Medicare Under 65: What You Need to Know
Most people think of Medicare as a program for people 65 and older. For the majority, that is true.
But millions of Americans become eligible for Medicare well before their 65th birthday: through disability, end-stage renal disease, or ALS. If you or a family member is in that situation, understanding how Medicare works under 65 is critical.
This guide explains exactly who qualifies, how it works, and what your options are, including the often-difficult question of getting Medigap coverage before age 65.
Who Qualifies for Medicare Under 65?
There are three pathways to Medicare before age 65. For a refresher on how Medicare’s parts fit together, see our basic Medicare facts guide.
1. Social Security Disability Insurance (SSDI)
If you are approved for Social Security Disability Insurance (SSDI) benefits, you automatically become eligible for Medicare. However, coverage does not start right away.
There is a 24-month waiting period from your SSDI benefit start date. That means you must wait two full years after your first disability payment before your Medicare coverage begins.
For example: if the Social Security Administration determines your disability began in January 2023 and your SSDI benefits start in July 2023 (after a 5-month SSA waiting period), your Medicare coverage would begin in August 2025, which is 24 months after your first benefit payment.
This is a long time to wait, and it leaves many disabled individuals in a gap where they need to find alternative coverage during those two years.
2. End-Stage Renal Disease (ESRD)
If you have permanent kidney failure that requires regular dialysis or a kidney transplant, you qualify for Medicare regardless of age, and in most cases there is no waiting period.
Coverage typically begins:
- The fourth month of dialysis treatments
- The month you are admitted to a hospital for a kidney transplant
- If you participate in a home dialysis training program, the month training begins
There are specific rules depending on when you start dialysis and whether you have employer coverage, so it is worth reviewing your situation carefully or speaking with a Medicare advisor.
3. ALS (Lou Gehrig’s Disease)
If you are approved for SSDI due to ALS (amyotrophic lateral sclerosis), the 24-month waiting period is waived. Medicare coverage begins the same month your SSDI benefits start.
What Does Medicare Under 65 Cover?
Medicare for people under 65 works essentially the same as it does for people 65 and older. You receive the same Parts A and B coverage.
Medicare Part A covers:
- Inpatient hospital stays
- Skilled nursing facility care (after a qualifying hospital stay)
- Hospice care
- Some Home health care
Medicare Part B covers:
- Doctor visits and outpatient care
- Preventive services
- Durable medical equipment
- Lab tests and X-rays
- Some home health services
You will have the same costs as any other Medicare beneficiary: Part B Premium, deductibles, and Coinsurance, unless you qualify for a Medicare Savings Program that helps with those costs.
Medicare Part A Costs Under 65
Most people over 65 get Part A for free because they (or their spouse) paid Medicare taxes for at least 10 years (40 quarters) while working.
If you are under 65 and on Medicare through SSDI, you also generally get Part A premium-free, but only if you or your spouse worked and paid Medicare taxes for the required quarters.
If you do not meet the work history requirement, you can still get Part A but will pay a monthly premium:
- Up to $518/month (2026) if you have fewer than 30 quarters of work history
- $285/month if you have 30 to 39 quarters
Most SSDI recipients do meet the work history requirement because they worked before becoming disabled, but it is worth confirming.
Can You Get a Medigap Plan Under 65?
This is where things get complicated, and often unfair.
Federal law does not require insurance companies to sell Medigap plans to people under 65. The federal Medigap Guaranteed issue protections that guarantee your right to buy any plan without Underwriting only apply when you turn 65.
However, many states have passed their own laws requiring insurers to offer at least some Medigap plans to Medicare beneficiaries under 65. To learn more about your specific situation, see our guide on whether you can buy a Medigap policy before turning 65.
States That Require Medigap Access Under 65
The rules vary significantly by state. Some require insurers to offer all plans, others require only certain plans, and the prices can be much higher. Here is a general overview:
| State Requirement | States (examples) |
|---|---|
| Must offer all standardized plans | California, Colorado, Connecticut, Maine, Massachusetts, New Jersey, New York, Oklahoma, Oregon, Pennsylvania |
| Must offer at least some plans | Florida, Georgia, Illinois, Kansas, Louisiana, Michigan, Minnesota, Missouri, North Carolina, and others |
| No requirement (limited or no access) | Many remaining states |
Because this varies so much by state and changes over time, we strongly recommend checking with a licensed Medicare advisor in your state to understand exactly what is available to you.
The Cost Challenge
Even in states that require Medigap availability under 65, the premiums can be significantly higher than what someone the same age would pay at 65. Insurance companies are allowed to charge more because the claims experience for younger Medicare beneficiaries with serious disabilities tends to be higher.
Some beneficiaries under 65 pay two to three times what a 65-year-old would pay for the same plan. It can be a real financial strain.
