Medicare is a government-sponsored health insurance program that’s typically for those age 65 and older, but there are some exceptions. A person may qualify for Medicare at a younger age if they have certain medical conditions or disabilities.
Read on to learn about some of the age exceptions for Medicare coverage.
What are the Medicare eligibility requirements if you’re under 65?
The following are some circumstances when you might qualify for Medicare before age 65.
Receiving Social Security for a disability
If you’ve received Social Security Disability Insurance (SSDI) for 24 months, you’ll automatically be enrolled in Medicare on the 25th month after your first SSDI check was received.
According to the Centers for Medicare & Medicaid Services (CMS), in 2019 there were 8.5 million people with disabilities on Medicare.
End stage renal disease (ESRD)
You can qualify for early Medicare coverage if you:
- have received a diagnosis of ESRD from a medical professional
- are on dialysis or have had a kidney transplant
- are able to receive SSDI, Railroad Retirement benefits, or qualify for Medicare
You must wait 3 months after starting regular dialysis or receiving a kidney transplant to qualify for Medicare coverage.
Your Medicare coverage will begin the first day of the fourth month of your dialysis treatment. You can get coverage as soon as your first month of treatment if you complete a Medicare-approved training program to do your own at-home dialysis treatment.
Providing coverage to those with medical disabilities and some chronic health conditions has even increased access to healthcare and reduced the number of deaths. An estimated 500,000 people with Medicare have ESRD, according to a 2017 article. The researcher determined that the ESRD Medicare program prevents up to 540 deaths from ESRD each year.
Amyotrophic lateral sclerosis (ALS or Lou Gehrig’s disease)
ALS is a progressive disease that often requires medical support for mobility, breathing, and nutrition. If you have ALS, you will qualify for Medicare coverage the first month you’re approved for SSDI benefits.
Currently, ESRD and ALS are the only medical conditions that qualify for Medicare coverage without a 2-year waiting period.
Other conditions that may qualify for SSDI include:
- mental health disorders
- musculoskeletal system and connective tissue disorders
Spouses of people 65 and older on Medicare
One spouse’s working history can help the other spouse obtain Medicare coverage once they turn age 65.
However, a spouse who’s younger than 65 can’t qualify for early Medicare benefits, even if their older spouse is age 65 or older.
What coverage does Medicare offer for those under 65 with disabilities?
The federal government designed the Medicare program to be like an a la carte menu of options. Each aspect of Medicare provides coverage for different types of medical services.
- Medicare Part A covers hospital and inpatient coverage.
- Medicare Part B covers medical visit coverage and outpatient medical services.
- Medicare Part C (Medicare Advantage) is a “bundled” plan that provides parts A, B, and D services.
- Medicare Part D provides prescription drug coverage.
- Medicare supplement (Medigap) plans provide additional coverage for copayments and deductibles as well as some other medical services.
Some people choose to get each individual Medicare portion while others prefer the bundled approach to Medicare Part C. However, Medicare Part C isn’t available in all parts of the country.
Some people have to pay penalties if they enroll late in Medicare services. Keep these dates in mind when it comes to Medicare enrollment:
Some circumstances exist when a person can qualify for Medicare before age 65. If you or a loved one has been diagnosed with a chronic health condition or have an injury that keeps you from working, talk to your doctor about if or when you could qualify for Medicare.
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