Medicare Coverage for People Under 65 With Disabilities
The age at which people traditionally qualify for Medicare is 65 years old. But in some cases, people under the age of 65 who have certain disabilities may also qualify for Medicare coverage.
When can someone under 65 receive Medicare benefits?
If you qualify for Medicare coverage based on your Social Security disability status, you will automatically be enrolled in Part A and Part B of Medicare after first receiving disability benefits for 24 months.
You will receive your Medicare card in the mail approximately three months before your 25th month of receiving disability benefits.
If you have Amyotrophic lateral sclerosis (ALS, or Lou Gehrig’s disease), you typically will be enrolled in Medicare the same month that your disability benefits begin. There isn’t a 24 month waiting period as with other disabilities.
If you have End-Stage Renal Disease (ESRD), you typically will be able to enroll in Medicare three months after a course of regular dialysis begins, or after you receive a kidney transplant.
Those with ESRD generally must manually enroll in Medicare.
Disabilities that may qualify for Social Security benefits and Medicare eligibility
If you are under 65 years old and have a disability other than ALS or ESRD, you must first qualify for disability benefits through the Social Security Administration before you will qualify for Medicare.
The Social Security Administration’s impairment listing manual lists a number of types of disabilities that may qualify someone for disability benefits.
- Musculoskeletal problems
- Cardiovascular conditions
- Speech and sense impairments
- Respiratory illnesses
- Neurological disorders
- Mental disorders
- Immune system disorders
- Various syndromes such as Marfan Syndrome and Sjogren’s Syndrome
- Skin disorders such as dermatitis
- Digestive tract problems
- Kidney disease and genitourinary problems
- Hematological disorders
- Bone marrow disorders
An individual’s disability does not have to match the exact requirements outlined in this guide.
Applicants may be awarded disability benefits if aspects of their condition are determined by the Social Security Administration to be medically equivalent to the listed criteria.
Medicare for children
The minimum age at which you can collect Social Security disability benefits is 18. But under the following circumstances, children under the age of 18 can be eligible for Medicare.
- The child has End Stage Renal Disease (ESRD) and requires dialysis or a kidney transplant.
- The parent or legal guardian of the child has ESRD requiring dialysis or a transplant and is receiving Social Security disability benefits. The child may qualify for Medicare benefits as a dependent.
Getting Medicare at age 65
For people without a qualifying disability, eligibility for Medicare Part A requires each of the following:
- You are at least 65 years old.
- You are a U.S. citizen or permanent legal resident having lived in the U.S. for at least five years.
- You are eligible to receive Social Security benefits or Railroad Retirement Board benefits.
If you have worked and paid Medicare taxes for at least 40 quarters (10 years), you will be eligible for premium-free Part A.
If you paid Social Security taxes for fewer than 40 quarters, you can still be eligible for Medicare Part A, but you will have to pay a monthly premium.
You may also become eligible for Medicare because of your spouse’s health care coverage.
If you are at least 65 years old and married to someone at least 62 years old who has worked and paid Social Security taxes for 40 quarters, you may qualify for Medicare as their dependent, even if you do not qualify for Medicare on your own.
How to sign up for Medicare
If you are not automatically enrolled in Medicare because of your disability, you can sign up for Medicare coverage in a few different ways:
- Apply online on the Social Security website
- Visit your local Social Security office
- Call Social Security at 1-800-772-1213 (TTY: 1-800-325-0778)
- If you worked for a railroad, call the Railroad Retirement Board at 1-877-772-5772
- Complete an Application for Enrollment in Part B (CMS-40B)
Medicare Advantage plan options for people under 65 with a disability
A Special Needs Plan is a type of Medicare Advantage plan (Medicare Part C) that is designed for the specific needs of someone with a specific disability or medical condition.
For example, a Special Needs Plan designed for people with diabetes may likely include more coverage for insulin shots and specific medications used to treat the disease.
It may even include coverage for a diabetes self-management program, in which the beneficiary would receive counseling on diet and nutrition and other means of managing their diabetes.
Medicare Advantage plans provide all of the same hospital insurance and medical insurance coverage of Medicare Part A and Part B combined into one plan.
Medicare Advantage plans may also offer additional benefits that Original Medicare doesn’t offer, such as coverage for:
Some people with disabilities may opt for a Medicare Advantage plan because of the additional benefits some plans may offer.
Some Medicare Advantage plans also offer an increased focus on preventive and coordinated continued care, which could be important for a person with a disability.
Medicare Supplement options for people under 65 with a disability
While some people under the age of 65 may qualify for Medicare because of a disability, insurance companies are not required by federal law to sell Medicare Supplement Insurance (Medigap) to anyone under age 65.
However, the following 32 states do require insurance companies to make at least one Medigap plan available to those under age 65 who are eligible for Medicare because of a disability:
- California (not required if you have End-Stage Renal Disease)
- Delaware (ESRD only)
- Massachusetts (does not include ESRD)
- New Hampshire
- New Jersey
- New York
- North Carolina
- South Dakota
- Vermont (does not include ESRD)
Three things to know about buying Medigap under the age of 65:
- Though state laws only require the above states to offer at least one Medigap plan, each insurance company is free to offer more than one plan if they wish. But keep in mind that if you are under 65, your Medigap plan options may be more limited than those who are 65 and over.
- There may be insurance companies in other states who are willing to sell Medigap policies to people under age 65, despite not being required to do so.
- If you are under 65, you may have to pay more for your Medigap policy. Each state has its own rules regarding guaranteed issue rights for people under age 65.
Here is a list of additional resources for people with disabilities.
- Social Security Disability Income (SSDI)
This federal program pays benefits to those with a qualifying disability who are eligible for the program based on their tax history.
- Low Income Energy Bill Assistance Program (LIHEAP)
The Low Income Energy Bill Assistance Program provides help with home energy bills. While the program is not specifically designed for people with disabilities, priority is usually granted to the most at-risk, which includes seniors and those with a disability.
- Volunteer Income Tax Assistance (VITA)
This program offers free tax preparation for people with disabilities.
- Department of Housing and Urban Development (HUD)
The Department of Housing and Urban Development provides housing vouchers to eligible people with disabilities.
- Section 811
This program subsidizes rental housing opportunities that provide access to supportive services to help people with disabilities live more independently.
- State vocational rehabilitation agencies
Your state agency may offer grants or loan programs to help cover the cost of modifying your vehicle to accommodate your disability.
- National Aging and Disability Transportation Center (NADTC)
This organization promotes the availability and accessibility of transportation options for people with disabilities.
- Ticket to Work
This is a free and voluntary program that provides vocational training to people age 18 to 64 who receive Social Security disability benefitis.
The blind and those with disabilities can receive help finding a job with a non-profit organization through AbilityOne.
- Federal Student Aid
A number of scholarships and grants are available through the Office of the U.S. Department of Education.
- College scholarships for people with disabilities
Financial assistance for college tuition available to students with disabilities.
- National Center for College Students with Disabilities
This is a federally funded national center with free information about campus climate, student needs and more.
- Americans with Disabilities Act (ADA) information line
Call 1-800-514-0301 (TTY: 1-800-514-0383) for questions about ADA requirements.
- Voter accessibility laws
Voter accessibility laws ensure that people with disabilities are given a fair opportunity to vote. Select your state and local area from this list to find out what you’ll need to know about your polling place.