Key Takeaways
- You can get Medicare before 65 if you have been receiving Social Security disability benefits for 24 months, have end-stage renal disease, or have been diagnosed with ALS.
- The 24-month waiting period for disability begins when your disability payments start, not when you explore or are diagnosed.
- People with end-stage renal disease can enroll in Medicare as soon as they start dialysis or receive a kidney transplant, regardless of age.
- You must contact Social Security or Medicare directly to enroll early — the programs do not automatically sign you up when you become may be able to access.
- If you miss the enrollment window, you may face late penalties on your premiums that last for as long as you have Medicare.
Medicare for People on Disability Before Age 65
If you receive Social Security Disability Insurance (SSDI) or Railroad Retirement Board (RRB) disability benefits, you become may be able to access for Medicare after you have been receiving those payments for 24 months. This 24-month clock starts on the first day you receive a disability check, not the day you applied or were approved.
The Social Security Administration determines whether your condition meets the definition of disability for SSDI purposes. That definition is strict: your condition must prevent you from working and is expected to last at least 12 months or result in death. Once you have been on SSDI for 24 months, Medicare Part A (hospital insurance) and Part B (medical insurance) both begin automatically on the first day of the month you turn 65 — or, if you are already past 24 months of SSDI, on the first day of the month after your 24-month period ends.
You do not need to do anything to enroll in Part A and Part B if you are already receiving SSDI when your 24 months are up. Social Security sends the information to Medicare automatically. However, you should still review your Medicare card when it arrives to make sure the information is correct.
Medicare for End-Stage Renal Disease
If you have end-stage renal disease (ESRD) — kidney failure requiring dialysis or a transplant — you can enroll in Medicare at any age. Your may be able to access begins the first month you start dialysis treatment or the month you receive a kidney transplant, whichever comes first. You do not have to wait for any period of time after diagnosis.
You must enroll in Medicare Part A and Part B yourself; the dialysis center or transplant team does not do it for you. Contact Medicare at 1-800-MEDICARE or visit Medicare.gov to start the process as soon as your nephrologist (kidney specialist) confirms you need dialysis or have received a transplant. If you delay enrollment, you may face a permanent increase to your Part B premium.
If you are already covered by an employer's health plan when you start dialysis, you can keep that coverage and add Medicare. Medicare becomes your primary payer after 30 months of dialysis or 12 months after a transplant, meaning Medicare pays first and your employer plan pays second.
Medicare for People Diagnosed With ALS
If you have amyotrophic lateral sclerosis (ALS, also called Lou Gehrig's disease), you can enroll in Medicare when ready upon diagnosis, at any age. You do not have to wait for Social Security to approve disability benefits or for any other condition to develop. Your Medicare coverage can begin as early as the first day of the month in which you are diagnosed.
You must contact Medicare yourself to enroll. Call 1-800-MEDICARE or visit Medicare.gov and explain that you have ALS. You will need documentation from your doctor confirming the diagnosis. Unlike SSDI, which requires a formal process and approval process, Medicare enrollment for ALS can move quickly once you provide medical proof.
How to Enroll Before Age 65
The steps differ depending on which category you fall into. If you are on SSDI and have reached 24 months, Social Security handles the enrollment automatically — you do not need to contact Medicare. If you have ESRD or ALS, you must contact Medicare directly.
To enroll with ESRD or ALS, call Medicare at 1-800-MEDICARE (1-800-633-4227). Have your Social Security number, date of birth, and medical documentation ready. You can also visit Medicare.gov and select "Enroll in Medicare" or visit your local Social Security office in person. The phone line is usually fastest for early enrollment cases because staff can confirm your condition and start the process when ready.
After you enroll, Medicare sends you a Medicare card in the mail. This usually takes 1 to 2 weeks. Your coverage begins on the date Medicare approves, not the date you receive the card. Keep a record of your enrollment confirmation number in case you need to follow up.
What Happens If You Miss the Enrollment Window
If you become may be able to access for Medicare before 65 and do not enroll during your initial enrollment period, you may face a late enrollment penalty. For Part B, this penalty is a permanent 10 percent increase to your monthly premium for each 12-month period you were may be able to access but not enrolled. This penalty stays with you for as long as you have Medicare.
The initial enrollment period for early Medicare is different from the standard enrollment period for people turning 65. For SSDI beneficiaries, your initial enrollment period is the three months before and three months after the month your 24-month period ends. For ESRD, it is the three months before and three months after the month you start dialysis or receive a transplant. For ALS, it is the three months before and three months after the month of diagnosis.
If you miss this window, you can still enroll, but the penalty applies. There is no "catch-up" period that erases the penalty. The only exception is if you had other health coverage (such as an employer plan) during the time you were may be able to access but not enrolled in Medicare — in that case, you may not owe a penalty.
Working While on Medicare Before 65
If you are on SSDI and working, your earnings affect your disability benefits but not your Medicare coverage. Once you have been on SSDI for 24 months, you keep Medicare even if your earnings increase or you return to full-time work. This is one of the protections built into the program to encourage people with disabilities to try working.
However, if your earnings are high enough, Social Security may determine that you are no longer disabled and stop your SSDI payments. If that happens, you can continue Medicare for an additional 93 months (about 7.5 years) without paying premiums, as long as you remain disabled. After that period ends, you can keep Medicare by paying the monthly premium yourself, or you can drop it if you have other coverage.
Frequently Asked Questions
Can I get Medicare if I am disabled but not receiving SSDI?
No. Medicare may be able to access for people under 65 requires that you are actually receiving SSDI or RRB disability payments, not just that you are disabled. If you have not applied for SSDI or your process was denied, you do not may have access to for early Medicare on disability grounds. You would need to meet one of the other early may be able to access categories: ESRD or ALS.
What if I am on SSDI but my condition improves and I go back to work?
If Social Security determines you are no longer disabled and stops your SSDI payments, you keep Medicare for an additional 93 months without paying premiums. After that, you can continue Medicare by paying the monthly premium, or drop it if you have other coverage. You do not lose Medicare when ready when your disability benefits end.
Do I need to enroll in Part D (prescription drug coverage) at the same time?
Part D is optional and separate from Part A and Part B. You can enroll in Part D when you enroll in Part B, or you can wait and enroll later. However, if you wait more than 63 days after becoming may be able to access for Part B, you may face a late enrollment penalty on Part D premiums. It is usually best to enroll in Part D at the same time as Part B to avoid this penalty.
If I have ESRD and receive a kidney transplant, does my Medicare coverage end?
No. Once you have Medicare due to ESRD, you keep it for life. If you receive a transplant, your Medicare coverage continues. Your may be able to access does not end even if the transplant is successful and you no longer need dialysis. You will continue to pay premiums like any other Medicare beneficiary.
How do I know if my disability meets Social Security's definition?
Social Security makes this information during the SSDI process process. You cannot determine it yourself based on your diagnosis. If you think you may be disabled under Social Security's rules, contact Social Security at 1-800-772-1213 or visit your local Social Security office to discuss your situation and learn about the process process.