As you might be familiar with, the Medicare eligibility age is 65, and to be eligible you have to be an American citizen or legal permanent resident of at least five consecutive years. However, did you know you might be entitled for Medicare before age 65?
Medicare eligibility before age 65
- If you’re under 65 years old, you might be fit for Medicare:
- If you get disability benefits from Social Security or specific disability benefits from the Railroad Retirement Board (RRB) for at least 24 months in a row
- If you have amyotrophic lateral sclerosis (ALS, also called Lou Gehrig’s disease)
- If you have end-stage renal disease (ESRD). ESRD is permanent injury to the kidneys that needs regular dialysis or a kidney transplant
If you’re qualified for Medicare because of any of these conditions, you may obtain health insurance through Medicare Part A (hospital insurance) and Medicare Part B (medical insurance), which make up Original Medicare. Your enrollment in Medicare may or may not be automatic, as explained below.
How to apply for Medicare Part A and Part B before age 65
Some individuals are automatically enrolled in Original Medicare. If you’ve been receiving disability benefits from Social Security or the Railroad Retirement Board (RRB) for 24 months in a row, you will be automatically enrolled in Original Medicare, Part A and Part B, when you reach the 25th month.
If you have ALS or Lou Gehrig’s disease, you’re automatically enrolled in Medicare the month you begin receiving your Social Security disability benefits.
Medicare eligibility for Medicare Advantage (Part C) before 65
After you’re enrolled in Original Medicare, you may choose to remain with Original Medicare (Medicare Part A and Part B) or consider enrollment in a Medicare Advantage plan offered by a private, Medicare-approved insurance company.
Medicare eligibility for Medicare Part C (Medicare Advantage) works a little differently. You’re fit for Medicare Advantage plans if you have Part A and Part B and live in the service area of a Medicare Advantage plan. If you have End Stage Renal Disease (ESRD), you usually can’t enroll in a Medicare Advantage plan, but there may be some limitations, such as a Medicare Advantage plan offered by the same insurance company as your employer-based health plan, or a Medicare Special Needs Plan.
Getting Medicare if you are under 65 and disabled
If you become qualified for Medicare because of a disability, and have been receiving Social Security Disability Insurance (SSDI) for 24 months you will be automatically enrolled in both Medicare Part A and Part B.
You do not need to contact anyone. You will receive a package in the mail three months before your coverage starts with your new Medicare card and a letter explaining how Medicare works and that you have been automatically signed up for both Medicare Part A and Part B. If you are receiving SSDI, your package and card will come from Social Security.
The letter also explains that your monthly Part B premium will be automatically taken away from your Social Security check beginning the month your coverage begins. You will be given the option to turn down Part B.
Do not turn down Medicare Part B unless you have employer insurance from your or your spouse’s current job. If you do not have employer insurance and you turn down Part B, you may have to pay a substantial premium penalty when you do sign up.