Medicare for People With Disabilities Under 65: Eligibility and Costs
Reviewed October 3, 2026. You can get Medicare before 65 if you’ve received Social Security Disability Insurance (SSDI) or Railroad Retirement Board disability benefits for 24 months, if you have ALS (Lou Gehrig’s disease), or if you have End-Stage Renal Disease (ESRD). People on SSDI are enrolled in Part A and Part B automatically, and their Medicare card arrives about 3 months before coverage starts.
Quick answer: SSDI: Medicare starts automatically after 24 months of disability benefits. ALS: Medicare starts as soon as disability benefits begin. ESRD: you must apply, and timing depends on dialysis or transplant. Once you have Medicare, you can add Part D drug coverage, choose a Medicare Advantage plan, and may qualify for state help with costs.
Who qualifies for Medicare under 65
| How you qualify | When Medicare starts | Enrollment |
|---|---|---|
| Social Security disability benefits (SSDI) | After 24 months of disability benefits (your 25th month) | Automatic |
| Railroad Retirement Board disability benefits | After 24 months of disability benefits | Automatic |
| ALS (amyotrophic lateral sclerosis) | As soon as disability benefits begin | Automatic |
| End-Stage Renal Disease (permanent kidney failure) | Depends on dialysis or transplant timing | You must apply through Social Security |
Medicare.gov confirms that you’ll get Medicare automatically after receiving disability benefits for 24 months, and that people with ALS get Medicare automatically as soon as disability benefits start (Medicare.gov). For ESRD, Social Security says to call 800-772-1213 and tell the representative you want to apply for Medicare because you have ESRD (SSA.gov).
How the 24-month waiting period works
The 24 months count from the first month you’re entitled to disability benefits, not from when your disability began or when you applied. Social Security disability benefits themselves usually begin after a five-month waiting period, so for many people Medicare starts roughly two and a half years after the disability began. Months of entitlement in an earlier period of disability can count toward the 24 months in some cases.
What Medicare covers for people with disabilities
- Part A (hospital insurance): inpatient hospital stays, skilled nursing facility care after a qualifying stay, hospice and some home health care. Most people get it premium-free.
- Part B (medical insurance): doctor visits, outpatient care, preventive services, mental health care, therapy and durable medical equipment such as wheelchairs and walkers. The 2026 standard premium is $202.90 a month and the deductible is $283 (CMS).
- Part D (prescription drugs): optional plans from private insurers. In 2026, out-of-pocket drug costs are capped at $2,100 (Medicare.gov). See how Medicare Part D works.
- Part C (Medicare Advantage): private plans that combine Parts A and B and usually Part D, often with extras like dental or vision. Special Needs Plans exist for people with certain chronic conditions or who have both Medicare and Medicaid.
Your Medicare choices when coverage starts
Your welcome package arrives about 3 months before coverage begins. Because Part B has a premium, the package explains how to keep or decline it. Think carefully before declining: if you don’t have other qualifying coverage, you may pay a Part B late enrollment penalty if you sign up later. Review the 2026 Part B premium and the Part B deductible to plan your costs.
You can stay with Original Medicare and add a Part D plan, or join a Medicare Advantage plan instead. If you’re unsure which to choose, compare plan networks and costs with our HMO vs. PPO guide.
Medigap under 65
Federal law doesn’t require insurance companies to sell Medicare Supplement (Medigap) policies to people under 65, but some states do require it. If you can’t buy a Medigap policy now, you’ll get a Medigap Open Enrollment Period when you turn 65.
Help paying Medicare costs on a limited income
- Medicare Savings Programs. State programs can pay your Part B premium, and the QMB program also covers deductibles and coinsurance. 2026 QMB limits are $1,350 a month in income for an individual ($1,824 for a couple) with resources of $9,950 ($14,910 for a couple), according to Medicare.gov. See our Medicare Savings Programs guide.
- Medicaid. If you qualify for both programs, Medicaid can cover costs Medicare doesn’t. Read our dual eligibility guide.
- Extra Help. This federal program lowers Part D premiums and copays. People who get Medicaid, SSI or a Medicare Savings Program qualify automatically.
Working while on Medicare through disability
If you return to work, you can usually keep Medicare for a long time. Social Security says you can keep Medicare hospital and medical insurance for at least 93 months after your trial work period ends, as long as you still have a disabling impairment (SSA.gov). If your premium-free Part A ends because of work, the Qualified Disabled and Working Individuals (QDWI) program may help pay your Part A premium if your income and resources are limited.
What happens when you turn 65
At 65, you keep Medicare, but you now qualify based on age instead of disability. You get a new Initial Enrollment Period and, importantly, a six-month Medigap Open Enrollment Period when you can buy any Medigap policy sold in your state without medical underwriting. Our turning 65 checklist lays out the timeline.
If you have military coverage, see how TRICARE For Life works with Medicare. If someone helps you handle Medicare paperwork or appeals, they can be formally named with an Appointment of Representative form (CMS-1696).
Frequently asked questions
How long do you have to be on disability to get Medicare?
Usually 24 months of Social Security or Railroad Retirement disability benefits. Medicare then starts automatically.
Do people with ALS have to wait 24 months for Medicare?
No. People with ALS get Medicare automatically as soon as their disability benefits begin.
Is Medicare free for people on disability?
Part A is usually premium-free, but Part B has a monthly premium ($202.90 standard in 2026). A Medicare Savings Program or Medicaid may pay it if your income is limited.
Can I get Medicaid and Medicare at the same time?
Yes. If you qualify for both, you’re dual eligible, and Medicaid can pay many costs Medicare doesn’t, including premiums.
Do I get Medicare if I receive SSI but not SSDI?
SSI alone doesn’t qualify you for Medicare, because Medicare eligibility under 65 is based on Social Security or Railroad Retirement disability benefits. Most people on SSI qualify for Medicaid instead.
Will I lose Medicare if I go back to work?
Not right away. Social Security says you can keep Medicare for at least 93 months after your trial work period if you still have a disabling impairment.
This article is general information, not legal, tax or individual insurance advice. Medicare365 is not affiliated with or endorsed by the U.S. government or the federal Medicare program.