Millions of people ages 65 and older qualify for Medicare, the federal health insurance program. What you may not know is that Medicare under 65 eligibility exists for people with disabling medical conditions.
The disability professionals at Sackett and Associates have been helping people with disabilities living in Northern California and throughout the country obtain benefits through the Social Security Administration for the past 45 years. This article explains the benefits available through Medicare for disabled under 65 and how to qualify for them.
Qualifying for Medicare before age 65
One way to qualify for early Medicare disability coverage is by being eligible for Social Security Disability Insurance benefits administered by the Social Security Administration. To be eligible for SSDI benefits, you must have a history of working at jobs or self-employment with Social Security taxes paid on the money that you earned.
The work record must be long enough and of recent duration for you to be eligible for SSDI. Social Security uses work credits to determine whether your work history meets the criteria.
You earn work credits based on earnings. For example, in 2025, you receive one work credit for each $1,810 in wages or self-employment income up to a maximum of four credits annually. The earnings required for a work credit change each year.
The number of credits needed for eligibility depends on a person’s age when they become disabled. For instance, a 24-year-old disabled worker needs six work credits earned within three years, but a 27-year-old needs 12 credits earned within six years of the onset of their disability.
If you qualify for SSDI benefits, you become eligible for Medicare, but coverage does not begin immediately. The waiting period that applies to SSDI and Medicare coverage is 24 months from the start of your disability payments.
Someone who does not have enough work credits for SSDI eligibility, or receives only a small amount each month in SSDI benefit payments, may also qualify for Supplemental Security Income disability benefits. You must meet income and resource limits to be eligible for the SSI program, and that includes the income you get as SSDI benefits.
SSI eligibility includes Medicaid, which provides coverage for medical and long-term care, provided you qualify for the program. Medicaid coverage begins immediately upon approval by the state where you reside. If you also receive SSDI benefits and qualify for Medicare after the 24-month waiting period, Medicare becomes the primary provider of benefits. Medicaid becomes the secondary insurer in what is called dual eligibility.
Medical Conditions Qualifying For Medicare For the Disabled Under 65
There are two disabilities that qualify for Medicare before reaching age 65 without waiting 24 months from the date of the first SSDI benefit payment. The first medical condition is amyotrophic lateral sclerosis (ALS), which is also called Lou Gehrig’s disease.
A person diagnosed with ALS qualifies for Medicare coverage immediately upon the commencement of SSDI monthly benefits. The 24-month wait period does not apply.
The other condition is end-stage renal disease, also known as permanent kidney failure. To be eligible for Medicare with permanent kidney failure, one of the following situations must apply:
- You receive maintenance dialysis.
- You receive a kidney transplant.
Medicare coverage begins three months after you begin dialysis or three months after a kidney transplant.
Coverage Available Through Medicare For Someone Eligible For SSDI
Medicare coverage has two parts. Part A pays for the following inpatient services:
- Hospitals
- Skilled nursing facilities
- Hospice
Medicare, unlike Medicaid, does not pay for long-term care in a nursing home. It will pay for care at a skilled nursing facility on a short-term basis following a hospital stay.
Medicare Part B coverage pays for outpatient care, including office visits with your healthcare providers and preventive care. When you qualify for Medicare for the disabled under 65, it includes Parts A and B.
Medicare eligibility for individuals under 65 generally continues as long as they remain eligible for SSDI. If your medical condition improves to where you are no longer disabled, your Medicare coverage may end. There are, however, programs that allow a person on SSDI to work while receiving benefits during a Trial Work Period and an Extended Period of Eligibility. These programs have special rules you can learn more about by speaking with a disability professional at Sackett and Associates.
Learn More About Your Disability Benefits From Sackett Law
Getting help with the Social Security disability, Medicare, and Medicaid programs can be challenging unless you rely upon the disability professionals at Sackett and Associates. The disability lawyers at Sackett Law have spent the past 45 years helping people in Northern California and throughout the country to navigate the disability benefit programs administered by the Social Security Administration. When you need advice you can rely upon and representation from experienced disability lawyers, contact Sackett Law for a free consultation.
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