare if:

  1. 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.
  2. 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.
  3. 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.

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Medicare Advantage Plans for Disabled Under 65

Most individuals enrolled in Social Security Disability opt to enroll in Medicare Advantage plans. Medicare Advantage plans combine Medicare coverage with additional benefits to become your primary coverage. Medicare Advantage plans 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:

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.

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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 Medicare Supplement (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.

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FAQs

What is Medicare disability?
Medicare is available to people under 65 who have a disability and meet other requirements. If you have a disability and you’re over age 65, you’re automatically eligible because of age.
What disability qualifies for Medicare under 65?
If you have ALS, you qualify for automatic enrollment. You can enroll right away if you have End-Stage Renal Disease. If you have another disability, you can get Medicare if you’ve been collecting Social Security disability for 24 months.
Do I have to pay for Medicare Part B if I am disabled?
Yes, if you are on Medicare, Part A will likely have a $0 monthly premium and you’ll pay a premium for Part B that is determined by your income.
Is Medicare free for the disabled?
Part A of Medicare is considered free if you pay into Medicare taxes for enough quarters. Those with lower incomes can get assistance with premium payment.
What are the best Medicare Supplement plans for disabled individuals under 65?
Carriers who offer Medigap to those under 65 always offer Medicare Supplement Plan A, which includes the most basic benefits. Additionally, premiums for this plan are lower since it includes fewer benefits. As Medigap premiums are much higher when you’re under 65, it can be beneficial to enroll in a Plan such as A to control costs and switch to a plan with the best Medigap plan after you turn 65.
Can you get Medicare if you're disabled?
Yes, you can get Medicare if you are receiving SSDI for 24 or more months or if you have ESRD or ALS.
How do I apply for Medicare on disability?
You won’t need to apply; you’ll automatically get Parts A and B of Medicare once you collect SSDI for 24 months. If you have ALS or ESRD, you’ll get Parts A and B automatically, as soon as your SSDI begins.
How does Medicare work for the disabled?
Medicare works in the same way for the disabled as it does for those who age into the program at 65.
How much does Medicare cost on disability?
How much Medicare costs on disability depends on how long you pay Medicare taxes as well as your income level.
When can a disabled person enroll in Medicare Part D?
It’s best to sign up for a Part D plan when you first enroll. Your seven-month Initial Enrollment Period for Part D begins three months before Medicare benefits start.
When does Medicare start after disability?
You can enroll in Medicare when you receive SSDI benefits for 24 months.
Does my Social Security disability change when I turn 65?
No, your SSDI benefits don’t change when you turn 65 and don’t impact your Medicare.
Do you automatically get Medicare with a disability?
You automatically get Medicare when your disability benefits begin for ALS or ESRD. Otherwise, they automatically begin 24 months after you start receiving SSDI benefits.
How long do you have to be disabled before you can get Medicare?
To enroll in Medicare, you must be receiving SSDI for 24 months.
What happens with Medicare when a disabled person turns 65?
If you chose not to take Part B when first eligible, you’ll be enrolled in Part B when you turn 65.
Do I have to wait two years for Medicare?
Once you start collecting SSDI, you must wait 24 months before becoming Medicare-eligible if you don’t have ESRD or ALS.

How to Get Help with Medicare if You’re Disabled and Under 65

We understand Medicare is confusing. That’s why we take our time to answer all your questions. Our agents consider the coverage you need and make the best recommendation based on your situation. Don’t waste your time calling each company individually. To get started with a quote, complete this form to see what options are available in your area.

David Haass

David Haass

David Haass is the Chief Technology Officer and Co-Founder of Elite Insurance Partners and MedicareFAQ.com. He is a member and regular contributor to Forbes Finance Council and stay up-to-date with the latest Medicare trends and changes. He holds a Bachelor of Science in Business Administration and Management from the University of Florida.

26 thoughts on "Medicare Coverage for Disabled Under 65"

  1. I retired at 65 and my wife retired at 62. We have a disabled grandson living in our home and has been disabled since birth and is currently 23 years old. He is on Medicaid; but when he turned 21 he lost his dental coverage through Medicaid. He has been drawing SSI for several years. We checked to see if he qualified for Medicare but found out he was not qualified until age 65 due to not being on SSDI. So at this time he does not have dental coverage under Medicaid. He has Cowden’s Syndrome and it affects his teeth. His Dentist has reached out to us in hopes of finding some type of coverage and suggested we apply for Medicare. We did check into it and found he does not qualify since he has never worked. We’re at a loss as to what we need to do. Do you have any suggestions. Thanks in advance.

