Most people think of Medicare as health insurance for people 65 and older, but millions of younger adults qualify too. Medicare under 65 is available to people who receive Social Security disability benefits, people with ALS and people with end-stage renal disease (ESRD). The rules for when coverage starts, and which extra coverage you can buy, are different from the rules at 65.
This guide to Medicare under 65 explains the 24-month waiting period for disability, the faster paths for ALS and kidney failure, automatic enrollment, Medigap and Medicare Advantage options for younger people, help from Medicaid and Medicare Savings Programs, and what changes when you turn 65.
Quick answer: If you are under 65, you can get Medicare if you have received Social Security Disability Insurance (SSDI) or certain Railroad Retirement disability benefits for 24 months, if you have ALS (coverage starts the month your disability benefits begin), or if you have ESRD and need regular dialysis or a kidney transplant. Most people on disability are enrolled automatically, but people with ESRD must sign up. (SSA.gov)
Who Qualifies for Medicare Under 65?
There are three main paths to Medicare under 65:
- Disability: You have been entitled to SSDI benefits, or certain Railroad Retirement Board disability benefits, for 24 months.
- ALS (Lou Gehrig’s disease): You qualify for Medicare as soon as your SSDI benefits start, with no 24-month wait.
- End-stage renal disease: Your kidneys have permanently failed and you need regular dialysis or a kidney transplant, and you, your spouse or a parent has enough work history under Social Security, Railroad Retirement or as a government employee.
Having a disability by itself isn’t enough. For the disability path to Medicare under 65, you must be approved for SSDI, which is based on your work record. Supplemental Security Income (SSI) alone doesn’t lead to Medicare, although people on SSI usually qualify for Medicaid.
SSDI and the 24-Month Waiting Period
For most people seeking Medicare under 65, the biggest hurdle is time. Medicare begins after you have been entitled to SSDI cash benefits for 24 months. Your coverage starts in the 25th month of benefits.
Why it can take closer to 29 months
SSDI has its own 5-month waiting period. Benefits usually begin with the sixth full month after Social Security decides your disability started. Then the 24-month Medicare clock runs. Put together, many people wait about 29 months from the date their disability began until Medicare starts.
Credit for past months
The 24 months don’t always have to be new. If you were approved for SSDI after a long appeal, benefits may be paid back to an earlier entitlement date, and those back months can count toward the 24. Months from an earlier period of disability may also count in some cases.
Coverage while you wait for Medicare under 65
The waiting period can leave a gap. Common ways to stay covered include:
- COBRA from a former employer
- A plan from the Health Insurance Marketplace, such as NY State of Health in New York, often with premium tax credits
- Medicaid, if your income and resources are low enough
- Coverage through a working spouse’s employer plan
If you use COBRA, our guide to Medicare and COBRA explains how the two fit together once Medicare begins.
Medicare Under 65 With ALS: No Waiting Period
People with amyotrophic lateral sclerosis (ALS) have a much faster path. Since 2020, federal law has removed the 5-month SSDI waiting period for people with ALS, and the 24-month Medicare wait doesn’t apply either.
- Your Medicare starts the same month your SSDI benefits begin.
- You are enrolled in Part A and Part B automatically.
- Apply for SSDI as soon as you are diagnosed, because benefits and Medicare depend on your SSDI start date.
ALS care often involves specialists, wheelchairs, communication devices and breathing equipment, so it is worth reviewing early whether Original Medicare with a Medigap plan or a Medicare Advantage plan fits your care team better.
Medicare Under 65 With ESRD: Dialysis and Transplant Timing
End-stage renal disease follows its own rules, and enrollment is not automatic. You need to sign up through Social Security. If you sign up late, coverage can be retroactive for up to 12 months.
When ESRD coverage starts
| Situation | When Medicare usually starts |
|---|---|
| In-center dialysis | The first day of the fourth month of dialysis |
| Home dialysis training | As early as the first month of dialysis, if you start a Medicare-certified home training program within the first 3 months |
| Kidney transplant | The month you are admitted to a Medicare-certified hospital for the transplant or related care, if the transplant happens that month or within the next 2 months |
| Transplant delayed more than 2 months | 2 months before the month of the transplant |
For example, if you start in-center dialysis on July 1, Medicare generally begins October 1.
When ESRD coverage ends
If your Medicare is based only on ESRD, it ends 12 months after the month you stop dialysis, or 36 months after the month of a successful kidney transplant. Since 2023, people who lose Medicare 36 months after a transplant may be able to keep Part B coverage just for immunosuppressive drugs, if they don’t have certain other coverage.
Coordination with employer coverage
If you have job-based health coverage when you become eligible because of ESRD, your employer plan usually pays first for a 30-month coordination period, and Medicare pays second. After that, Medicare becomes primary. Read more on the Medicare.gov ESRD page.
Automatic Enrollment for Medicare Under 65
If you qualify through SSDI or ALS, you don’t need to apply for Medicare separately:
- You are automatically enrolled in Part A and Part B.
- Your red, white and blue Medicare card arrives in the mail about 3 months before your coverage starts.
