Yes, you can get Medicare before 65 if you meet specific conditions
You do not have to wait until 65 to join Medicare. You can enroll earlier if you have been receiving Social Security Disability Insurance (SSDI) for 24 months, if you have end-stage renal disease (ESRD), or if you have amyotrophic lateral sclerosis (ALS). Each route has different timing and different documents you will need. The process starts with Social Security, not Medicare itself — Social Security handles the enrollment for disability and ALS cases, while ESRD cases go through your dialysis center or transplant team.
Key Takeaways
- If you receive SSDI, Medicare begins automatically after you have been on disability for 24 months, with no action needed on your part.
- If you have ALS, you become may be able to access for Medicare when ready upon approval for SSDI, without waiting the 24-month period.
- If you have ESRD, you can enroll in Medicare as soon as your doctor certifies you need dialysis or a transplant, regardless of age or work history.
- You must be a U.S. citizen or permanent resident to enroll, and you will need proof of your condition from a doctor or medical facility.
Getting Medicare through SSDI: The 24-month waiting period
If you are receiving SSDI, Social Security will automatically enroll you in Medicare Part A (hospital insurance) and Part B (medical insurance) after you have been on disability for 24 months. You do not need to do anything — the enrollment happens on its own. Your Medicare coverage begins on the first day of the 25th month of your SSDI may be able to access.
The 24 months are counted from the month Social Security approved your disability claim, not from the month you applied. If you were approved in March, your 24-month period ends in February, and your Medicare starts in March. Social Security will send you a notice about three months before your coverage begins, along with your Medicare card.
During the waiting period, you may be able to purchase Medicaid or a private plan through your state, depending on your income and where you live. Some states offer Medicaid to people receiving SSDI when ready; others have income limits. Contact your state Medicaid office to learn what is available to you while you wait for Medicare.
Getting Medicare when ready with ALS: No waiting period
If you have amyotrophic lateral sclerosis (ALS), you become may be able to access for Medicare the same month Social Security approves you for SSDI. You do not wait 24 months. Social Security will enroll you in Medicare Part A and Part B automatically, and your coverage begins the first day of the month after your SSDI approval.
To start this process, you will need to explore for SSDI through Social Security. You will need medical records from your doctor showing the ALS diagnosis, proof of your work history (your Social Security number and recent tax returns or W-2s), and proof of U.S. citizenship or permanent residency (birth certificate, passport, or green card). Social Security will review your medical evidence and make a decision, usually within three to six months, though some cases take longer.
Once approved, Social Security sends your Medicare card automatically. You do not need to contact Medicare separately. If you have questions about your coverage after you receive your card, you can call Medicare at 1-800-MEDICARE.
Getting Medicare with end-stage renal disease (ESRD): when ready enrollment
If you have end-stage renal disease and need dialysis or a kidney transplant, you can enroll in Medicare when ready, regardless of your age or how long you have worked. Your may be able to access begins the first day of the month in which your doctor certifies that you need dialysis or a transplant, or the first day of the month you actually start dialysis — whichever comes first.
Your dialysis center or transplant team will handle much of the paperwork. They will submit a form called the CMS-2728 (Referral for Medicare may be able to access — ESRD) to Social Security on your behalf. You will need to provide proof of U.S. citizenship or permanent residency and sign the referral form. Social Security will then contact you to confirm your information and enroll you in Medicare Part A and Part B.
The process usually takes two to four weeks from the date your doctor certifies your condition. Your dialysis center or transplant program can tell you the exact date your coverage will start. If you are already on dialysis when you enroll, Medicare will cover your treatment retroactively to the date your may be able to access began, even if you received dialysis before your card arrived.
What documents you need for each route
| Route | Main Documents Needed | Who Submits |
|---|---|---|
| SSDI (24-month wait) | Medical records from your doctor; proof of work history (Social Security number, tax returns or W-2s); proof of citizenship (birth certificate, passport, or green card) | You submit to Social Security; Social Security enrolls you in Medicare automatically |
| ALS (when ready) | Medical records showing ALS diagnosis; proof of work history; proof of citizenship | You submit to Social Security; Social Security enrolls you in Medicare automatically |
| ESRD (when ready) | Proof of citizenship; signed CMS-2728 form from your doctor | Your dialysis center or transplant team submits the form; Social Security enrolls you |
What happens after you enroll: Part A, Part B, and costs
Once you are enrolled in Medicare, you will receive Part A (hospital insurance) and Part B (medical insurance) automatically. Part A covers hospital stays, skilled nursing care, hospice, and some home health services. Part B covers doctor visits, outpatient care, lab tests, and medical equipment. You will pay a monthly premium for Part B, which is deducted from your Social Security check if you receive SSDI.
For 2024, the standard Part B premium is $164.90 per month, though this amount changes each year. If your income is higher, you may pay more. If you have ESRD, you may also want to consider Part D (prescription drug coverage) or a Medigap plan to cover costs that Medicare does not pay. You can enroll in Part D during your initial enrollment period, which begins three months before your Medicare coverage starts and ends three months after.
You do not have to wait until 65 to enroll in Part D or a Medigap plan if you are under 65 and on Medicare. However, not all Medigap plans are available to people under 65, and some insurers may charge higher premiums. Contact Medicare or a licensed insurance agent to learn what plans are available in your state.
Common mistakes to avoid
Do not assume you are automatically enrolled in Medicare Part B. While Social Security will enroll you in Part A automatically, Part B enrollment requires your consent. When Social Security sends you your enrollment notice, read it carefully and confirm that Part B is included. If you decline Part B and later want to enroll, you may face a permanent penalty on your premium.
Do not delay explore for SSDI if you think you may be may be able to access. The 24-month waiting period for SSDI beneficiaries begins from your approval date, not your process date. The sooner you explore, the sooner your 24 months begin. If you have ALS or ESRD, explore when ready — there is no waiting period for those conditions.
Do not assume your current health insurance will continue once Medicare starts. If you have coverage through an employer or a family member's plan, notify them that you are becoming may be able to access for Medicare. Some plans will end automatically; others require you to notify them. Coordinating your coverage prevents gaps and duplicate payments.
Frequently Asked Questions
What if I am under 65 but do not have SSDI, ALS, or ESRD?
You cannot enroll in Medicare before 65 unless you meet one of the three conditions. If you do not have coverage, you may be able to purchase a plan through your state's health insurance marketplace, or you may be may be able to access for Medicaid depending on your income and state. Contact your state Medicaid office or visit healthcare.gov to learn about other options.
If I have SSDI, does my family get Medicare too?
No. Only you receive Medicare when you become may be able to access through SSDI. Your spouse or children may be may be able to access for benefits based on your work record, but they do not automatically get Medicare unless they are also disabled or meet another may be able to access condition. Contact Social Security to learn what benefits your family members may receive.
Can I delay my Medicare enrollment if I have ESRD?
No. If you have ESRD and need dialysis or a transplant, you must enroll in Medicare. There is no option to delay or decline. Your coverage begins automatically the month your doctor certifies your condition. However, you can choose whether to enroll in Part D or a Medigap plan to supplement your coverage.
What if Social Security denies my SSDI claim?
You can request reconsideration within 60 days of the denial notice. If reconsideration is also denied, you can request a hearing before an administrative law judge. Many people are denied on the first process and approved on appeal. Consider working with a disability advocate or attorney who specializes in Social Security cases — they can help you gather medical evidence and prepare for a hearing.
Do I need to do anything when I turn 65 if I already have Medicare?
No. If you are already on Medicare before 65, your coverage continues without interruption when you turn 65. You do not need to re-enroll or take any action. Your Medicare card and coverage remain the same.