Medicare Eligibility If You Are Under 65

Last Updated : 20/10/20184min read

As you might know, 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 continuous years. However, did you know you might be qualified for Medicare before age 65? This article will share the special situations when you may be eligible for Medicare if you are under 65.

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Medicare eligibility before age 65

If you’re under 65 years old, you might be eligible for Medicare:

  • If you receive disability benefits from Social Security or certain 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 damage to the kidneys that requires regular dialysis or a kidney transplant

If you’re eligible for Medicare because of any of these circumstances, you may receive 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 people 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.

Some people will need to sign up for Medicare themselves. If you have end-stage renal disease (ESRD), and you would like to enroll in Medicare Part A and Part B, you will need to sign up by visiting your local Social Security Office or calling Social Security at 1-800-772-1213 (TTY users 1-800-772-1213). If you worked for a railroad, please contact the RRB to enroll by calling 1-877-772-5772 (TTY users 1-312-751-4701), Monday through Friday, 9 AM to 3:30 PM, to speak to an RRB representative.

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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 eligible 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 exceptions, such as a Medicare Advantage plan offered by the same insurance company as your employer-based health plan, or a Medicare Special Needs Plan (SNP).

When you enroll in a Medicare Advantage plan, you’re still in the Medicare program and need to pay your monthly Medicare Part B premium and any premium the plan charges. The Medicare Advantage (Medicare Part C) program offers an alternative way of receiving Original Medicare coverage (except for hospice benefits, which Original Medicare will still provide) but may offer additional benefits. For example, Original Medicare doesn’t include prescription drug coverage or routine dental/vision care, but a Medicare Advantage plan may include these benefits and more. Benefits, availability and plan costs vary among plans.

Hopefully, you now have a better idea how Medicare eligibility works if you’re under 65. If you’re enrolled in Original Medicare but want to explore other Medicare plan options, I’ll do my best to answer your questions. If you like, request a phone appointment or get an email from me; I’ll send you Medicare information tailored to your needs.  Check out my profile by clicking on the “View profile” link below. To see Medicare plan options now, try the Find Plans or Compare Plans buttons on this page.

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