- Part A is usually premium-free because of your work record.
- Part B has a monthly premium, $202.90 in 2026 for most people, which is usually deducted from your disability check.
You can decline Part B by following the instructions that come with your card. Be careful, though. If you don’t have other coverage that counts, you could face a late enrollment penalty if you sign up later. In general, for people on disability, only coverage from a large employer plan, through your own or a family member’s current job, lets you delay Part B safely. Read our guide to the Medicare late enrollment penalty before you decide.
What Medicare Under 65 Covers
Medicare under 65 covers the same benefits as Medicare at 65. There is no separate “disability Medicare.” You get:
- Part A: hospital stays, skilled nursing facility care, hospice and some home health care
- Part B: doctor visits, outpatient care, durable medical equipment, therapy, mental health care and preventive services
- Part D: prescription drug coverage, which you choose through a separate plan or a Medicare Advantage plan
The costs are the same too. In 2026, the Part A deductible is $1,736 per benefit period, the Part B deductible is $283, and Part B generally covers 80% of approved costs after the deductible. Part D out-of-pocket costs for covered drugs are capped at $2,100 in 2026.
Medigap With Medicare Under 65
Original Medicare leaves gaps, including a 20% coinsurance with no yearly limit. A Medigap policy fills many of those gaps. But with Medicare under 65, getting one can be harder.
- Federal law doesn’t require insurance companies to sell Medigap policies to people under 65.
- Many states do require it. Roughly 30 or more states require insurers to offer at least one Medigap plan to people under 65, but the rules vary widely.
- Prices can be higher. In some states, insurers can charge younger people much more than people 65 and older.
New York Medigap rules for Medicare under 65
New York offers some of the strongest protections in the country. If you have Medicare Part A and Part B, insurers must sell you a Medigap policy at any time of year, whatever your age or health. New York also uses community rating, so premiums don’t change based on your age or health, although they vary by company and region. Insurers may apply a waiting period of up to 6 months for pre-existing conditions if you didn’t have enough prior coverage. Rules can change, so confirm current details with the New York State Department of Financial Services or a licensed agent. For more on local rules, see Medicare in New York.
Learn how Medigap works in general in What Is Medigap?
Medicare Advantage and Special Needs Plans
Anyone with Part A and Part B can join a Medicare Advantage plan, including people on Medicare under 65. Since 2021, people with ESRD can join most Advantage plans too.
Medicare Advantage plans often include drug coverage, a yearly out-of-pocket limit (up to $9,250 for in-network care in 2026) and extras like dental and vision. The trade-off is that most use networks and require prior approval for some services, which matters if you see many specialists. Learn the basics in What Is Medicare Advantage?
Special Needs Plans (SNPs)
Special Needs Plans are Medicare Advantage plans designed for specific groups:
- Chronic Condition SNPs (C-SNPs): for people with conditions such as ESRD, diabetes, chronic heart failure or certain lung diseases
- Dual Eligible SNPs (D-SNPs): for people who have both Medicare and Medicaid
- Institutional SNPs (I-SNPs): for people who live in a nursing home or need that level of care at home
For people on Medicare under 65 with serious conditions, SNPs often include care coordinators and benefits tailored to the condition. Availability depends on where you live.
Medicaid and Medicare Savings Programs
Many people on Medicare under 65 have limited income because they can’t work. If that’s you, extra help may be available:
- Medicaid: If you qualify for both Medicare and Medicaid, Medicaid can cover costs Medicare doesn’t and may pay for long-term care. Read about dual eligibility.
- Medicare Savings Programs: State programs that can pay your Part B premium and, for some people, your deductibles and coinsurance. See our guide to Medicare Savings Programs.
- Extra Help: Lowers Part D premiums, deductibles and copays. People who qualify for Medicaid or a Medicare Savings Program get it automatically.
There is also a program for people who return to work and lose premium-free Part A, called the Qualified Disabled and Working Individuals program, which can pay the Part A premium for those with limited income.
Working While on Medicare Under 65
Going back to work doesn’t have to mean losing Medicare under 65. Social Security offers work incentives:
- Trial work period: You can test your ability to work for 9 months without losing SSDI benefits.
- Extended Medicare: If your disabling condition continues, you can usually keep premium-free Part A for at least 93 months after your trial work period ends, which is more than 8 and a half years including the trial period.
- Part B continues as long as you keep paying the premium.
If you get job-based coverage while working, how it coordinates with Medicare depends on the size of the employer. Ask the employer’s benefits office or a licensed agent before you make changes.
Step-by-Step: Getting Medicare Under 65
- Apply for SSDI as early as you can. You can apply online at SSA.gov, by phone or at a local Social Security office. The sooner your claim is approved, the sooner your Medicare clock starts.
- Keep records of your disability onset date. Social Security uses this date to decide when your benefits and your Medicare begin.
- Arrange bridge coverage. While you wait, keep COBRA, buy a Marketplace plan or apply for Medicaid so you aren’t uninsured.
