Can I Get Medicare Before Age 65?

Medicare is widely recognized as a health insurance program for Americans aged 65 and older. But not everyone has to wait until their 65th birthday to qualify. Millions of Americans under 65 are already enrolled in Medicare due to specific circumstances related to disability or medical conditions. If you’re wondering whether you can get Medicare early, this guide explains how it works.

Who Is Eligible for Medicare Before 65?

To qualify for Medicare before turning 65, you must meet one of the following conditions:

• You have been granted Social Security Disability Insurance (SSDI) for a minimum of 24 months.
• You are experiencing End-Stage Renal Disease (ESRD) and require dialysis or a kidney transplant.
• You have been diagnosed with Amyotrophic Lateral Sclerosis (ALS), also called Lou Gehrig’s disease.

Unlike other disabilities, individuals with ESRD or ALS do not need to wait 24 months after receiving SSDI. People with ALS become eligible for Medicare the same month their disability benefits start. Those with ESRD generally qualify three months after beginning dialysis or immediately after a kidney transplant.

How Do You Enroll in Medicare If You’re Under 65?

Enrollment is often automatic if you receive SSDI benefits. After two years, you can expect to receive your red, white, and blue Medicare card by mail. This means you’re enrolled in Medicare Part A (hospital insurance) and Part B (medical insurance).

If you don’t receive your card or have questions, contact the Social Security Administration to confirm your status. In some cases, especially with ESRD, you may need to apply for Medicare coverage manually.

What Does Medicare Cover for People with Disabilities?

The good news is that Medicare offers the same coverage for people under 65 with disabilities as it does for older beneficiaries. This includes:

• Part A: Inpatient hospital stays, skilled nursing care, hospice, and some home health care.
• Part B: Doctor visits, outpatient care, preventive services, and durable medical equipment.
• Part D (optional): Prescription drug coverage through private plans.
• Medicare Advantage (Part C): An alternative to Original Medicare offered by private insurers.

Importantly, services don’t need to be directly related to your disability. If they meet Medicare’s coverage criteria, they should be available to you regardless of your condition.
What About Mental Health, Cognitive Impairments, or Chronic Illness?

Some people mistakenly believe Medicare won’t cover treatment if you have dementia, mental illness, or a condition that won’t improve. However, this is not true. Medicare rules emphasize that:

• Coverage cannot be denied solely because the condition is long-term or non-improving.
• Skilled care may be covered even when the goal is maintenance rather than improvement.
• Each case must be evaluated based on the individual’s need, not a blanket “rule of thumb.”

The landmark Jimmo v. Sebelius case helped ensure that people are not unfairly denied coverage simply because they are not expected to get better. Learn more about this at the Center for Medicare Advocacy.

Can You Keep Medicare While Working?

Yes, in many cases. If you return to work after becoming eligible for Medicare due to a disability, your Medicare coverage doesn’t end right away. There are three phases to be aware of:

1. Trial Work Period (TWP): You can work for up to 9 months (not necessarily consecutively) within 5 years without affecting your SSDI or Medicare benefits.
2. Extended Period of Eligibility (EPE): After the TWP, you can keep your Medicare for another 93 months (almost eight more years), even if you earn above the SSDI income limits.
3. Indefinite Access: After those 93 months, you may still keep Medicare if you are still medically disabled, though you’ll need to pay the full premium for Part A (in addition to Part B).

If you work for a larger employer (with 100 or more employees), their insurance must be your primary coverage, with Medicare serving as a secondary payer.

Can You Buy Medicare If You’re Not on SSDI?

Suppose you don’t qualify for free Medicare Part A because you haven’t worked enough quarters. In that case, you may still be able to buy into Medicare before age 65, though this usually applies only if you meet other criteria. For example, some individuals may qualify to pay a premium for Part A if they have a disability but do not qualify for SSDI.
Those with low income and few resources may also qualify for Medicare Savings Programs through their state to help cover premiums and other out-of-pocket costs.

Final Thoughts

Yes, you can get Medicare before age 65—but only if you meet specific eligibility requirements due to disability, ESRD, or ALS. Once enrolled, you’ll have access to the full scope of Medicare benefits, just like older beneficiaries.

Understanding your rights, staying informed about your options, and collaborating with trusted healthcare professionals can help ensure you receive the care you need.
For more in-depth information and updates, visit Medicare.gov or contact your local State Health Insurance Assistance Program (SHIP) for assistance.