Medicare for Disabled People Under 65: How to Get Coverage

Talon Abernathy
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Updated

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To get Medicare when you're under 65, first you have to apply for Social Security disability benefits. Then, after a two-year waiting period, your Medicare health insurance benefits will begin.

Medicare covers more than 7 million people under age 65 who have certain disabilities and medical conditions. This includes people who have heart disease, Parkinson's disease and other long-term medical conditions.

What disabilities qualify for Medicare under 65?

You can qualify for Medicare before age 65 if you have a long-term medical condition that prevents you from working.

Examples of medical conditions that make you eligible for Medicare

  • Parkinson’s disease
  • Heart disease
  • Multiple sclerosis
  • Amyotrophic lateral sclerosis (ALS)
  • Mental illness
  • Lupus
  • Cystic fibrosis
  • Permanent kidney failure

Many other conditions can qualify you for Medicare before age 65. To see if you're eligible, check the Social Security Administration list of qualifying medical conditions. If you're under age 18, there is a different list of qualifying medical conditions.

How to qualify for Medicare under the age of 65

  1. Apply for disability benefits through the Social Security Administration. It will take about three to five months to find out if you're eligible.
  2. You'll start getting disability payments five months after you qualify. This is called Social Security Disability Insurance (SSDI).
  3. Medicare will automatically begin 24 months after you start getting disability insurance payments, in most cases.
  4. After your Medicare benefits start, you can decide what type of Medicare plan you want. For example, you can bundle your coverage with Medicare Advantage, add a Medigap policy or select a prescription drug plan (Part D).
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While you're waiting for Medicare benefits, you can get health insurance through a family member, Medicaid or by shopping on the marketplace during open enrollment. With these plans, companies can't turn you down for coverage or charge you higher rates because of a medical condition.

What is the waiting time for Medicare benefits to begin?

With most diseases and conditions, Medicare coverage begins 24 months after disability benefits (SSDI) payments start.

Exceptions to the two-year waiting period

  • The 24-month waiting period does not apply to people with kidney failure and ALS. Medicare coverage with these two conditions starts when you begin to get SSDI payments.
  • If you qualify for disability payments after an appeal, your 24-month waiting period starts the first month you should have gotten disability benefits.
  • If you get SSDI for a few months, lose eligibility and then get it back later, the time you should have been collecting SSDI counts toward the 24-month waiting period. Keep in mind you won't get Medicare benefits while you're waiting for your appeal to get accepted.

What Medicare will cover

If you qualify for Medicare because of a disability or medical condition, you get the same health insurance benefits as seniors who have Medicare.

Who Medicare will cover

Medicare's health insurance benefits only cover the person who qualifies. Medicare doesn't also cover family members.

How much does Medicare cost for disabled people under 65?

People who qualify for Medicare because of a disability pay the same amount as seniors for Original Medicare (Parts A and B). All Medicare enrollees have the same rates for Medicare Advantage and Part D plans offered in their location.

Medicare Part A (hospital insurance)

  • Monthly cost: Most people who have Medicare do not pay a monthly rate for Medicare Part A (pays for hospital stays).
  • Deductible: $1,676 for each hospital stay
  • Coinsurance: $419 per day for days 61-90 in the hospital

Medicare Part B (pays for doctor visits)

  • Monthly cost: Medicare Part B costs $185 per month in 2025, and this is usually taken from each month's SSDI payment.
  • Deductible: $257 for the calendar year
  • Coinsurance: Enrollees usually pay 20% of medical costs, unless they have extra coverage through a Medigap plan or have a different benefit structure with a Medicare Advantage plan.

Medicare Part C (Medicare Advantage)

  • Monthly cost: Medicare Advantage plans cost $28 per month, on average. This cost is on top of what you pay for Parts A and B.
  • Deductible and coinsurance: Varies by plan

Medicare Part D (prescription drug plan)

  • Monthly cost: Medicare Part D costs $65 per month, on average. Plans cost between $0 and $191 per month, depending on the company and level of coverage. Companies can't charge you more because of a medical condition.

Medicare Supplement (Medigap)

  • Monthly cost: The average cost of Medigap Plan G is $504 per month for those who qualified for Medicare before age 65 because of a disability. That's much higher than the average cost of $159 per month when people sign up at age 65.

Why is Medicare Advantage a good choice for disabled Medicare beneficiaries under 65?

Medicare Advantage plans are the best choice for those who have Medicare because of a disability or medical condition.

It's an affordable way to get coverage, and there's a wide range of plan options, so you can choose the coverage you need.

Medicare Advantage plans, also known as Medicare Part C plans, are "all-in-one" alternatives to Original Medicare, including Medicare Part A, Part B and usually Part D prescription drug coverage. With these plans, you don't need to buy separate Part D and Medigap plans, as you would with Original Medicare.

Unlike Original Medicare, Medicare Advantage plans limit the amount you'll pay for medical care in a single year. You won't pay more than $9,350 per year for in-network care or $14,000 per year for out-of-network care, although many plans cap your annual payments at a much lower amount. This caps the total amount you pay when you get medical care. In contrast, you could face unlimited health care costs with Original Medicare and no Medigap coverage.

Special Needs Plans

Unlike Original Medicare, Medicare Advantage offers Special Needs Plans (SNPs) for people with specific disabilities. These plans have extra, tailored coverage that goes beyond what a normal Medicare Advantage plan might offer.

