Medicare is federal health insurance for seniors 65 or older, persons with specific disabilities and also individuals who’ve been diagnosed with End Stage Renal Disease.
Medicare has two parts:
Part A, which is hospital insurance, and Part B, which is medical insurance. In most cases, Part A is covered under Medicare and Part B is available at a monthly premium which is determined based on your work history (if and for how long you have paid Medicare taxes).
When people think of Medicare, they usually picture federal health insurance for individuals 65 and older. But what if a disability prevents you from working long before you reach retirement age? Fortunately, there is a pathway to get this crucial health coverage early.
While it’s well-known for people 65+, Medicare also covers millions of younger individuals with qualifying disabilities. This post will demystify Medicare eligibility for those under 65, explaining how the system works, who qualifies, and how to navigate the process.
1. The Basics: How Medicare Works for People with Disabilities
For individuals under 65, the primary pathway to early Medicare eligibility is by receiving Social Security Disability Insurance (SSDI) benefits. If you have been approved for SSDI, you are on the path to Medicare coverage, but there is typically a waiting period.
- The 24-Month Waiting Period: This is the most important rule to understand. When on disability, when does Medicare start? For most SSDI recipients, Medicare coverage begins after they have received disability benefits for 24 months. This waiting period starts ticking from the first month you receive an SSDI check, not from the date you became disabled.
- Automatic Enrollment: The good news is that for most, the process is automatic. After your 24-month waiting period, you will be automatically enrolled in Medicare. This directly answers the question, “How do I get Medicare after 2 years of disability?” You don’t have to do a thing.
- Coverage Starts on the 25th Month: Your red, white, and blue Medicare card will arrive in the mail about 3 months before your coverage is set to begin, which is the first day of your 25th month of receiving SSDI.
- Medicare Parts A and B: You will be automatically enrolled in both Part A (Hospital Insurance) and Part B (Medical Insurance). Part A is typically premium-free, while Part B requires a monthly premium that is usually deducted from your Social Security benefit.
2. Are There Exceptions? Qualifying for Medicare Sooner
The 24-month waiting period can be a significant hardship, but there are two major exceptions for specific medical conditions that waive this requirement entirely.
- Amyotrophic Lateral Sclerosis (ALS) / Lou Gehrig’s Disease: If you are approved for SSDI because of an ALS diagnosis, the 24-month waiting period is waived. Your Medicare coverage will start immediately, the very same month your first SSDI benefit check is issued.
- End-Stage Renal Disease (ESRD): Individuals with ESRD (permanent kidney failure requiring dialysis or a transplant) also have special eligibility rules. For ESRD, coverage is not tied to a waiting period and is based on the diagnosis itself. Medicare coverage may begin as early as the first month of a regular course of dialysis treatment.
3. How to Enroll and Get the Help You Need
“How do I apply for Medicare disability?” is a common question, and the answer depends on your situation.
Actionable Steps for Enrollment
- Automatic Enrollment (Most Disabilities): As mentioned, if you have been receiving SSDI for 24 months, enrollment is automatic. You don’t need to file a separate application.
- Applying Manually (Special Cases): For conditions like ESRD or if you need to enroll for another reason, you can apply for coverage online through the Social Security website or by contacting your local Social Security office to have your records reviewed.
Seeking Assistance
- Contact Social Security: For complex cases, especially those involving ESRD, it’s best to contact the Social Security Administration directly to ensure your enrollment is processed correctly.
- Get Free Counseling: Every state has a State Health Insurance Assistance Program (SHIP). SHIPs provide free, impartial, one-on-one counseling to help you understand your Medicare options and make informed decisions.
4. What Happens After You’re Enrolled?
Life changes, and your Medicare coverage can adapt. Here are a couple of important post-enrollment considerations.
- Returning to Work: If your health improves and you are able to return to work, you can keep your Medicare coverage as long as you are still considered medically disabled by Social Security. Your premium-free Part A coverage can be retained for up to 8.5 years after you return to work.
Turning 65: When you turn 65, your Medicare eligibility automatically transitions from being disability-based to being age-based. This is a seamless process, but it may also provide you with new opportunities to enroll in other plans, such as Medigap (Medicare Supplement Insurance) policies, which often have more favorable enrollment windows once you are eligible based on age.
The enrollment period for Medicare begins 3 months before a person turns 65 years of age, but there are some exceptions that may allow you to receive Medicare early.
When you are under 65, you are eligible for Medicare if:
- You’ve been on Social Security Disability Insurance (SSDI) for at least two years
- You are on SSDI because you suffer from amyotrophic lateral sclerosis (ALS/Lou Gehrig’s disease)
- You have been diagnosed with End Stage Renal Disease
The two year waiting period for medicare begins the first month that you receive an SSDI check. At the beginning of the 25th month, individuals on SSDI will be automatically enrolled in Medicare.
If you receive SSDI because you have Amyotrophic Lateral Sclerosis, the two-year waiting period is waived, and Medicare automatically begins the first month that your SSDI benefits start.
Sign up for Medicare online or contact your local social security office to review your records and see if you qualify for early Medicare coverage.
Contact us for more information about getting Medicare if you are disabled
If you think you’re eligible to receive both Medicare and disability, contact us today or call (844) 777-0615, and we’ll help sort it out and get you the benefits you deserve.
If you believe that you are disabled and entitled to Social Security disability benefits we recommend you complete this free evaluation to find out if your specific circumstances qualify ≫
