Medicare Before 65: How Disability Qualifies You for Early Medicare

Most people associate Medicare with turning 65 -- but approximately 9 million Medicare beneficiaries are under 65. If you receive Social Security Disability Insurance (SSDI), you automatically qualify for Medicare after a waiting period. Understanding how this works helps you plan for coverage during the gap and maximize your benefits once Medicare begins.

When you're approved for SSDI, Social Security begins paying disability benefits after a 5-month waiting period. After you've received SSDI for 24 months, you automatically become eligible for Medicare -- regardless of your age.

The timeline:

• Month 1: SSDI application approved, 5-month waiting period begins
• Month 6: First SSDI payment received
• Month 30 (24 months after first payment): Medicare eligibility begins

The 24-month Medicare waiting period is one of the most criticized aspects of the disability system -- it leaves newly disabled people without Medicare coverage during a period when they often have significant medical needs.

When Medicare begins for SSDI recipients, you receive the same coverage as any other Medicare beneficiary:

• Part A: Hospital insurance (usually premium-free if you have sufficient work credits)
• Part B: Medical insurance ($134/month premium in 2018, or higher with IRMAA)
• Part D: Prescription drug coverage (separate enrollment required)
• Medicare Advantage: Available as an alternative to Original Medicare

You are automatically enrolled in Parts A and B -- you'll receive your Medicare card approximately 3 months before your 24-month anniversary.

The gap between SSDI approval and Medicare eligibility is a serious coverage problem. Options during the wait:

Medicaid: If your income and assets are low enough, you may qualify for Medicaid immediately upon SSDI approval. In Florida, Medicaid eligibility for disabled individuals is based on SSI-related criteria.

COBRA: If you had employer coverage before becoming disabled, COBRA extends that coverage for up to 18 months (29 months for disabled individuals). COBRA is expensive but provides continuity of coverage.

ACA Marketplace: SSDI recipients can purchase coverage through the ACA Marketplace. SSDI income counts toward the income calculation for premium tax credits.

Spouse's employer coverage: If your spouse has employer coverage, joining their plan may be an option.

Here is an important and often overlooked fact: Medigap insurers are not required by federal law to sell policies to Medicare beneficiaries under 65. Florida, however, requires insurers to offer at least one Medigap plan to under-65 Medicare beneficiaries -- but they can charge higher premiums.

If you're under 65 and on Medicare due to disability, shop carefully for Medigap coverage. Premiums can be significantly higher than for 65-year-olds, and not all plans may be available.

Medicare Advantage plans must accept all Medicare-eligible individuals, including those under 65 with disabilities. MA plans may offer lower premiums and out-of-pocket maximums that make them attractive for disabled beneficiaries with high healthcare needs.

When you turn 65, your Medicare coverage continues seamlessly -- you don't need to re-enroll. Your coverage transitions from disability-based Medicare to age-based Medicare. At this point, you have a new Initial Enrollment Period for Medigap, and insurers must sell you a Medigap policy at standard rates without medical underwriting.

This is an important opportunity -- if you couldn't afford Medigap under 65 or were denied due to health conditions, you can enroll at 65 with guaranteed issue rights.

We do not offer every plan available in your area. Please contact Medicare.gov or 1-800-MEDICARE to get information on all of your options.