Since its inception in 1965, Medicare has primarily provided healthcare coverage for adults over age 65. But some individuals with disabilities who are younger than age 65 may also qualify for coverage under this federal health insurance program.
In this guide, we’ll explain the three main ways anyone under age 65 can qualify for Medicare, which include:
1. Being on Social Security Disability Insurance, also referred to as SSDI, for 24 months
2. Getting a diagnosis of amyotrophic lateral sclerosis or ALS, also known as Lou Gehrig’s disease
3. Getting a diagnosis of end-stage renal disease, also known as kidney failure
There are some nuances to know about Medicare eligibility for individuals with disabilities, so read on for more details about what to expect and how to ensure you get the health coverage you need as quickly as possible.
[READ: Medicare Special Needs Plans (SNPs): 2026 Coverage & Eligibility Guide]
What to Know About Medicare Disability Under 65
In general, if you’re under the age of 65 and have a disability, you must meet specific eligibility criteria. This starts with receiving SSDI benefits for two years before you become eligible for Medicare.
In some cases, you may also be eligible for Supplemental Security Income, also called SSI, a federal program that provides monthly payments to cover basic living expenses such as food and housing.
Both SSDI and SSI are administered by the Social Security Administration and provide assistance to people who meet the federal agency’s requirements for disabilities.
The SSA has a five-month waiting period between applying and when eligible applicants begin receiving cash payments.
— SSDI. You and certain family members — including a spouse, divorced spouse, children under the age of 16 and adult children who were disabled before age 22 — can receive benefits if you are insured. Your eligibility is based on how long and how recently you worked and whether you paid Social Security taxes on those earnings.
— SSI. Adults and children who meet the SSA’s requirements for a qualifying disability and have limited income and resources can receive benefits from this program.
The two programs are different but have the same medical requirements. However, if your situation meets the nonmedical requirements established by the SSA, then you may be eligible for monthly benefits if your medical condition is expected to last at least a year or is terminal. You can apply for benefits via the SSA’s website.
RRB benefits for healthcare coverage with a disability
Another federal benefits program, the Railroad Retirement Board, or RRB, was established in the 1930s for railroad workers to support them when financial upheaval from the Great Depression threatened existing retirement and pension programs.
The RRB is an independent federal agency based in Chicago. It’s similar to the SSA in that the agency works directly with recipients via more than 50 field offices across the U.S. Both organizations also use the same definition of total disability and the same formula to calculate payments. To be eligible for RRB benefits, you must have worked for at least 10 years in covered service for the railroad industry or at least five years after 1995.
[READ: What Is Medicare-Medicaid Dual Eligibility?]
[Read: When Can You Sign Up for Medicare?]
List of Disabilities That Qualify for Medicare Under Age 65
The term “disabled” refers to almost any condition that results in a demonstrable disability in which you cannot perform regular, continuous work activity on a full-time basis and that has persisted or is expected to last at least 12 months, explains Kathleen Holt, a Connecticut-based attorney and the state’s healthcare advocate.
“It’s not a specific condition,” she notes. “You could have multiple sclerosis and continue to work, or you can have MS and be so incapacitated that you reach a point where you meet that criteria and you’re unable to perform regular work activity for a 40-hour workweek.”
The key to becoming eligible for Medicare benefits is having a medical condition that makes it impossible for you to work enough to access employer-sponsored healthcare benefits.
Holt notes that about 15% of Medicare beneficiaries are people with disabilities who are younger than 65.
While there’s no single list of all disabilities that qualify people under 65 for Medicare coverage, the following conditions can lead to long-term disability that may make someone eligible for coverage:
— Alzheimer’s disease and other forms of dementia
— Asthma
— Autism spectrum disorders
— ALS
— Chronic heart disease or heart failure
— Chronic obstructive pulmonary disease
— Severe depression and other mood disorders
— Epilepsy
— End-stage renal disease
— HIV/AIDS
— Lupus
— Severe arthritis
This is not an exhaustive list of all the conditions that could result in disability that would be qualifying for Medicare coverage. Talk with your healthcare provider about whether a chronic or severe issue you’re dealing with might make you eligible for Medicare.
