What Disabilities Qualify for Medicare Under 65? A Complete Guide

While Medicare is primarily for Americans 65 and older, it’s also available earlier for people living with certain disabilities or medical conditions. If your disability prevents you from working for at least a year, you may be eligible for Medicare, even if you’re under 65.

Understanding Medicare Eligibility Under 65

You can qualify for Medicare insurance under the age of 65 if you meet one of the following conditions:¹

• You are receiving Social Security Disability Insurance (SSDI) benefits.
• You have End Stage Renal Disease (ESRD).
• You have Amyotrophic Lateral Sclerosis (ALS, also known as Lou Gehrig’s disease).

What Medical Conditions Qualify for Social Security Disability?

There isn’t a definitive list of conditions that do or don’t qualify for SSDI. However, the SSA has a list of impairments² that might qualify if they’re severe enough. If you don’t have an impairment or disability on the list, it doesn’t necessarily mean you don’t qualify.

How Long Do You Have to Wait for Medicare After SSDI Approval?

If you have been approved for SSDI benefits, you become eligible for Medicare 24 months after your SSDI entitlement date.³ This is the date when you’re formally eligible for benefits, typically five months after the onset of your disability. There are two exceptions to this waiting period:

Exceptions for Amyotrophic Lateral Sclerosis (ALS)

If you have been diagnosed with ALS, Medicare coverage begins as soon as you start to receive SSDI benefits.⁴

Exceptions for End Stage Renal Disease (ESRD)

Coverage usually starts four months after dialysis begins, or sooner if you qualify for home dialysis training.

What Parts of Medicare Cover People with Disabilities?

People who meet all the criteria for Social Security Disability are generally automatically enrolled in Medicare Parts A and B.⁵

Part A: Hospital Coverage

Once you’re eligible for Medicare, you’re usually eligible for Part A premium-free if you or your spouse paid Medicare taxes for at least 10 years. Part A covers:

• Inpatient hospital care
• Skilled nursing facility care (after a hospital stay)
• Hospice care
• Some home health services

Part B: Medical Insurance

Enrollment in Medicare Part B is automatic when your 24-month SSDI waiting period ends. However, you’ll pay a monthly premium for this coverage. Part B covers:

• Doctor visits
• Outpatient care
• Preventive services (like screenings and vaccines)
• Mental health services
• Durable medical equipment

Part D: Prescription Drug Coverage

Offered by private insurers, Medicare Part D covers prescription medications.5 This is coverage that you can enroll in as a standalone plan or as a part of a Medicare Advantage plan. Keep in mind, if you don’t sign up when you’re first eligible – during your Initial Enrollment Period – and you don’t have other creditable coverage, you may have to pay a late enrollment fee if you decide to add Part D coverage later.

Part C: Medicare Advantage Plans

Medicare Advantage plans, also offered by private insurers approved by Medicare, combine Parts A and B, and usually Part D.⁵ These plans may offer extra benefits such as dental, vision and transportation to and from medical appointments.

How to Apply for Medicare If You Have a Disability

If you have a disability and are receiving SSDI benefits, you don’t need to apply separately for Medicare (Parts A and B). Typically, you’ll be enrolled automatically once you become eligible.
Here’s how it works:

• If you’re under 65 and receiving SSDI, you’ll be automatically enrolled in Medicare Parts A and B after 24 months of receiving SSDI benefits.
• If you have ALS, you will get Medicare Parts A and B once your SSDI benefits start.
• If you have ESRD, you may qualify for Medicare earlier, but you must apply manually, through Social Security. You can apply online at ssa.gov/medicare, by phone at 1-800-772-1213 or in person at your local Social Security office.
• Part C (Medicare Advantage) and Part D (Prescription Drug Coverage) are not automatic. You can enroll in these through a private insurance company once you’re eligible for Medicare. Enrollment typically happens during your Initial Enrollment Period (the seven months surrounding your Medicare eligibility date) or during the Annual Enrollment Period (October 15 – December 7 each year).

Costs of Medicare for People with Disabilities

Medicare costs are generally the same whether you qualify because of age (65+) or disability (under 65 and on SSDI). Note that the amounts supplied here reflect 2025 costs.

Part A Costs: Hospital Insurance

• Monthly premium:⁶
• Usually free if you or your spouse worked and paid Medicare taxes for at least 10 years
• If not, premiums could be up to $518/month
• Deductible:⁶
• You pay $1,676 for each hospital stay (per benefit period)
• Coinsurance (your share of the costs after the deductible and applies to hospital stays only):⁶
• $0/day for the first 60 days of a hospital stay
• $419/day for days 61–90
• $838/day after day 90 (unless you use lifetime reserve days, which are limited)

Part B Costs: Medical Insurance

• Monthly premium:⁶
• $185/month (or more if you have a high income)
• Deductible:
• $257/year
• Coinsurance:⁶
• After you meet the deductible, Medicare pays 80% of approved medical costs such as doctor visits, tests, outpatient care, mental health services and medical equipment
• You pay the remaining 20%

Part D Costs: Prescription Drug Coverage

• Monthly premium:⁶
• Varies by plan — usually around $10 to $50/month
• Deductible:
• Some plans have one
• Cost-sharing:
• You might pay a set dollar amount (copay) or a percentage (coinsurance), depending on the drug.
• Plan D annual out-of-pocket limit: For covered drugs, once your combined deductible, copays and coinsurance reach roughly $2,000 (in 2025), you won’t pay additional out-of-pocket costs for those drugs for the rest of the year.

