Medicare usually requires that people are 65 years old or above to qualify for a plan. However, some individuals can qualify for Medicare earlier if they have a disability or certain medical conditions.
Medical conditions that can qualify a person for Medicare before they turn 65 years old include end stage renal disease (ESRD) and amyotrophic lateral sclerosis (ALS).
This article details the eligibility criteria for people who need Medicare before they turn 65 years old. It also explains how a person can find out whether they qualify.
A person can qualify for Medicare insurance when they are under age 65 years if one of the following applies:
In these instances, a person may be able to receive Medicare Part A without paying a premium. Part A covers in-hospital treatment and long-term skilled nursing care.
They may also be able to receive Medicare Part B, which covers medical treatment and consultations, such as doctor’s visits and physical therapy sessions.
However, they will have to pay a monthly premium for Part B unless they receive assistance from their state’s insurance assistance program.
A person may have a disability that restricts their ability to work. People with these disabilities may often qualify for Social Security (SSA) or Railroad Retirement Board (RRB) benefits.
Once a person has received these benefits for 24 months, they can sign up for a Medicare plan, even though they are under age 65 years.
A person with a disability may otherwise have difficulty getting health insurance. A private insurer may charge them higher premiums due to preexisting medical conditions.
As a result, Medicare can provide a more cost-effective coverage option.
Examples of disabilities that may qualify a person for SSA or RRB benefits include:
| Condition Type | Definition |
|---|---|
| musculoskeletal disorders | conditions that affect: •bones or major joints •ligaments •tendons •muscles •other soft tissues |
| respiratory disorders | conditions that cause obstruction or restriction of air moving in and out of the lungs |
| digestive disorders | conditions that cause dysfunction of the liver, gastrointestinal tract, or pancreas |
| special sense and speech | includes vision loss, hearing loss, and speech disorders |
| cardiovascular system | any condition that affects the functioning of the circulatory system or the heart |
| genitourinary disorders | conditions that affect the urinary or reproductive system that result in chronic kidney disease |
| skin disorders | includes genetic photosensitivity, chronic conditions affecting the skin or mucous membranes, and burns |
| hematological disorders | conditions that disrupt the development of red blood cells, white blood cells, clotting-factor proteins, or platelets |
| endocrine disorders | conditions that cause hormonal imbalances and affect the glands of the endocrine system including: •thyroid •pituitary •adrenal •pancreas •parathyroid |
| neurological disorders | includes epilepsy, ALS, coma or persistent vegetative state, and conditions that disorganized motor function, communication impairment, and limitations in mental and physical functioning |
| congenital disorders | conditions that affect multiple body systems, namely non-mosaic Down syndrome |
| mental health disorders | includes categories, such as: •depression •anxiety •bipolar disorders •schizophrenia spectrum disorders •autism spectrum disorders •eating disorders |
| immune system disorders | conditions that cause dysfunction in at least one component of the immune system |
| cancer | all cancers expect certain ones associated with HIV |
Medicare has specific criteria for children under 18 years old who wish to claim disability benefits or enroll in Medicare.
The SSA does not pay disability benefits to a young person until they reach age 18 years. For this reason, a person with a disability does not qualify for Medicare until they are 20 years old (or 18 years old if they have ALS).
ESRD is the final stage of chronic kidney disease (CKD) and
As a result, the kidneys cannot filter fluids and electrolytes while removing waste. A person with ESRD produces very little urine, if any. The waste that the body usually removes from the body in urine can build up.
This can become fatal without treatment. However, a person
Those with ESRD can qualify for Medicare if:
- Their kidneys are no longer functioning.
- They require dialysis or have had a kidney transplant.
They must also meet at least one of the following requirements:
- They have worked at least 40 quarters, during which they paid Medicare taxes.
- They are eligible for or currently receive SSA or RRB benefits.
- They are the spouse or dependent child of a person who meets the Medicare eligibility criteria.
Medicare benefits do not often begin immediately, even if a person has ESRD and receives dialysis. For most people with ESRD, Medicare coverage starts in the fourth month of dialysis.
Some exceptions apply. A person can begin receiving Medicare benefits alongside ESRD treatment if they participate in a home dialysis training program to conduct their own dialysis with assistance from a healthcare professional. However, not all people with ESRD can qualify for at-home dialysis.
Read more about ESRD and Medicare.
People with ALS, also called Lou Gehrig’s disease, can qualify for Medicare when they are under age 65 years.
ALS is a progressive neurodegenerative disorder that disrupts a person’s ability to speak, move, eat, and breathe.
Currently, ALS has no cure. Most people with the condition die from the inability to breathe within 3 to 5 years from the first appearance of symptoms, according to the
Unlike people with ESRD, individuals with ALS can receive Medicare Part A benefits in their first month of receiving SSA or RRB benefits.
The SSA automatically enrolls a person with ALS in a Medicare plan when it starts paying Social Security benefits.
ALS often progresses rapidly and leads to high healthcare costs. This is why Medicare benefits will usually begin as soon as possible.
The SSA considers nearly all cancers for disability benefits. People who receive SSA benefits for cancer may also qualify for Medicare coverage.
Medicare may cover certain preventive care services and screenings. The types of cancers that Medicare may cover these services for
- breast
- cervical
- colorectal
- lung
- prostate
Medicare may also generally cover cancer treatments, such as chemotherapy.
Read more about Medicare and cancer treatment.
A person should contact the SSA with any questions about their work history and eligibility for Medicare by visiting the Contact Us section of the Medicare website or calling 800-772-1213 (TTY: 800-325-0778).
If a person receives benefits from the RRB, they can call 877-772-5772 to find out more about qualifying for Medicare.
Individuals can also sign up for Medicare online.
Read more about applying for Medicare.
Extra Help is a Social Security program that provides additional financial assistance for people with limited means who need prescription drug coverage through Medicare.
To qualify for Extra Help, an individual must have less than $17,220 in resources, according to the SSA. Married couples who live together must have less than $34,360 in combined resources.
The SSA defines resources to include the following:
- bank accounts
- bonds
- mutual funds
- real estate
- stocks
A person’s annual income must also be $22,590 or less for an individual or $30,660 or lower for a married couple who live together, per the SSA. Even if an individual is slightly over the income threshold, they may still qualify for Extra Help.
To apply for Extra Help, a person can go to the SSA website, call the SSA at 800-772-1213, or apply in person at a local SSA office.
Find out more about Extra Help.
People with ESRD, ALS, and certain other disabilities may qualify for coverage from Medicare before they are age 65 years. Coverage can typically begin between as young as 18 to 20 years old.
Those with ESRD qualify after 4 months of dialysis or after taking a home dialysis training course. People who live with other disabilities can apply after 2 years of receiving Social Security benefits.
Individuals with ALS become eligible for Medicare at the same time they can start receiving Medicare coverage.
Individuals can contact Medicare, the SSA, or the RRB for more information on applying for Medicare and the coverage they can receive.