[READ: Health Saving Accounts and Medicare: Using an HSA to Pay for Medicare Premiums]
How to Apply for Medicare Under Age 65 With a Disability
To become eligible for Medicare under the age of 65, there are a few steps you must follow:
— Apply for SSDI benefits
— Wait 24 months
— Enroll in Medicare
Apply for SSDI benefits
To qualify for Medicare based on disability in 2026, you’ll have to apply for SSDI benefits. The Social Security office must first recognize that you are disabled before you can being the process of applying for that Medicare coverage.
When you qualify for Medicare because of a disability, that triggers an Initial Enrollment Period (disability) that spans seven months. This is similar to the seven-month IEP that opens up for Medicare beneficiaries three months before they turn 65 and closes three months after the month in which they turned 65.
To apply for SSDI, you’ll need the following documents and information:
— Your Social Security number
— Medical records from your doctors, therapists, hospitals, clinics and caseworkers that substantiate your medical issue and disability status
— Laboratory and test results
— Names, addresses, phone and fax numbers of your doctors, clinics and hospitals
— Names of all medications you are taking
— Names of your employers and job duties for the last 15 years
Wait 24 months
There is a 24-month waiting period after you start drawing SSDI benefits before you become eligible for Medicare coverage. And it’s critical to understand that this 24-month clock only starts after the Social Security Administration’s mandatory five-month waiting period for SSDI payments has completed. This means that for many people, the SSDI Medicare waiting period between your disability onset date and being covered by Medicare is effectively 29 months.
However, if you have either ALS or end-stage renal disease, the waiting period is waived. You can apply for an ALS Medicare waiver or an ESRD Medicare waiver, and that will eliminate the waiting period between application and getting Medicare coverage for these conditions. (See more about the ALS and ESRD timelines below.)
For people who need to wait two years, this period can be a hardship, Holt notes, but you can still access health insurance during the SSDI waiting period and the 24-month Medicare waiting period. This can be done via your state’s Affordable Care Act marketplace or your spouse’s employer-sponsored plan, if it covers family members.
The ACA marketplace, also referred to as Obamacare, provides private insurance options to individuals outside of traditional employer-sponsored healthcare. A critical piece of these plans is that you can’t be disqualified for a preexisting condition, and that protection applies to the disability for which you’re awaiting Medicare eligibility, Holt says.
Enroll in Medicare
Once you’re in the SSDI system and have fulfilled the 24-month waiting period, you’ll be automatically enrolled in Medicare.
As you go through the Medicare process, Dr. Meena Seshamani, secretary of the Maryland Department of Health and former deputy administrator and director of the Center for Medicare at the Centers for Medicare & Medicaid Services in Washington, D.C., recommends visiting Medicare.gov’s “Get Started With Medicare” page, where you’ll be guided through a series of questions about your situation to determine your eligibility and help you get enrolled.
The CMS website makes it very easy for someone to walk through enrollment and figure out their eligibility, Seshamani says.
CMS also staffs a 24/7 call center at 1-800-Medicare (1-800-633-4227) where you can ask questions and get support.
“People can call and say, ‘Hey, I want to check, am I eligible for Medicare? How can I sign up?’ and somebody can help you walk through that,” Seshamani explains, adding that CMS prioritizes helping people figure out which option is best for them.
[READ: Does Medicare Cover Dementia Care?]
[Read: Questions to Ask During Medicare Open Enrollment]
What to Know About ESRD and ALS Medicare Timelines
Medicare has specific waiting period exemptions for people with ALS and end-stage kidney disease. Here’s what to know about how that changes your timelines for coverage.
End-stage renal disease coverage details
People with severe kidney disease can apply for a waiver that condenses the ESRD Medicare timeline to provide retroactive coverage. For example, if you become eligible for Medicare based on ESRD in February, but don’t sign up for Medicare until November, your Medicare coverage will start in February, covering you for those months right when you first became eligible.
