People under age 65 may qualify for Medicare if they have certain medical conditions, such as end stage renal disease (ESRD) and ALS, or receive Social Security Disability Insurance.
Medicare is a government-sponsored health insurance program typically for people 65 years and older, with some exceptions.
Read on to learn about some of the age exceptions for Medicare coverage.
If you’ve received Social Security Disability Insurance (SSDI) for 24 months, you’ll automatically be enrolled in Medicare on the 25th month after receiving your first SSDI check.
The following are some circumstances when you might qualify for Medicare before age 65.
End stage renal disease (ESRD)
You can qualify for early Medicare coverage if you:
- have received a diagnosis of ESRD from a medical professional
- are on dialysis or have had a kidney transplant
- are able to receive SSDI, Railroad Retirement benefits, or qualify for Medicare
If you’re getting a kidney transplant, your Medicare coverage can begin the month you are admitted to a Medicare-certified hospital or for healthcare services needed before your transplant if it takes place within the same month or the following 2 months.
If you’re on regular dialysis, your Medicare coverage will begin on the first day of the 4th month of your dialysis treatment. This 4-month waiting period starts even if you have not signed up for Medicare yet. You can get coverage as soon as your first month of treatment if you complete a Medicare-approved training program for at-home dialysis treatment.
Amyotrophic lateral sclerosis (ALS or Lou Gehrig’s disease)
ALS is a progressive disease that often requires medical support for mobility, breathing, and nutrition. If you have ALS, you qualify for Medicare coverage the first month you’re approved for SSDI benefits.
Other disabilities
ESRD and ALS are the only health conditions that qualify for Medicare coverage without a 2-year waiting period.
Other conditions that may qualify for SSDI include:
- mental health disorders
- musculoskeletal system and connective tissue disorders
- injuries
- cancer
Spouses of people 65 and older on Medicare
One spouse’s working history can help the other spouse obtain Medicare coverage once they turn 65.
However, a spouse younger than 65 cannot qualify for early Medicare benefits, even if their older spouse is 65 or older.
The federal government designed the Medicare program as an à la carte menu of options. Each aspect of Medicare provides coverage for different types of medical services.
Examples include:
- Medicare Part A covers hospital and inpatient coverage.
- Medicare Part B covers medical visit coverage and outpatient medical services.
- Medicare Part C (Medicare Advantage) is a “bundled” plan that provides parts A, B, and D services.
- Medicare Part D provides prescription drug coverage.
- Medicare supplement (Medigap) plans provide additional coverage for copayments, deductibles, and other medical services.
Some people choose to get each Medicare portion, while others prefer the bundled approach to Medicare Part C. However, Medicare Part C isn’t available in all parts of the country.
How do I apply for Medicare if I’m under 65?
If you’re receiving benefits from the SSA or the Railroad Retirement Board (RRB), you don’t have to apply for Medicare. You’ll automatically be signed up for Medicare parts A and B as you near your 65th birthday.
Your Medicare card and enrollment information will be mailed to you 3 to 4 months before your birthday. But if you’d like to enroll in Part D or want to switch to Medicare Advantage (Part C), you can do this during your initial enrollment period. We’ll explain more about that later.
What happens to my disability Medicare when I turn 65?
If you were enrolled in Medicare before age 65 based on a disability, you won’t need to reenroll when you turn 65. But, if you lose your disability-based eligibility for SSDI before your 65th birthday, you will lose your Medicare and need to reenroll once you qualify based on age.
There are many conditions that Social Security considers eligible for disability benefits. A full list of categories and conditions that qualify under each is available on SSA.gov.
Some circumstances exist when a person can qualify for Medicare before age 65. Some people may be automatically enrolled, while others may need to apply.
If you or a loved one has received a diagnosis of a chronic health condition or have an injury that keeps you from working, talk with your doctor about if or when you could qualify for Medicare.