    1. Hello Michael,

      There are a few things here that are important. First off, if your grandson is disabled and draws SSDI for 24 months, they will be eligible for Medicare. However, Medicare rarely covers dental care unless it’s medically necessary. While this may be the case in your grandson’s case, you’ll still need his primary physician to sign off declaring it medically necessary. Otherwise, you may want to look into a dental insurance policy.

  2. After 24 months of being on Social Security Disability one is eligible to sign up for Plan D prescription plan. Do they have to wait for the next open enrollment or can they immediately sign up after the 24 months?

    1. Robert, you will be eligible to enroll in a Medicare Part D plan as soon as you are eligible and enrolled in Medicare Part A.

  3. My husband is 54 and on SSDI. For the past several years his part c and d was covered under my employers insurance. Now I am going to be an independent contractor and he will no longer have the cover starting in May. Can he get a part c and d plan without paying a penalty? Is my employment status a qualifying event for him?

    1. Shannon, typically if he was on a Part C plan covered by your employer, that would be sufficient coverage to avoid a late enrollment penalty. However, with May upon us, I recommend calling your local social security office to verify the coverage is creditable.

  4. My son is 21 and is disabled. He receives Medicare A&B. As of December 31, 2020 he had prescription coverage under my insurance. Since January 1, 2021 he has not had prescription coverage. ,Does he have to sign up for a part D plan? Will he be penalized if he doesn’t?

    1. Rose, great question! He will need to enroll in Part D coverage within two months of losing his credible coverage to avoid the Part D penalty.

  5. My daughter-in – law has been on social disability for about 6 years. she has been covered by her husbands insurance (my son) . now my son wants to retire at 62, can my daughter-in-law get medicare? is there a waiting period? he cant get medicare until he is 65.

    1. Loanne, if your daughter in law has been receiving disability for over 24 consecutive months, she would qualify for Medicare. It is best to contact your local Social Security office to see if she qualifies for Medicare.

  6. My daughter is 22 and received social security for a disability dishonored at age 3. Her father is deceased (she was 5). I think her benefits are covered under childhood disability. After turning 18 she qualified for disability and continued to receive the same amount. She is now on Medicare part a/b. When she turned 21 Tricare moved her to “young adult” and her premium went from $26 to $247! Can she qualify for a Medicare advantage plan? She can’t afford the $400 a month for premiums plus her rx co-pays. She is paying almost $600 combined. What are her options?

    1. Hi Joni, we are sorry to hear about the recent increase in your daughter’s premiums. Individuals under 65 on Medicare due to disability may enroll in a Medicare Supplement plan. The options depend on the ZIP Code in which the beneficiary resides. Keep in mind that she will still need to pay her Part B premium in addition to the Advantage plan’s premium (if it has one) or she can see if she is eligible for a Medicare Savings Plan and Extra Help for assistance with paying for her Medicare and Part D.

  7. Can you sign up for Medicare Advantage if you are eligible for Medicare because of disability. 63 years old have had only Part A because opted out of Part B having wife’s group coverage which terminated 03/01/2021. Applied for Part B to begin 06/01/2021 but did not get approval until 1st week of June. Can I qualify for MAPD plan beginning 7/01 under these circumstances? Thanks

      1. my name is Ben Majors i am a disabled sheriffs deputy and i’ve had medicare part A,B and D for several years. Should i get part C. i need new hearing aids and i’d have to have part c.

      2. Ben, thank you for reaching out. Part C is an option that allows hearing aid coverage on some plans, but it is not your only choice. If you like your current coverage and only need additional Hearing coverage, you can look into Dental, Vision, Hearing plans as an addition to your Original Medicare.

  8. 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

    1. 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.

    2. I’ve been on disability since 2018. I have Medicare part A and B. I’m also under my husbands insurance. With the cost of Medicare going up to $170.10 per month is there a Medicare Advantage plan that I would be able to get with good coverage and less cost per month?

      1. Hi Lisa – typically, with Medicare Advantage, you’ll need to pay your Part B premium in addition to the premium for your plan (if the plan comes with a monthly premium). Premium reduction plan availability depends on your location.

  9. 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.

  10. 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.

    1. 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.

  11. 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.

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