Medicare Under 65: Disability, ESRD & ALS

Who Can Get Medicare Before 65?

Most people qualify for Medicare at 65. You may get it sooner if you receive Social Security Disability Insurance (SSDI), have End-Stage Renal Disease (ESRD) (kidney failure), or have ALS (Lou Gehrig's disease). Each path has different rules for waiting periods and when coverage starts.

The SSDI Route: The 24-Month Rule

If you are approved for SSDI, you get Medicare after you've been receiving SSDI for 24 months in a row. The waiting period starts from the month you were first approved for benefits, not the month you applied.

During those first 24 months, you may qualify for Medicaid depending on your state's rules and income. Many states offer coverage to SSDI recipients with low income and few resources. If you have Medicaid while waiting for Medicare, your Medicaid doesn't stop when Medicare starts. Instead, you become dual eligible (covered by both programs).

At the end of month 24, you are automatically enrolled in Medicare Part A (hospital insurance) and Part B (medical insurance) unless you decline. Your coverage starts on the first day of the month after your 24-month waiting period ends.

Faster Eligibility: ALS & ESRD

Two medical conditions skip the 24-month wait:

• ALS (amyotrophic lateral sclerosis): You get Medicare right away when Social Security approves you for SSDI or Supplemental Security Income (SSI) because of ALS. Your coverage starts the same month you are approved for disability.
• ESRD (End-Stage Renal Disease): You may qualify for Medicare when you need dialysis or a kidney transplant, even if you don't receive SSDI. Coverage starts the month your dialysis begins, or the month you get a kidney transplant, whichever comes first. You may qualify even if you are still working.

Coverage Pathways and Start Dates

The table below shows when Medicare coverage starts for each path:

What Parts of Medicare Do You Get?

When you become Medicare-eligible through disability, you automatically get:

• Part A (Hospital Insurance): Covers hospital stays, skilled nursing care, hospice, and some home health services.
• Part B (Medical Insurance): Covers doctor visits, outpatient care, tests, medical equipment, and preventive care.

You can also add:

• Part D (Prescription Drug Coverage): Covers medications through a plan you choose. You pay a premium and may have copays (small amounts you pay per prescription) or coinsurance (your share of the cost). Plans change every year, so review your options during the annual enrollment period.
• Medicare Advantage (Part C): A private insurance alternative to Original Medicare. A private insurer covers all Part A and Part B services, usually with lower premiums and out-of-pocket costs—though you may pay more per visit. Plans vary by region and services covered.
• Medigap (Medicare Supplement): Private insurance that pays some costs Original Medicare (Parts A and B) does not cover, like copays and deductibles. Important: Medigap availability for people under 65 varies by state. Some states have limited plans for younger people; others require you to be 65 or older. Check with your state's insurance commissioner to see what plans you can get.

If You Also Qualify for Medicaid: Dual Eligible Coverage

Many SSDI recipients also qualify for Medicaid because their income is low. If you have both Medicare and Medicaid, you are dual eligible. Medicaid pays many costs Medicare does not—like premiums, copays, and deductibles—and may cover other services like long-term care.

Dual eligible rules vary a lot by state. Some states offer broad Medicaid coverage; others are more limited. Your state's Medicaid program decides:

• Whether you qualify based on income and resources
• What services are covered
• Whether you can use Medicare Advantage or must use Original Medicare
• How premiums and cost-sharing work

For your state's dual eligible rules, visit the Dual Eligible page or contact your state Medicaid agency.

Getting Help Paying: Savings Programs & Extra Help

If you have low income or few resources, you may qualify for programs to help pay Medicare costs:

• Medicare Savings Programs (MSP): State programs that pay your Medicare Part B premiums and may cover Part A premiums, deductibles, and copays. Income limits vary by state and year. Visit Getting Help Paying for more.
• Extra Help (Low-Income Subsidy): A federal program that helps pay Part D premiums, deductibles, and copays for prescription drugs. If you get SSDI, you may qualify automatically. Enroll at ssa.gov or through Medicare.
• Medicaid: If you also qualify for your state's Medicaid, it can cover costs Medicare does not pay.

What You Need to Do

Here's your next step: Check your eligibility with the Social Security Administration (SSA) and confirm your Medicare enrollment.

• If you get SSDI, contact SSA at ssa.gov or 1-800-772-1213. Confirm how many months you've been receiving benefits and when your 24-month waiting period (if applicable) ends.
• If you have ALS or ESRD, give SSA or your treatment facility documentation so they can process your Medicare eligibility right away.
• About 3 months before your expected Medicare start date, watch your mail for a Medicare card from the Social Security Administration.
• If you don't get your card or have questions, contact Medicare at medicare.gov or 1-800-MEDICARE (1-800-633-4227).

Next Steps

Once Medicare starts, you need to:

• Review your coverage options (Original Medicare or Medicare Advantage, add Part D, think about Medigap or Medicaid).
• Understand your costs and what you pay under your chosen plan.
• If you are dual eligible, learn how Medicaid and Medicare work together.
• If you need financial help, look into assistance programs you may qualify for.
• Review enrollment deadlines and annual changes so you can switch plans if you want to.

Additional Resources

For more on specific topics:

• Coverage Basics — what different Medicare parts cover
• Plan Types — Medicare Advantage vs. Original Medicare vs. Medigap
• Medigap — supplemental insurance and what's available in your state
• State Insurance Departments — contact your state for Medigap and Medicaid info
• Enrollment & Deadlines — key dates for choosing and changing plans