Disability Qualifications for Medicare

Medicare is often associated with people over the age of 65. But you may be surprised to learn that this federal health insurance program is also available to people with certain disabilities and End Stage Renal Disease, regardless of age. Learn more about Medicare disability qualifications below.

Man talks with his doctor

Qualifying for Medicare because of a disability

The qualification for Medicare on the basis of a disability includes the following scenarios: 

  1. You have received disability benefits for at least 24 months

If you have received disability benefits from either Social Security or the Railroad Retirement Board for at least 24 months, you may be eligible for Medicare. If you meet this requirement, you will be automatically enrolled in both Part A and Part B of Medicare (known as “Original Medicare”) on your 25th month of disability benefits. Approximately three months prior, you should receive a package in the mail containing your Medicare card and information about how Medicare works.

  1. You have been diagnosed with ALS (Lou Gehrig’s disease)

You will be automatically enrolled in Original Medicare if you have been diagnosed with amyotrophic lateral sclerosis (also known as ALS and Lou Gehrig’s disease) during the first month in which you receive disability benefits as a result of the disease.

  1. You have End Stage Renal Disease (ESRD)

If you have End Stage Renal Disease requiring either a kidney transplant or dialysis, you may be eligible for Medicare. However, you typically must enroll in the coverage manually.

Qualifying for other coverage options

If you qualify for Original Medicare because of a disability, you may be eligible to enroll in a Part C or Part D plan. Those with End Stage Renal Disease usually can’t enroll in a Medicare Advantage plan.

Part C is known as “Medicare Advantage” and consists of a collection of private health insurance plans that offer the same benefits as Medicare Part A and Part B**, plus others in many cases.

Part D provides prescription drug coverage. You can receive Part D through a Medicare Advantage plan that offers drug coverage, or through a standalone, private Prescription Drug Plan (PDP) that can be used with Original Medicare or a Medicare Advantage plan that doesn’t offer drug coverage.

Connect with an agent

If you have any additional questions or wish to learn more about qualifying for Medicare because of a disability, connect with a licensed insurance agent today. Call TTY Users: 711.

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**Medicare Part A still covers hospice care, even if you are enrolled in a Medicare Advantage plan.

MedicareAdvantage.com is a website owned and operated by TZ Insurance Solutions LLC. TZ Insurance Solutions LLC and TruBridge, Inc. represent Medicare Advantage Organizations and Prescription Drug Plans having Medicare contracts; enrollment in any plan depends upon contract renewal.

Plan availability varies by region and state. For a complete list of available plans, please contact 1-800-MEDICARE (TTY users should call 1-877-486-2048), 24 hours a day/7 days a week or consult www.medicare.gov.

Medicare has neither reviewed nor endorsed this information.