What Are Your Options If Medigap Is Too Expensive or Unavailable?
If you cannot get a Medigap plan or cannot afford the premium, here are other paths to managing your Medicare costs.
Medicare Advantage
Medicare Advantage (Part C) plans are available to all Medicare beneficiaries regardless of age. These plans are offered by private insurers and must cover everything Original Medicare covers, often with added benefits like dental, vision, and hearing.
Many Medicare Advantage Plans have low or even $0 monthly premiums. The trade-off is that they use networks, require referrals in some cases, and have cost-sharing structures that can add up if you use a lot of medical services.
For someone under 65 with significant health needs, the out-of-pocket maximum on a Medicare Advantage plan is important to evaluate carefully.
Medicare Savings Programs
If your income and assets are limited, you may qualify for a Medicare Savings Program (MSP). These state-administered programs help pay for:
- Part B premiums
- Part A and/or Part B deductibles
- Coinsurance and copays
There are four levels of MSPs: QMB, SLMB, QI, and QDWI. A SHIP counselor (State Health Insurance Assistance Program) can help you apply at no cost.
Extra Help for Part D
If you need Prescription Drug Coverage (Part D), you may qualify for the Extra Help program, also called the Low Income Subsidy (LIS). This federal program significantly reduces your Part D premiums and drug costs.
What Happens When You Turn 65?
When you turn 65, you enter your Medigap Open Enrollment Period: a once-in-a-lifetime, six-month window during which you can buy any Medigap plan with no health questions and no underwriting.
This is a fresh start. Even if you had a Medigap plan under 65, you have full guaranteed issue rights when you turn 65.
This is also your chance to:
- Lock in lower premiums based on your age at enrollment
- Choose a richer plan like Plan G that may not have been available or affordable before
- Establish long-term coverage at standard rates
Do not miss this window. It begins the month you are both 65 and enrolled in Medicare Part B. Mark the date and plan ahead.
Tips for Navigating Medicare Under 65
Get help from a SHIP counselor. Every state has a State Health Insurance Assistance Program (SHIP) that provides free, unbiased Medicare counseling. If you are under 65 and navigating your options, this is an excellent starting resource.
Ask your state Insurance Department what is required. State rules on Medigap availability under 65 change, and a call to your state’s department of insurance can confirm exactly what carriers are required to offer you.
Do not delay Part B enrollment. When you first become eligible for Medicare under 65, enroll in Part B promptly. Delaying Part B enrollment can result in a late enrollment Penalty that lasts for life.
Keep records of your disability determination. Your SSDI approval letter and benefit start date are important documents for establishing your Medicare eligibility timeline.
Plan ahead for age 65. Know when your Medigap Open Enrollment Period will begin and start researching plans several months in advance so you can act quickly when the window opens.
Frequently Asked Questions
I was just approved for SSDI. When does my Medicare start?
Medicare typically begins 24 months after your first SSDI benefit payment. The exact date depends on when Social Security determined your disability began and when your first benefit was paid.
I have ESRD and need dialysis. Do I have a 24-month wait?
No. People with ESRD generally qualify for Medicare much sooner, usually by the fourth month of dialysis treatment. The exact timing depends on your situation.
My state does not require Medigap availability under 65. What should I do?
Consider Medicare Advantage as a way to cap your out-of-pocket costs. Also explore Medicare Savings Programs and Extra Help if your income qualifies.
Can I keep my employer coverage and Medicare at the same time?
In some cases, yes. If you have employer coverage and become eligible for Medicare, both can coordinate. Which coverage is primary depends on the size of your employer. A licensed advisor can help you navigate this.
Will my Medigap plan under 65 continue when I turn 65?
You generally have the right to continue your current plan or change during your Medigap Open Enrollment Period at 65. The Open Enrollment Period is your best opportunity to lock in coverage with no underwriting.
Bottom Line
Medicare under 65 is available, and for many people with disabilities or serious illness, it is a lifeline. But it comes with real limitations when it comes to supplemental coverage.
If you are navigating Medicare before age 65, understanding your rights in your specific state and getting expert guidance can make a significant difference in both your coverage and your costs.
Have questions about your Medicare options under 65? REMEDIGAP’s licensed advisors can help you understand what’s available in your state and plan for the future.
This article is for educational purposes. Medicare eligibility rules, state Medigap requirements, and program details may change. Confirm current information at Medicare.gov or speak with a licensed Medicare advisor.
💡 Your next step: Medicare under 65 comes with coverage gaps. If you qualify, compare which Medigap supplement plans are available in your state.
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Written by Michael Quinn
Licensed Broker, REMEDIGAP Founder
Fact Checked by Joann Quinn
Chief Compliance Officer
As a licensed insurance broker, REMEDIGAP upholds the principles of integrity in our editorial standards and ensures transparency in how we receive compensation from our insurance partners.