Medicare for People Under 65 With Disabilities: What You Need to Know
Medicare for People Under 65 With Disabilities: What You Need to Know
Most people think of Medicare as something you get at age 65 — but did you know that millions of people under 65 qualify for Medicare early due to a disability?
If you or a loved one is receiving Social Security Disability Insurance (SSDI), you may become eligible for full Medicare benefits after a 24-month waiting period.
Here’s how it works, what’s covered, and what you need to know to make smart choices.
Who Qualifies for Medicare Before Age 65?
You may be eligible for Medicare under age 65 if you:
- Receive SSDI benefits for 24 consecutive months
- Are diagnosed with ALS (Lou Gehrig’s disease) — Medicare starts immediately, no waiting period
- Have End-Stage Renal Disease (ESRD) and meet treatment criteria — typically Medicare begins after dialysis for 3 months or a kidney transplant
You do not need to be 65 — but your Medicare card won’t arrive until after the 24th month of disability payments, unless you have ALS or ESRD.
What Does Medicare Cover for Disabled Individuals?
Once you’re enrolled, you get the same benefits as those who qualify by age:
Medicare Part
What It Covers
|
Part A |
Inpatient hospital stays, skilled nursing, hospice |
|
Part B |
Doctor visits, outpatient care, durable medical equipment |
|
Part C (Medicare Advantage) |
Optional all-in-one plans with dental, vision, hearing, transportation, and drug coverage |
|
Part D |
Prescription drug coverage |
How Much Does Medicare Cost If You’re Under 65 and Disabled?
- Part A: Usually free if you worked and paid Medicare taxes long enough
- Part B: Monthly premium applies (standard is $185/month in 2025, but varies with income)
- Part D: Premium depends on your plan
- Part C (MAPD): Optional; some plans start at $0 premium
Disabled individuals often qualify for financial assistance, like:
- Extra Help (for drug costs)
- Medicare Savings Programs
- Medi-Cal (in California)
Medicare Advantage Plans for People Under 65
If you have Medicare due to disability, you may also enroll in a Medicare Advantage (Part C)plan — which often includes:
- Dental, vision, hearing
- Over-the-counter (OTC) allowances
- Transportation
- $0 copays for certain medications or services
Not all counties offer the same plans — we help you find the best fit for your health and financial needs.
What About Medicare Supplement (Medigap) Plans?
Under federal law, insurance companies are not required to sell Medigap policies to people under 65, but some states — including California — do offer limited access.
Key points:
- Fewer options and higher premiums
- Medigap Plan A is often the only option under 65
- Once you turn 65, you get a new Open Enrollment Period with full Medigap rights
For many clients under 65, a well-chosen MAPD plan offers better value and benefits than Medigap at this stage.
FAQs: Medicare for People with Disabilities
1. When does Medicare start after disability approval?
Usually in the 25th month after SSDI benefits begin — unless you have ALS or ESRD.2. Do I need to enroll myself?
No. Enrollment is automatic once you qualify. You’ll get your red, white, and blue card in the mail.3. Can I get help paying Medicare premiums?
Yes. Many disabled beneficiaries qualify for Extra Help, Medi-Cal, or Medicare Savings Programs.4. Can I change my plan if my health needs change?
Yes — during Annual Enrollment Period (AEP) or if you qualify for a Special Enrollment Period (SEP).
Need Help Navigating Medicare With a Disability?
At Peace & Grace Insurance Services, we:
- Help disabled clients understand their Medicare options
- Compare MAPD plans and Medigap availability
- Help you apply for Extra Help, Medi-Cal, and savings programs
- Make sure your prescriptions, doctors, and health needs are covered
Call/Text: 209-812-4026
Email: CSinsurepng@icloud.com
Proudly serving all counties in California
