What Happens When You Turn 65 With Disability Medicare

Your Medicare coverage changes when you reach 65

When you turn 65, your Medicare for the Disabled (also called Disability Medicare) automatically converts to regular Medicare Part A and Part B. You do not have to do anything — the Social Security Administration handles the switch for you. Your coverage continues without a gap, but the program name and some details change.

This transition happens on the first day of the month in which you turn 65. If you were receiving Social Security Disability Insurance (SSDI) or were a disabled widow or widower collecting benefits, you move from disability status to age-based Medicare. Your premiums, deductibles, and covered services may shift, so understanding what changes helps you plan ahead.

Key Takeaways

• Your Disability Medicare automatically converts to regular Medicare Part A and Part B when you turn 65 — no action needed on your part.
• Your Part B premium may increase at 65, and you will owe a higher deductible for hospital stays under Part A.
• Any supplemental coverage (Medigap) or prescription drug plan (Part D) you had continues, but you should review it to make sure it still fits your needs.
• If you were under 65 and had Medicare due to End-Stage Renal Disease or ALS, different rules explore to your transition.

How your Part A and Part B coverage changes

Under Disability Medicare, you had Part A (hospital insurance) and Part B (medical insurance) with no premium for Part A. At 65, Part A remains free because you or your spouse paid Medicare taxes while working. Part B, however, has a monthly premium that increases each year — the standard amount in 2024 is $174.70 per month, though higher earners pay more.

Your deductibles also change. While disabled, your Part A hospital deductible was $1,600 per benefit period. At 65, this amount stays the same, but the rules about what counts as a new benefit period may affect how often you pay it. Your Part B deductible remains $240 per year. These amounts adjust annually, so check your Medicare Summary Notice each year to see the current figures.

If you had a Medigap policy (supplemental insurance) while disabled, it continues after you turn 65. However, your rates may increase because you are now in the older age group. Contact your Medigap insurer before your 65th birthday to understand any rate changes.

What happens to your prescription drug coverage

If you enrolled in a Part D plan (prescription drug coverage) while disabled, that plan continues after you turn 65. You do not need to switch plans unless you want to. However, you should review your current plan each year during the Annual Enrollment Period (October 15 to December 7) because your medications, their costs, and plan formularies change.

If you did not have Part D coverage while disabled, you can enroll when you turn 65 without a penalty. If you wait past your 65th birthday and do not have creditable coverage (coverage as good as Part D), you will pay a late enrollment penalty for as long as you have Medicare. The penalty is roughly 1% of the national average Part D premium for each month you were without coverage.

Medicare Advantage plans and your transition at 65

If you were enrolled in a Medicare Advantage plan (Part C) while disabled, that coverage continues when you turn 65. These plans are run by private insurers and include Part A, Part B, and usually Part D all in one plan. Your plan may change its rates or benefits for the new year, so review your plan documents before January 1.

You can switch to a different Medicare Advantage plan or to Original Medicare (Part A and Part B with a separate Medigap and Part D plan) during the Annual Enrollment Period. This is a good time to compare whether your current plan still meets your needs, especially if your doctors or medications have changed.

Special rules if you have End-Stage Renal Disease or ALS

If you may have access to for Medicare before 65 because of End-Stage Renal Disease (ESRD) or Amyotrophic Lateral Sclerosis (ALS), your transition at 65 follows different rules. With ESRD, your Medicare coverage continues for 36 months after you start dialysis or receive a kidney transplant, even after you turn 65. After that 36-month period ends, your coverage converts to age-based Medicare.

With ALS, you became may be able to access for Medicare when ready upon diagnosis, and your coverage continues without interruption at 65. There is no time limit on ALS-related Medicare coverage. In both cases, contact Social Security or Medicare before your 65th birthday to confirm your transition plan and understand any changes to your premiums or coverage.

What to do before you turn 65

About three months before your 65th birthday, you will receive a notice from Social Security explaining your transition. Read this notice carefully — it tells you your new Part B premium and any changes to your coverage. If you have questions about the notice, call Social Security at 1-800-772-1213.

Review your current medications and doctors to make sure they are covered under your new plan. If you use a Medicare Advantage plan, check whether your doctors are still in-network. If you use Original Medicare with Medigap, confirm that your Medigap plan will continue and what your new rates will be. Make any changes during the Annual Enrollment Period (October 15 to December 7 of the year you turn 65) if you want different coverage starting January 1.

If you have other health insurance through a current or former employer, tell that plan that you are turning 65 and becoming may be able to access for Medicare. Coordination of benefits rules determine which plan pays first, and you want to make sure there are no gaps or overlaps.

Questions to ask your doctor or Social Security

Before your transition, ask your doctor whether your current treatment plan will be covered under your new Medicare plan. Ask specifically about any specialists you see, any procedures you have scheduled, and any medications you take regularly. If your doctor is not in-network under a Medicare Advantage plan you are considering, ask whether they accept Medicare and whether you can see them under Original Medicare instead.

Call Social Security at 1-800-772-1213 to confirm the exact date your coverage changes and to ask about your new Part B premium. Ask whether any of your other benefits (such as Supplemental Security Income, or SSI) will change when you turn 65. If you have ESRD or ALS, ask specifically about the 36-month rule or ALS coverage rules so you understand when your coverage might change again.

Frequently Asked Questions

Do I have to pay for Part B when I turn 65?

Yes. Part A (hospital insurance) remains free, but Part B (medical insurance) has a monthly premium that you pay. The standard premium in 2024 is $174.70 per month, though it increases each year and is higher for people with higher incomes. Your premium is usually deducted from your Social Security check.

What if I do not want Medicare when I turn 65?

You cannot refuse Medicare Part A — it starts automatically. However, you can decline Part B if you have other health insurance through an employer or union. If you decline Part B and later want it, you will pay a penalty for each year you were without it. Talk to Social Security before your 65th birthday if you think you will not need Part B.

Will my doctors still accept my insurance after I turn 65?

Most doctors who accept Medicare Disability will accept regular Medicare at 65. However, if you switch from a Medicare Advantage plan to Original Medicare, or vice versa, some doctors may not be in-network under your new plan. Contact your doctors before your birthday to confirm they accept your new coverage type.

Can I change my Medicare plan when I turn 65?

Yes. You can make changes during the Annual Enrollment Period (October 15 to December 7) of the year you turn 65. You can switch between Medicare Advantage and Original Medicare, change your Medigap plan, or change your Part D prescription drug plan. Changes take effect January 1 of the following year.

What happens to my Medicaid if I have it?

Medicaid rules vary by state. Some states continue Medicaid for people who turn 65 and move to Medicare; others do not. Contact your state Medicaid office before your 65th birthday to find out whether your coverage continues and what you need to do to keep it.