The two most common SNPs are Chronic Condition Special Needs Plans (C-SNPs) and Dual Eligible Special Needs Plans (D-SNPs).

  • In order to join a C-SNP, your doctor has to fill out a form at the time of enrollment. Which plans are available depends on where you live. In some cases, these plans work with doctors who specialize in certain diseases, such as heart disease or diabetes.
  • D-SNPs are available to people who qualify for both Medicare and Medicaid, also known as the dual-eligible population. With a D-SNP, you pay very little when you go to the doctor.

Drawbacks of Medicare Advantage

  • The main disadvantage of Medicare Advantage is that you still pay a portion of your medical costs. That means you could pay thousands of dollars out of pocket if you need a lot of medical care.

    Medicare Advantage plans have low monthly costs. But you'll typically have to pay part of the costs when you see a doctor or get medical care, which can add up.

  • Medicare Advantage plans also restrict where you can get medical care by having networks of doctors and hospitals where you'll have the most medical coverage. The networks can even limit where you can get medical equipment like wheelchairs.

    When enrolling in a plan, check to see if your doctor will accept your Medicare Advantage plan. You should also check the plan's list of doctors that you can see.

Why Medigap isn't always great for Medicare enrollees who have disabilities

Medigap policies are usually much more expensive for Medicare enrollees under age 65 than for seniors who enroll at age 65.

In many states, you can't get a Medigap policy if you're under the age of 65. In other states, these policies may have very high costs.

However, some states have rules that require insurance companies to offer more affordable Medigap options for people with disabilities. This means how much you pay for Medigap differs depending on where you live.

In these states, companies have to sell Medigap policies to Medicare enrollees under age 65 who have disabilities because of guaranteed issue rights. These states also require companies to keep down coverage costs.

  • Hawaii
  • Idaho
  • Illinois
  • Kansas
  • Kentucky
  • Maine
  • Massachusetts
  • Minnesota
  • Mississippi
  • Missouri
  • New York
  • Oregon
  • Pennsylvania
  • South Dakota

In these states, companies have to make all Medigap policies available to the under-65 population. But these states also allow insurers to charge high rates.

  • Delaware
  • Colorado
  • Florida
  • Georgia
  • Indiana
  • Louisiana
  • Montana
  • New Hampshire
  • Tennessee
  • Vermont
  • Wisconsin

In these states, companies have to offer at least one Medigap policy to Medicare enrollees under 65.

  • Arkansas
  • California
  • Connecticut
  • Maryland
  • Michigan
  • Nebraska
  • New Jersey
  • North Carolina
  • Oklahoma
  • Rhode Island
  • Texas
  • Virginia

These states do not require companies to offer supplemental policies to Medicare enrollees who are under 65 and have a disability. However, these states have other types of coverage, such as special policies for people with disabilities.

  • Alabama
  • Alaska
  • Arizona
  • District of Columbia
  • Iowa
  • New Mexico
  • North Dakota
  • South Carolina
  • Utah
  • Washington
  • West Virginia
  • Wyoming

These states do not require supplemental plans for Medicare enrollees under age 65.

  • Nevada
  • Ohio

Keeping Medicare benefits after going back to work

If you are under age 65, you can keep your Medicare benefits when going back to work, as long as your medical condition or disability still meets Medicare's coverage rules.

Even if you lose your Social Security disability benefits, you can still get Medicare benefits for eight and a half years.

However, if your employer offers health insurance, you have to take that coverage. You can still keep Medicare, but your Medicare coverage may pay for care that your work insurance doesn't cover. This means Medicare would be considered secondary insurance.

Getting financial help for Medicare costs

  • If you have a low income, you may qualify for Medicaid and Medicare, which will help reduce or get rid of your costs.
  • If you earn too much to qualify for Medicaid, you may still qualify for a Medicare Savings Program, which can help lower your costs.
  • There is also the Medicare Extra Help program that can reduce the cost of a prescription plan and the cost of drugs at the pharmacy.

Frequently asked questions

Can you get Medicare early if you are disabled?

Yes, you can get Medicare before the age of 65 if you have a disability. To qualify, you have to apply for disability benefits and the Social Security Administration has to decide that you are disabled.

Is Medicare free for the disabled?

No, Medicare is not free for the disabled. Medicare Part A is free for most people who have coverage because of a disability or medical condition. However, most people pay at least $185 per month for Medicare Part B. If you have a low income, you can get help paying for Medicare.

Does SSDI automatically qualify you for Medicare?

You automatically qualify for Medicare benefits if you have SSDI for at least 24 months with most diseases and conditions.

Methodology

Medicare costs and deductibles are from Medicare.gov and the Centers for Medicare & Medicaid Services (CMS).

The cost of Medicare Advantage is based on 2025 plans that include prescription drug coverage. Special needs plans, sanctioned plans, PACE plans, prepayment plans (HCPPs), Medicare medical savings account (MSA) plans, Medicare-Medicaid plans and employer-sponsored plans were excluded from our analysis.

The cost for Medicare Part D is based on the average of available stand-alone prescription drug plans, excluding employer-sponsored and sanctioned plans. The average cost of Medicare Supplement plans is based on data for Medigap plans sold to a female nonsmoker under age 65, excluding Select plans and states with nonstandard plans.

Additional details about coverage and costs came from the Centers for Medicare & Medicaid Services, the Department of Health and Human Services, and MedicareResources.org.

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