In addition, if you’re on dialysis, Medicare coverage usually starts on the first day of the fourth month of your dialysis treatment. This four-month waiting period starts even if you haven’t signed up for Medicare. For example, if you start dialysis on July 1, coverage beings on October 1, even if you don’t sign up for Medicare until December 1.
Medicare coverage can also begin as early as the first month of a regular course of dialysis treatment if you meet additional criteria:
— You participate in a home dialysis training program offered by a Medicare-certified training facility during the first three months of your regular course of dialysis
— You’re expected to finish training and be able to do your own dialysis treatments at home
— You maintain a regular course of dialysis throughout the waiting period
It can get complicated to follow, so talk with a local Medicare specialist or the SSDI office for more tailored advice.
ALS coverage details
If you have an ALS diagnosis, both the five-month SSDI waiting period and the standard 24-month Medicare coverage waiting period are completely waived. This means that Medicare Parts A (inpatient or hospital coverage) and B (outpatient or doctor’s visits coverage) become active the very same month your SSDI benefits begin, which happens when you’ve received a medical diagnosis of ALS.
Medicare vs. Medicaid for People With Disabilities
Medicare, which is funded through federal Social Security taxes, was originally established to provide coverage for older adults who lost employer-based insurance when they retired at age 65. But in the 1970s, Medicare also began covering individuals under age 65 who receive Social Security disability benefits. Medicare does not have any income limits you must meet to qualify, simply an age or a qualifying disability.
Medicaid, on the other hand, is a state-administered, needs-based program that serves low-income individuals regardless of age. It’s funded through a mix of federal, state and local taxes but applicants must meet specific income and asset levels to qualify. Medicaid enrollment priority is usually given to:
— Older adults
— People with disabilities
— Pregnant people
— Children and families in need
To apply for Medicaid, you’ll need to go through your local state agency that processes those requests.
In most states, if you have a disability and you receive SSI, you’re automatically eligible for Medicaid. More than one-third of Medicaid beneficiaries qualify this way, according to the Medicaid and CHIP (Children’s Health Insurance Program) Payment and Access Commission.
When it comes to considering Medicare versus Medicaid disability benefits, there can be overlap between which program you qualify for, so it’s best to ask a caseworker in your state to clarify your options.
[READ How Medicare Beneficiaries Can Save Money on Prescription Drugs]
Comparing Medicare and Social Security
When considering Social Security versus Medicare, it’s important to recognize that these are two separate benefit programs from the federal government. Social Security provides financial support, whereas Medicare is health insurance coverage. These two safety net programs work together to support people with disabilities to remain as healthy as possible.
As mentioned, for someone looking to gain health insurance coverage via Medicare because of a disability, they must first apply for disability benefits from Social Security.
Where to Get Help With Medicare Enrollment
Regardless of age or disability status, many people can benefit from guidance when first getting enrolled in Medicare or when making changes during an open enrollment period. The great news is that this type of help does exist and is free.
In addition to the services available at CMS, the State Health Insurance Assistance Program — a grant-based program in every state, Washington, D.C., Puerto Rico, Guam and the U.S. Virgin Islands — can help enrollees.
“The whole point of our SHIP programs is to have individuals locally available to provide in-depth, one-on-one assistance in navigating and enrolling in Medicare,” says Rebecca Kinney, director for the Administration for Community Living’s Office of Health Care Information and Counseling in Washington, D.C.
You can find your local program and set up an appointment from SHIP’s website. During your appointment, a SHIP counselor will go over all your options and help you apply for Medicare.
“There’s a lot of choices and things that can be really overwhelming,” Kinney explains. “That’s what SHIP is there (for) — to help them try to sort through and navigate.”
More from U.S. News
Does Medicare Cover Botox? What to Know About Coverage, Costs and Conditions
Preventing Costly Medicare Mistakes: Tips and Strategies
How AI-Generated Content Feeds Affect Your Mental Health
Medicare Eligibility for People Under 65 With Disabilities originally appeared on usnews.com
