Yes, you can get Medicare before 65 if you meet one of three conditions

Medicare is not limited to people 65 and older. You may be covered if you have been receiving Social Security Disability Insurance (SSDI) for at least 24 months, if you have end-stage renal disease (ESRD), or if you have amyotrophic lateral sclerosis (ALS). Each path has different timing and requirements, and the process starts with your Social Security or medical records, not with Medicare directly.

The key is that Medicare does not decide whether you may have access to — Social Security or your medical team does. Once you meet the condition, Medicare coverage follows automatically or with a straightforward enrollment step. Understanding which path applies to you saves months of confusion.

Key Takeaways

  • You may have access to for Medicare before 65 if you have received SSDI for 24 months, have ESRD, or have been diagnosed with ALS.
  • SSDI beneficiaries are enrolled in Medicare automatically after 24 months; you do not need to take any action.
  • People with ESRD can get Medicare as soon as their condition is diagnosed, even if they are still working.
  • ALS patients are enrolled in Medicare when ready upon diagnosis, without the usual waiting period.
  • You must be a U.S. citizen or permanent resident and have worked long enough to have earned Social Security credits.

Medicare through SSDI: The 24-month waiting period

If you receive Social Security Disability Insurance, you become covered by Medicare automatically after you have been on SSDI for 24 months. You do not have to do anything — Social Security handles the enrollment. Your Medicare coverage begins on the first day of the 25th month of your SSDI payments.

The 24-month clock starts from the first month you received a disability payment, not from the month you applied. If you applied in January but your first check arrived in March, the clock starts in March. Social Security will send you a notice before your Medicare coverage begins, usually about three months in advance.

During those first 24 months, you may still have other insurance through a job, a family member's plan, or a marketplace plan. You can keep that coverage if you want, but once Medicare starts, you will need to decide whether to drop it or keep it alongside Medicare.

Medicare for end-stage renal disease (ESRD)

If you have end-stage renal disease — meaning your kidneys no longer work well enough to sustain life without dialysis or transplant — you may get Medicare regardless of your age. Coverage can start as soon as your nephrologist (kidney specialist) determines you have ESRD, even if you are still working and earning income.

You do not have to wait for dialysis to begin. Some people are covered as soon as they are diagnosed and referred for treatment. Others may have a short waiting period depending on when their treatment plan is finalized. Your dialysis center or transplant team will help you understand your specific timeline.

To get Medicare for ESRD, you must have worked long enough to have earned Social Security credits — the same requirement as for regular Social Security. If you have not worked enough, you may still be covered if a parent or spouse has earned enough credits. Your Social Security office or dialysis center can check your work history.

Medicare for ALS (amyotrophic lateral sclerosis)

If you have been diagnosed with ALS, you are enrolled in Medicare when ready, without any waiting period. This is the fastest path to Medicare coverage before 65. You do not have to be on disability first, and you do not have to wait 24 months.

Your doctor must submit medical evidence of your ALS diagnosis to Social Security. Once Social Security receives the diagnosis and confirms you meet the work-credit requirement, your Medicare coverage begins. The entire process typically takes a few weeks to a few months, depending on how quickly your medical records reach Social Security.

Like ESRD, ALS coverage requires that you or a family member have earned enough Social Security work credits. If you are unsure whether you have worked long enough, contact Social Security before your doctor submits the diagnosis.

Work credits and citizenship requirements

To get Medicare through any of these three paths, you must have earned enough Social Security work credits. In 2024, you earn one credit for each $1,730 of wages you have paid Social Security taxes on, up to four credits per year. Most people need 40 credits total (roughly 10 years of work), though the exact number depends on your age when you became disabled.

You must also be a U.S. citizen or a permanent resident who has lived in the United States for at least five years. If you are not sure about your work-credit total, you can check your Social Security statement online at ssa.gov, or call Social Security at 1-800-772-1213 to ask.

If you have not earned enough credits yourself, Social Security may count credits from a parent or spouse. This is called "deemed" coverage and is most common for people who became disabled before age 22 or for spouses of disabled workers.

What happens to your other insurance when Medicare starts

If you have insurance through an employer, a family member's plan, or the marketplace when Medicare begins, you have choices. You can drop that coverage and use Medicare alone, or you can keep both and let Medicare be your primary payer. The rules differ depending on what type of coverage you have.

If your employer has 20 or more employees and you are still working, your employer plan may remain primary and Medicare secondary. If you drop employer coverage to use Medicare alone, you may not be able to re-enroll in that employer plan later. Before you make a change, ask your employer's benefits office or your plan's customer service what happens if you switch.

If you have marketplace insurance, you should report your Medicare enrollment to the marketplace so your subsidy can be adjusted. Keeping marketplace coverage after Medicare starts may mean paying more than you need to.

Enrollment in Medicare Parts B, C, and D

When you become covered by Medicare, you are automatically enrolled in Part A (hospital insurance) and Part B (medical insurance). However, you still need to choose a prescription drug plan (Part D) and decide whether to use Original Medicare with a Medigap policy or to join a Medicare Advantage plan (Part C).

You have a limited window to make these choices. If you do not choose a Part D plan within 63 days of your Medicare start date, you may pay a penalty for every month you go without coverage. The same applies to Part B if you delay enrollment (though Part B is automatic for most people on SSDI or ESRD).

Social Security will send you information about these choices before your coverage begins. If you do not receive it, contact Medicare at 1-800-MEDICARE or visit Medicare.gov to review your options and enroll.

Frequently Asked Questions

Do I have to be on disability for 24 months before I can work again?

No. The 24-month waiting period is only for Medicare enrollment. You can return to work at any time while on SSDI, though your benefits may change depending on how much you earn. Your Medicare coverage continues regardless of whether you are working.

If I have ESRD and get a kidney transplant, do I lose Medicare?

No. Once you are enrolled in Medicare for ESRD, you stay on Medicare for life, even after a successful transplant. Your coverage does not end when your kidney function improves.

Can I get Medicare if I am not a U.S. citizen?

You may be covered if you are a permanent resident (green card holder) and have lived in the United States for at least five years. Undocumented immigrants and temporary visa holders do not may have access to for Medicare through these programs. Contact Social Security to discuss your specific situation.

What if my SSDI process is still pending — can I get Medicare early?

No. Medicare coverage begins only after Social Security approves your disability claim and you have received payments for 24 months. If your process is denied, you do not get Medicare through this path.

How do I know when my 24 months of SSDI are up?

Social Security will send you a notice about three months before your Medicare coverage begins. You can also check your My Social Security account online at ssa.gov or call 1-800-772-1213 to ask when your 25th month of SSDI will be.