The rules work a little differently than Medicare at age 65. Start with this 70-second video, then read on for your options.
▶ Watch: Medicare on SSDI (Social Security Disability) and the 29-month wait (70 sec)
Approved for Social Security disability? Here's the part nobody tells you. Medicare doesn't start right away. For most people, it's about 29 months from the day the disability began.
First, there's a 5-month wait before SSDI payments start. Then you need 24 months of SSDI before Medicare kicks in, in month 25. There are exceptions. With ALS, Medicare starts with your first SSDI payment. Kidney failure has its own path.
So how do you stay covered until then? Options include COBRA, Medicaid, or an ACA Marketplace plan, which may cost less based on your SSDI income. And since Medicare doesn't cover routine dental or implants, a dental plan with no waiting period can start now, and stay with you.
When Medicare does start, end your Marketplace plan the day before, so you don't pay for both. We're licensed agents in eight states, and we help people bridge this gap every week. Call (800) 939-3330, extension 150, or visit insurehealthplans.com.
Most people get Medicare before 65 through Social Security Disability Insurance (SSDI). There are three main paths:
Because SSDI itself has a five-month waiting period, most people reach Medicare about 29 months after their disability began. Supplemental Security Income (SSI) on its own doesn't lead to Medicare, but it often qualifies you for Medicaid.
The 24-month waiting period can leave a gap. Common ways to stay covered include:
Parts A and B cover hospital and medical care, but Part B usually leaves you paying 20% of approved costs, with no yearly limit on what you could owe.
A Supplement helps pay your share of costs and lets you see any doctor or hospital nationwide that accepts Medicare. For people under 65, availability and pricing depend on your state (see below). You'd usually add a separate Part D drug plan.
Medicare Advantage plans are available to people under 65, including those with ESRD. Many have low monthly premiums and include drug coverage and extras like dental and vision. In exchange, most use provider networks, some services need prior approval, and you pay copays up to a yearly out-of-pocket maximum.
If your income and savings are limited, you may qualify for Extra Help with drug costs, a Medicare Savings Program that can pay your Part B premium, or Medicaid alongside Medicare. People with both Medicare and Medicaid may also be eligible for special Medicare Advantage plans built for them.
Medigap rules for people under 65 vary widely from state to state:
In states that do require coverage, there's usually a six-month open enrollment window that starts when your Part B begins. Missing it can mean health questions or a denial. For an overview, see Medicare.gov's guide to Medigap coverage.
We're licensed in California, Arizona, Texas, Ohio, Iowa, Pennsylvania, Michigan and Florida, and we'll check the current rules and available plans in your state for you.
If you couldn't get the coverage you wanted before 65, this is your chance to choose again. Mark the date, and talk with a licensed agent a few months ahead. For a side-by-side look at the two main paths, see Medicare Advantage vs. Medicare Supplement.
No-cost, no-obligation help from a licensed agent.
Generally 24 months after your SSDI benefits begin. Medicare starts in the 25th month, and you're usually enrolled in Parts A and B automatically. People with ALS don't have to wait, and people with kidney failure (ESRD) follow separate rules.
It depends on your state. Federal law doesn't require insurers to sell Medigap plans to people under 65. Some states require insurers to offer some or all plans, often during the six months after your Part B starts, while others have no requirement.
Yes. People under 65 who have Medicare Parts A and B, including those with ESRD, can generally join a Medicare Advantage plan that serves their area.
You get a new six-month Medigap Open Enrollment Period when you turn 65, even if you've had Medicare for years. During that window, insurers generally can't deny you a Supplement or charge more because of your health.
You generally lose Marketplace premium tax credits once you're eligible for premium-free Medicare Part A, so most people end their Marketplace plan when Medicare begins. Planning the switch ahead of time helps you avoid a gap or paying full price.
Not right away. Social Security's work incentive rules let many people keep Medicare for an extended period after returning to work, generally at least 93 months after a trial work period. Social Security can confirm how the rules apply to you.
We do not offer every plan available in your area. Currently we represent 17 organizations which offer 165 products in your area. Please contact Medicare.gov, 1-800-MEDICARE, or your local State Health Insurance Program (SHIP) to get information on all of your options.
Not connected with or endorsed by the U.S. government or the federal Medicare program. This page is for general information; Medicare and state rules can change.