- Watch your mail. Your Medicare card and a welcome package usually arrive a few months before coverage starts. Read them carefully, especially the Part B instructions.
- Choose how you want to get your benefits. Decide between Original Medicare, with a Part D plan and possibly a Medigap policy, or a Medicare Advantage plan.
- Apply for cost help. If your income is limited, apply for a Medicare Savings Program and Extra Help through your state or Social Security.
- Review your coverage every fall. Plans change each year, and the Annual Enrollment Period runs from October 15 to December 7.
For people with ESRD, the steps to Medicare under 65 are similar, but remember that you must apply yourself. Your dialysis center’s social worker can often help with the paperwork and with timing your enrollment around a home training program or a transplant.
Family members can help too. A spouse or adult child can gather records, join calls with Social Security and help compare plans, which is especially useful when illness makes long phone calls hard.
What Happens at 65
When someone on Medicare under 65 turns 65, their Medicare continues without a gap. Behind the scenes, your eligibility switches from disability to age. A few important things happen:
- A new enrollment period. You get a new Initial Enrollment Period around your 65th birthday. If you delayed Part B, you can sign up then.
- Penalties end. Any Part B late enrollment penalty you were paying because of disability-based Medicare generally stops at 65.
- A new Medigap open enrollment period. You get a 6-month Medigap open enrollment period starting when you are 65 and enrolled in Part B. During this window, insurers in every state must sell you any Medigap policy they offer, and they can’t charge more because of your health.
- A chance to change course. If you had a Medicare Advantage plan or no Medigap before 65, turning 65 is a valuable time to rethink your coverage.
Mark your 65th birthday on the calendar a few months ahead. Plan reviews take time, and the best Medigap choices are open to you only during that 6-month window.
Medicare Under 65 Examples
Example 1: The SSDI waiting period
Kevin, 52, stopped working after a back injury in January. Social Security approves his claim and finds that his disability began that month. His SSDI benefits begin in July after the 5-month waiting period, and his Medicare starts 24 months later. Until his Medicare under 65 begins, he buys a Marketplace plan through NY State of Health.
Example 2: ALS and fast coverage
Denise, 58, is diagnosed with ALS. She applies for SSDI right away. Because of her ALS, there is no SSDI waiting period, and her Medicare Part A and Part B start the same month her SSDI benefits begin.
Example 3: Dialysis and a Staten Island Medigap
Luis, 47, lives in Staten Island and starts in-center dialysis on March 1. He applies for Medicare, and his coverage starts June 1, the first day of his fourth month of dialysis. Because New York requires insurers to offer Medigap to people under 65, he buys a Medigap policy to help cover his 20% Part B coinsurance for dialysis.
Common Mistakes With Medicare Under 65
- Going without coverage during the 24-month wait. Look into COBRA, the Marketplace or Medicaid right away.
- Not applying for SSDI quickly with ALS. Medicare starts when SSDI starts, so delays cost coverage.
- Assuming ESRD Medicare is automatic. You need to sign up.
- Declining Part B without other coverage that counts. This can lead to a penalty and a coverage gap.
- Thinking Medigap is impossible with Medicare under 65. Many states, including New York, give under-65s access.
- Missing the Medigap window at 65. Your new open enrollment period is a one-time chance to buy any Medigap plan without health questions.
- Not checking for help with costs. Medicare Savings Programs and Extra Help can lower your monthly costs a lot.
Frequently Asked Questions About Medicare Under 65
Can I get Medicare under 65 if I’m on SSI only?
Generally no. SSI doesn’t lead to Medicare on its own. But people who receive SSI usually qualify for Medicaid. If you also have enough work history for SSDI, you may qualify for Medicare after 24 months of SSDI.
Is the 24-month waiting period ever waived?
Yes, for people with ALS. People with ESRD also follow separate rules based on dialysis or transplant dates rather than the 24-month wait.
Do I have to pay for Medicare under 65?
Part A is usually premium-free. Part B costs $202.90 a month for most people in 2026, though a Medicare Savings Program may pay it if your income is limited.
Can I buy a Medigap plan if I’m under 65?
It depends on your state. Federal law doesn’t require it, but many states do. New York requires insurers to sell Medigap to people with Medicare at any age, all year.
Can I join a Medicare Advantage plan under 65?
Yes. If you have Part A and Part B and live in the plan’s service area, you can join, including if you have ESRD.
Will my Medicare change when I turn 65?
Your coverage continues without a gap. You get a new enrollment period, any Part B penalty generally ends, and you get a new Medigap open enrollment period.
Get Help With Medicare Under 65
Getting Medicare under 65 brings unique choices, especially about Medigap, Medicare Advantage, Special Needs Plans and help with costs. If you or a family member qualifies for Medicare under 65 through disability, ALS or ESRD, we can help you compare options from multiple carriers. Caring Curations is an independent Medicare agency at 26 Bolivar St in Staten Island, New York. We know New York’s under-65 Medigap rules and can explain how they apply to you.
Book a free Medicare consultation or call 848-257-9344. We are licensed in 25 states, and our help is always free.
