How Medicare can cover you if you’re under 65

If you’ve heard anything about Medicare, it’s probably that coverage for most people starts at age 65. What’s less known is that millions of people enroll in Medicare long before they hit retirement age. In fact, 13% of Medicare beneficiaries were under 65 in 2020.

Those who qualify are people who have serious health conditions that qualify them for early enrollment in Medicare. Read on to learn what those conditions are.

Need some help navigating Medicare? Call a licensed insurance agent at (800) 827-9990, or compare plans online today.

Medicare for people with disabilities

If you have a disability that qualifies you for Social Security Disability Insurance (SSDI), you may be able to enroll in Medicare early. But there’s a 2-year waiting period: After you’ve received SSDI checks for 24 months, you’re eligible for Medicare. In fact, you’ll be automatically enrolled in Original Medicare at that point. (Original Medicare includes Medicare Parts A and B.) One exception: Residents of Puerto Rico aren’t automatically enrolled in Part B.

Looking a little closer at Original Medicare, it includes Medicare Part A, which covers hospital services, and Part B, which covers outpatient services. Part A is free for most people, but you’ll have to pay a monthly premium for Part B. The Part B premium is $164.90 for 2023.

You’ll also be automatically enrolled in Original Medicare if you get certain disability benefits from the Railroad Retirement Board (RRB). The RRB “acts just the same [with] Medicare, but just for the retired railroad beneficiaries,” says Shelley Miller, a in Moscow Mills, Missouri.

So what qualifies as a disability? Here’s the Social Security Administration’s definition:

• You cannot do work and engage in Substantial Gainful Activity (SGA) because of your medical condition.
• You cannot do work you did previously or adjust to other work because of your medical condition.
• Your condition has lasted or is expected to last at least one year or result in death.

You must also have earned enough work credits to qualify for disability benefits. That number varies based on how old you are when your disability starts. (In contrast, everyone born after 1928 needs 40 credits — typically 10 years of employment — to qualify for retirement benefits.)

You’ll also qualify for Medicare Part D (prescription medication coverage) and supplemental Medigap plans. Another entirely different option: You can enroll in a Medicare Advantage plan. You get these Medicare-approved plans through private insurance companies. Medicare Advantage plans cover everything Original Medicare does, plus they usually include prescription medication coverage and other benefits such as vision, dental and hearing coverage.

You’ll have a 7-month period to enroll in any of these plans. The enrollment period begins 3 months before your 25th month of getting SSDI checks and ends 3 months after. Remember, even if you do nothing during this time, you’ll be automatically enrolled in Original Medicare.

If you’re covered under your spouse’s health insurance and don’t want to keep Part B, you can cancel before the coverage start date printed on your Medicare card. “That information all comes with their Medicare card,” says Miller. “If they don’t want it, it tells them there specifically to send it back and Social Security will reissue a new card.”

Need help signing up for Medicare? Call a licensed insurance agent at (800) 827-9990, or compare plans online right now.

Medicare for people with ALS (Lou Gehrig’s disease)

If you’ve been diagnosed with Amyotrophic Lateral Sclerosis (ALS), you’ll be automatically enrolled in Medicare Parts A and B as described above. But Miller says there’s an important difference. Specifically, there’s no waiting period if you have ALS. Coverage begins the month your disability benefits begin, not 24 months later.

Medicare for people with end-stage renal disease

If you have End-Stage Renal Disease (ESRD) — aka permanent kidney failure that requires dialysis or a kidney transplant — you’ll be eligible for Medicare benefits early. Although ESRD patients qualify to enroll in Medicare early, the rules are a little different:

1. You must sign up — there’s no automatic enrollment.
2. When your benefits start depends on your individual situation. If you’re getting a kidney transplant, coverage can begin the month you go into the hospital for surgery, assuming the surgery will take place that month or within 2 months. On the other hand, if you’re on dialysis, coverage typically begins on the first day of your fourth month of dialysis treatments. You’ll have to show that you’ve been getting 3 months of regular dialysis. “To sign up for Medicare, contact Social Security and most likely the dialysis clinic will assist you,” Miller says.
3. Medicare coverage if you have ESRD doesn’t necessarily last for the rest of your life. It stops 12 months after your last dialysis treatment or 36 months after you have a kidney transplant.

Medicare Special Needs Plans

Regardless of how you join Medicare, the program works the same. “Medicare under 65 is the same as for those who are turning 65,” Miller says. However, if you enroll early, you may want to consider joining a Medicare Special Needs Plan (SNP). These are Medicare Advantage (Part C) plans that are specifically designed to better coordinate care for people with special needs.

Medicare SNPs target 3 groups. These include people who:

• Have chronic conditions
• Are dually eligible for both Medicare and Medicaid
• Reside in live-in institutions

It’s the chronic conditions category that’s important here. The list of qualifying conditions includes ESRD requiring dialysis, ALS, and a host of other conditions you might have if you qualify for disability benefits.

Nobody wants to become disabled or have a disease such as ALS or ESRD. But if this does happen, it’s good to know that Medicare is available to help cover the costs of your care.

Do you qualify for Medicare? Call a licensed insurance agent at (800) 827-9990, or compare plans online today.