Other coverage
Medicare under 65 with a disability
When Social Security disability benefits lead to Medicare, the ALS and kidney failure exceptions, keeping or turning down Part B, and your choices before and after 65.
Checked against official sources on October 27, 2026 · How we check facts
You don't have to be 65 to get Medicare. People who get Social Security or Railroad Retirement Board disability benefits get it too, usually after a wait.
When Medicare starts
- Most people: automatically after 24 months of disability benefits.
- ALS (Lou Gehrig's disease): the month your disability benefits start.
- Kidney failure: separate rules, at any age. See Medicare for kidney failure.
You're enrolled in Part A and Part B automatically, and your Medicare card arrives about 3 months before coverage starts. If you live in Puerto Rico or outside the U.S., you get Part A automatically but have to sign up for Part B.
Keeping or turning down Part B
Part B has a monthly premium. To turn it down, follow the instructions in your welcome package and send your card back; if you keep the card, you keep Part B. If you turn it down and want it later without qualifying for a Special Enrollment Period, you'll pay a late penalty for as long as you have Part B.
If you're covered through your own or a family member's current job at an employer with 100 or more employees, that plan pays first and Medicare second. With a smaller employer, or coverage from a past job, Medicare usually pays first, so turning down Part B could leave you with big bills. Ask the plan before you decide.
Your coverage choices
- Drug coverage and Medicare Advantage: you can join a Part D plan or a Medicare Advantage plan when your Medicare starts.
- Medigap: whether insurers must sell you a policy before 65 depends on your state. See Medigap under 65.
- Help with costs: Medicaid, Medicare Savings Programs and Extra Help can lower what you pay. See who qualifies.
If you go back to work
Most people who return to work but still have a disabling condition can keep premium-free Part A for at least 93 months (more than 7 years) after their trial work period ends. After that, you may be able to buy Medicare. Social Security can explain how your earnings affect your benefits.
When you turn 65
Your Medicare continues, now based on your age. You also get a new 6-month Medigap Open Enrollment Period, when insurers must sell you a Medigap policy without health questions, even if you had to wait or pay more before 65.
Common questions
How long do I wait for Medicare on disability?
Most people get Medicare automatically after 24 months of Social Security or Railroad Retirement Board disability benefits. People with ALS get it the month their disability benefits start.
Do I have to sign up for Medicare if I'm on disability?
No. You're enrolled in Part A and Part B automatically and your card arrives about 3 months before coverage starts. In Puerto Rico or outside the U.S., you must sign up for Part B yourself.
Can I get Medigap under 65?
It depends on your state. Some states require insurers to sell Medigap to people under 65 with Medicare; others don't. Everyone gets a Medigap Open Enrollment Period at 65.
Will I lose Medicare if I go back to work?
Usually not right away. Most people who still have a disabling condition keep premium-free Part A for at least 93 months after their trial work period ends.
Sources
- Medicare.gov: Getting Social Security benefits before 65
- Medicare.gov: How do I sign up for Medicare?
- Medicare.gov: How to drop Part A and Part B
- Medicare.gov: Who pays first?
- Social Security (Ticket to Work): Medicare and Medicaid employment supports
General information, not advice about a specific plan.