Under Age 65 Rules & Guidelines
Social Security Disability & Railroad Retirement Board
If you are under age 65 and have been awarded Social Security Disability (SSDI) or Railroad Retirement Board disability (RRB) benefits, after you have been on one of these programs for 24 months you are sent a letter explaining you are awarded Medicare Part A and Part B. This means you are automatically enrolled into Medicare and sent a card you do not have to do anything.
Medicare Coverage for ALS & ESRD
If you are under age 65 and have ESRD (End-Stage Renal Disease), and are on dialysis or needing a kidney transplant you are eligible for Medicare the first day of the 4th month after the dialysis/transplant. The coordination rules if you have employer group coverage, retiree coverage, or COBRA when you become eligible for Medicare can be complex. We highly recommend you consult with us prior to taking any action. You can click here for an overview of the coordination rules and examples.
If you have ALS (Lou Gehrig’s) disease then you are eligible for Medicare the first day of the month from when your Social Security benefits start. That is usually 5 months, and there is no 24 month waiting period.
If you are not eligible for Social Security but qualify due to health issues, then you will have to actively enroll into Medicare. It is NOT automatic.
Under Age 65 Medicare Advantage Plans and Medicare Supplement Plans
Both Medicare Advantage and Medicare Supplement plans are available for those Medicare beneficiaries under age 65.
If you want a Medicare Supplement Plan, you have 6 months from the date of your Part B starting to get a plan guarantee issue. This is very important as you may not be able to qualify in the future as you cannot answer the health questions. You have 3 months to get a drug plan.
If you want to go onto a Medicare Advantage plan (also called Part C of Medicare), you can enroll the month of entitlement and up to 2 months after. Starting 2021, people with ESRD will be allowed to enroll in Medicare Advantage Plans.
You may also be eligible for Medicaid. Make sure you check with your local Social Services Office in the county you live in to determine if you are eligible for that program as well.