People with certain disabilities are eligible for Medicare under the age of 65. Here’s who’s eligible and how to apply.

Medicare was established in 1965, as a program to provide health insurance for adults. In 1972, Medicare coverage was expanded to cover those under 65 with disabilities, as well as people with end-stage renal disease (ESRD) requiring dialysis or a kidney transplant.

Disability covered under Medicare for people under 65

Medicare coverage for people under 65 with disabilities is tied to Social Security Disability Insurance (SSDI) benefits.

“To get Medicare coverage under the age of 65 for disability, you must collect SSDI payments for 24 months, and in the twenty-fifth month, you will receive Medicare,” in says Emily Whicheloe, Director of Education at Medicare. Center for Rights.

To qualify for SSDI payments, you must first have a disability or blindness that “affects your ability to work for a year or more or will result in death,” according to the Social Security Administration (SSA ).

SSDI beneficiaries are often elderly, have serious physical or mental disabilities, according to the Center on Finance and Policy Priorities. The most common cause of disability for SSDI beneficiaries 50 and older is musculoskeletal conditions such as osteoarthritis and scoliosis. The leading cause of disability in SSDI beneficiaries under the age of 50 includes mental disorders such as schizophrenia and bipolar disorder.

The second requirement for qualifications is limited income. If you are able to work, your condition must prevent you from earning more than the amount considered “gross gainful employment” or (SGA). In 2024, SGA is $1,550 per month, or $2,590 if you are considered blind under SSA rules.

The third requirement for qualifications is to have an adequate work history. You usually need to have worked for at least five of the last 10 years, unless you are under 24, in which case different rules apply.

“If you haven’t worked enough or paid enough, you can still get Medicare,” says Christine Huberty, an attorney at the Center for Medicare Advocacy. You will only have to pay the premium for Part A and Part B. If you have worked hard enough, you can get Part A free, but you still have to pay the premium for Part B regardless. How much have you worked, to say. Huberty.

Once you meet these requirements, there is a long time between SSDI approval and when you start receiving payments.

“There is a five-month waiting period between SSDI approval and receiving an SSDI payment,” says Huberty. However, it’s been five months since the SSA determined that your disability began, which means it’s eligible for reimbursement, says Huberty.

Bottom line: instead of a 24-month waiting period, you can wait up to 29 months to get Medicare under age 65 with a disability.

“There are exceptions to the 24-month waiting period,” says Huberty. For those diagnosed with ALS (Lou Gehrig’s disease), Medicare is available once SSDI is approved. For those eligible for SSDI after a diagnosis of ESRD, Medicare is available after a three-month waiting period (after a transplant or starting dialysis treatment), or a one-month waiting period to start home dialysis, says Huberty.

Huberty also said wait times for SSDI approval may be faster for certain serious conditions, which are included in the Social Security Administration’s list of Compassionate Allowances.

You can apply for SSDI online or by speaking with an agent.

If you need health insurance while you’re waiting for Medicare to kick in, you can get it through your primary employer, your spouse’s employer, or the marketplace.

Medicare Part D and Medigap plan eligibility for people under 65 in Medicare

Although you will be able to get traditional Medicare Part A (hospital insurance) and Medicare Part B (medical insurance) after the SSDI waiting period, you may also want to consider additional insurance coverage. of health.

“Medicare Part D, or prescription drug coverage, is available to people under the age of 65 who qualify for Medicare,” says Whoeloe.

Medigap policies, also known as supplemental insurance, co-pays and deductibles

covered by other Medicare insurance. However, this protection may be difficult to obtain, says Whicheloe.

“Under federal law, Medigap policies are only required to be sold to people over the age of 65,” Whoeloe says. “However, states can expand Medigap enrollment protections to include people under 65 with disabilities.” For example, in New York, Medigap is available to anyone on Medicare, regardless of their age, Whoeloe says.

Disability covered under Medicare Advantage and Medicaid plans for people under 65

“If you’re under 65 and you’re eligible for original Medicare because of a disability, you’re also eligible for Medicare Advantage plans,” says Huberty.

Some Medicare Advantage plans, called Chronic Condition Special Needs Plans (C-SNPs), are available to those with certain chronic conditions, such as cancer, heart failure and severe mental illness, to name a few. Huberty. C-SNPs may provide additional and/or specific protection for chronic conditions, says Huberty.

Medicaid health coverage, based on minimum monthly income and assets, covers more than 10 million children and adults with disabilities, which is about 15% of all recipients Medicaid.

Medicaid provides coverage for a variety of disabilities, such as mental and behavioral health problems, physical disabilities and injuries, cognitive and developmental disabilities, and other health conditions.

As always, Medicaid coverage varies by state, so check with your state office.

How to sign up for Medicare once you’re done with the waiting period

Great news! You don’t have to do anything! You will be automatically enrolled in Medicare Part A and Part B. Three months before your parts A and B start, you will receive a welcome packet that includes your Medicare card.

One caveat: If you have to pay a premium for Part A because of limited work history, you should contact the SSA and enroll in Medicare, says Huberty.

Other cost assistance programs for people with disabilities under the age of 65

If you have trouble paying Medicare, you may also qualify for special government programs. These include:

• Extra Help: This program helps cover the cost of prescription drugs and Medicare Part D coverage. It is administered federally by the SSA.
• Medicare Savings Programs (MSPs): this helps cover Medicare Part A and B premiums, and may also cover Part A and B deductibles, coinsurance, and copayments. MSPs are available at the national level.

Contact your local Health Insurance Assistance Program (SHIP) for help applying for both programs.

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