Medicare provides important healthcare coverage for people over 65, but they aren’t the only population the program serves. Some people can receive Medicare before age 65, but there are a few conditions that must be met. Medicare eligibility for these groups isn’t based on age, but on health and disability status. 

If you think you might qualify for Medicare before you turn 65, here’s what you should know and the timeline you can expect. 

Medicare Eligibility Under 65

Medicare eligibility for those under 65 years old isn’t based on age, but on health and disability status. You may qualify for Medicare if you have:

• Lou Gehrig’s disease (Amyotropic Lateral Sclerosis, or ALS), 
• End-stage renal disease (ESRD), 
• Or a disability that qualifies you for Social Security Disability (SSDI) benefits, like lung cancer and leukemia, chronic heart failure, mental health conditions like schizophrenia and depression, and liver disease. 

Medicare 24-Month Waiting Period

If you qualify for Medicare because you’re under 65 and disabled, you won’t receive your benefits right away. There is a 24-month waiting period that starts when you are eligible for SSDI before your Medicare benefits kick in. 

You receive Medicare even if you’re working, as long as you qualify for SSDI and report your work to the Social Security Administration. If you aren’t working during the 24-month waiting period, you may be able to get health benefits from your former employer through a COBRA plan, which allows you to pay for your employee health plan, usually up to 18 months. You should reach out to your employer for more information. 

Waiting Period Exceptions

Medicare coverage for ALS and ESRD starts much sooner than it does for disabilities. There is no 24-month waiting period with these two conditions. If you have ALS, coverage starts the same month you qualify for SSDI. 

If you have ESRD, coverage usually starts the fourth month after you begin dialysis. If you have in-home dialysis, you could receive it immediately. It’s important to note that, if you are employed, you shouldn’t opt out of your employer’s health insurance. Your employer coverage will be the main payer for your medical bills for 30 months after your dialysis begins. Medicare is a secondary payer for your health bills for that time; after that, it becomes the primary payer for your bills. Your Medicare benefit will end one year after your dialysis ends or three years after your kidney transplant.

Filling The Gap

The 24-month waiting period can be a challenge for someone with disabilities who needs healthcare services. If you are in this position, you can look to the ACA Marketplace or get COBRA through your former employer to help bridge the gap until Medicare coverage begins.
Navigating health insurance options when you are disabled or have a chronic health condition can be stressful. If you are near the 25^th month of SSDI eligibility, have ESRD or ALS, contact SmartMatch. Licensed insurance agents can help you understand how Medicare benefits work when you’re under 65 and what kind of plan can fit your situation.