In some scenarios, Medicare may be available to people with disabilities and those who have end-stage renal disease. People under the age of 65 that have received Social Security Disability Insurance for the previous 24 months may qualify for Medicare. It is important to know if you qualify and how Medicare qualification works.

When Is a Person Able to Qualify for Medicare Due to a Disability?

  • Some people may qualify for Medicare coverage if they have received Social Security Disability Insurance (SSDI) payments for the last 24 months. To qualify for that type of disability, a person needs to meet the requirements for their health condition under Social Security law. Often, there are quite a few requirements to be met, but these differ from one condition to the next.
  • There is a 2-year waiting period from being considered disabled by Social Security before you qualify for Medicare. That period begins the first month that you receive a check for SSDI.
  • Once that two-year period ends, you may then be automatically enrolled in Medicare. This happens at the start of the 25th month that you received your first SSDI check.

Are There Some Conditions Where You Do Not Have to Wait the Two Years?

Some people may be able to bypass the two-year wait. Those who have Amyotrophic lateral sclerosis, also known as ALS, do not have to wait that long to receive Medicare immediately. In this case, Medicare coverage automatically begins the first month that you receive your SSDI benefits.

Exceptions are also made for people with end-stage renal failure.

Who Qualifies for Medicare with End Stage Renal Failure?

Those who have end-stage renal failure (ESRD) may be able to obtain Medicare if they are under the age of 65. To receive early Medicare, an official diagnosis of kidney failure is necessary. The candidate must also be getting dialysis treatments or have had a kidney transplant to qualify.

Someone with ESRD must also fulfill at least one of the three following conditions to receive Medicare before 65:

  • The individual has worked the required amount of time paying Social Security, the Railroad Retirement Board, or as a government employee.
  • The individual is getting or is eligible for Social Security or Railroad Benefits.
  • The individual is the spouse or dependent child of a person who meets either of the requirements listed above.

If the requirements above are satisfied, it is possible to apply for Medicare benefits before 65.  It is then possible to enroll in Parts A and B coverage at any time. Part A coverage will be back dated for up to 12 months.

If You Think You Qualify, How Do You Enroll in Medicare Under the Age of 65?

Generally, this process is automatic. If someone is deemed eligible for SSDI, they are deemed eligible for Medicare. SSDI recipients are automatically enrolled in Medicare depending on the reasons they qualify. For most people, there is a 2-year waiting period to qualify. For those who have a diagnosis of ALS, there is no waiting period, and coverage can begin right away. Most people with ESRD qualify within three months after the course of regular diagnosis begins or after a person receives a kidney transplant.

In the months leading up to qualification, Medicare will automatically send information about coverage. Of course, it may be advantageous to learn about options in Original Medicare, Medicare Advantage Plans, or Medigap coverage, before Medicare sends their information.

What Types of Benefits Are Provided to People Who Are Under 65 with Disabilities?

Medicare coverage is the same whether you have disabilities or are over the age of 65. That may include coverage for hospital stays and doctor visits. The coverage you receive is dependent on the plan you select, such as Original Medicare (Parts A and B), Prescription Drug Coverage (Part D), as well as Medigap, or Medicare Advantage Plans. It is a good idea to review all of your options (there are quite a few) to determine which ones apply to your needs the best.

Can a Person with Dementia or Mental Illness Qualify for Medicare Under the Age of 65?

Medicare itself does not discriminate in any way regarding chronic conditions, mental health conditions, or specific conditions like dementia. In order to qualify for Medicare with those conditions, you must first qualify for SSDI. The Social Security Administration sets the rules for what the diagnosis must be, symptoms, or advancement of the condition to obtain benefits. If SSDI approves your coverage, you may then qualify for Medicare.

It is important to know your rights. If you think you are eligible for Medicare, reach out to a trusted, experienced team of professionals to learn more.