Part C Costs: Medicare Advantage Plans

As these plans are offered by private insurance companies, monthly premiums can vary widely. Many plans have no additional premium beyond the standard Part B premium, while others average around $17 per month. Some plans with expanded benefits may cost $50 to $100 or more per month, depending on the insurer and where you live. Most Medicare Advantage plans also include a yearly limit on out-of-pocket costs, which can help manage expenses.

Common Challenges and How to Overcome Them

Accessing Medicare with a disability can present unique hurdles. Fortunately, there are strategies and resources available to help you overcome these challenges and ensure you receive the care you need.

Waiting Period for Coverage

Because Medicare kicks in after 24 months on SSDI, you may face a coverage gap. 

Workaround: Consider bridging the gap with Medicaid, COBRA, a spouse’s plan or marketplace insurance.

Complex and Confusing Options

With many parts to Medicare, it can feel challenging to grasp Parts A, B, C and D. 

Workaround: A State Health Insurance Assistance Program (SHIP) or a licensed advisor can offer guidance.

High Out-of-Pocket Costs

Premiums,deductibles and drug costs can add up. 

Workaround: A Medicare Savings Program can help. This state-run program helps people with limited income pay for some or all of their Medicare costs.

Gaps in Coverage

Medicare doesn’t cover dental, vision, hearing or long-term care.

Workaround: Substitute with a Medicare Advantage plan, Medicaid or private coverage such as dental insurance, long-term care insurance, critical illness insurance, or cancer, heart attack, & stroke insurance.

Medicare-Medicaid Confusion

While Medicare and Medicaid have similar names, they are very different programs. You may qualify for both7 (this is called dual eligibility) — and in fact, Medicaid may cover Medicare’s out-of-pocket costs.

Workaround: A SHIP counselor or licensed Medicare advisor can help.

Medicare for People With Disabilities

If you’re under 65 and living with a disability, Medicare can provide essential health coverage, but understanding how and when you qualify is key. Whether you’re just starting to receive SSDI or exploring plan options, knowing the rules, timelines and programs available can help you make confident, informed choices about your care.

FAQs on Medicare Qualifications for Disabilities

Q1. Do I Qualify for Medicare If I’m Under 65 and Disabled?

Yes. If you’re under 65 and have a qualifying disability, you can get Medicare after you’ve been approved for Social Security Disability Insurance (SSDI). You’ll generally become eligible for Medicare 24 months after your SSDI entitlement date.

Q2. How Soon Can I Get Medicare After Disability Approval?

Most people start Medicare coverage 25 months after their SSDI entitlement begins. This includes a five-month waiting period after your disability onset date, followed by a 24-month waiting period, though there are some exceptions.

Q3. Is There a Difference Between Disability Medicare and Regular Medicare?

The coverage is the same whether you qualify by age or disability. However, there are a few potential differences. For example, if you’re under 65, you may face a waiting period before Medicare begins. Also, some private Medicare Advantage Plans may be limited based on your age or disability status. On the other hand, people with disabilities are often more likely to qualify for financial help. 

Q4. What Medicare Parts Do I Get If I’m Disabled?

If you’re receiving SSDI, you’ll be automatically enrolled in Part A (usually free) and Part B (typically has a monthly premium). You can also choose to enroll in Part D, which adds prescription drug coverage, in a Part C (Medicare Advantage) plan, which replaces Parts A and Be and often includes Part D as well.

Q5. What Medical Conditions Qualify for Long-Term Disability Medicare?

There’s no single list of conditions that qualify. Instead, the Social Security Administration (SSA) determines eligibility based on how severe your condition is and whether it prevents you from working for at least 12 months.

Once you’re approved for SSDI, you’ll be on track to qualify for Medicare.

Q6. What Happens to My Medicare Disability Coverage When I Turn 65?

When you turn 65, your Medicare coverage continues without interruption, but you’re now considered eligible based on age instead of disability.

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Sources

¹ Medicare.gov. Web page: Who’s eligible for Medicare under 65. Retrieved on June 22, 2025, from https://www.medicare.gov/basics/get-started-with-medicare

² SSA gov. Web page: Disability Evaluation Under Social Security. Retrieved on June 24, 2025, from https://www.ssa.gov/disability/professionals/bluebook/AdultListings.htm

³ SSA.gov. Web page: Medicare information. Retrieved on June 22, 2025 from https://www.ssa.gov/disabilityresearch/wi/medicare.htm

⁴ Medicare.gov. Web page: I’m getting Social Security benefits before 65. Retrieved on June 22, 2025 from https://www.medicare.gov/basics/get-started-with-medicare/before-65

⁵ Medicare.gov. Web page: Parts of Medicare. Retrieved on June 22, 2025 from https://www.medicare.gov/basics/get-started-with-medicare/medicare-basics/parts-of-medicare

⁶ Medicare.gov. Web page: Costs. Retrieved on June 22, 2025 from https://www.medicare.gov/basics/costs/medicare-costs

⁷ Medicare.gov. Web page: Medicaid. Retrieved on June 22, 2025 from https://www.medicare.gov/basics/costs/help/medicaid

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