The majority of people must wait until they are 65 to enroll in Medicare, but if you are someone with a disability, is it possible to do so earlier? In some cases, you can. Usually, it depends on your condition and if you have received Social Security Disability benefits (SSDI) for a sufficient length of time. Here’s what you need to know about who is eligible for Medicare and how Medicare disability exemptions work.

What Disabilities Qualify for Medicare Under 65?

What kind of Medicare do you get with a disability? There are two types of enrollees under the age of 65: eligible disabled youths and individuals who receive SSDI.

Young people older than 20 must have received SSDI for at least two years (24 months) prior to becoming eligible for Medicare. Even if you have no work history, you may be able to receive SSDI if you developed a disability before the age of 22, are unmarried, and have at least one parent who receives retirement benefits from Social Security.

Children under 20 can only qualify for Medicare if they have end-stage renal disease (ESRD) that necessitates a kidney transplant and/or regular dialysis and if at least one parent receives Social Security retirement benefits.

For most other people under the age of 65, you will become eligible for Medicare in the 25th month you receive SSDI benefits.

Medicare Coverage for Working People with Disabilities

Disabled people who work must contend with three distinct time periods:

1. Trial work period
2. 93 months after the trial work period (referred to as the extended period of eligibility)
3. Indefinite period pursuant to the end of those 93 months

Throughout all three periods, you must meet the Social Security administration’s standards for what qualifies as disabled.

For the trial work period while on disability, there is a nine-month maximum in which you can continue receiving both SSDI benefits and Medicare coverage while having a job or pursuing self-employment. 

The nine months of the trial work period do not need to be consecutive as they take place in a rolling five-year time frame. To qualify for this trial work period that enables you to keep these benefits, you must work more than 80 hours per month if you are self-employed, or meet the monthly gross earnings threshold set by Social Security. For 2023, this amount is $1,050, so if your monthly income (excluding Supplemental Security Income) meets or exceeds this amount, the trial work period is assumed to begin.

If independent evidence proves you are no longer disabled, SSDI benefits can end before the trial work period ends. Otherwise, the nine-month period is when a caseworker evaluates whether you are still eligible for SSDI and Medicare.

If you successfully complete the trial work period without losing your benefits, you enter the extended period of eligibility. While you may lose SSDI cash benefits, you can continue to receive Medicare coverage. This extended period can last as long as 93 months after the trial work period ends, for a total of 8.5 years including the trial work period.

Your monthly income is judged by the Substantial Gainful Activity Levels guidelines, which for 2023 is $2,460 for blind individuals and $1,470 for all other disabled Medicare enrollees, both excluding Supplemental Security Income. You will not have to pay for Medicare Part A (hospitalization insurance), but you will still owe premiums for Part B (which covers supplemental medical insurance, such as doctor visits).

After the 8.5-year extended period has ended, disabled people who work can continue their Medicare coverage, provided that they remain medically disabled per Social Security rules. If you are still under 65, you must pay for Medicare Part A as well as Part B when this indefinite access to Medicare begins. The Part A premium will depend on how much you, or your spouse, have paid into Social Security. Low-income enrollees with countable resources under $4,000 ($6,000 for a married couple) may have access to state-level buy-in programs for disabled workers to help pay these premiums.

Expedited Disability Medicare Eligibility

If you have ALS (Lou Gehrig’s disease) or end-stage renal disease (ESRD), your Medicare enrollment is expedited, and you do not need to wait until the 25th month that you’ve received SSDI benefits.

Individuals with ALS automatically receive Parts A and B the month SSDI begins. For individuals with ESRD, most begin Medicare coverage on the first day of the fourth month of dialysis treatment.

How Do People with Disabilities Enroll in Medicare?

Your local Social Security office is the best resource to get up-to-date information on Medicare eligibility and enrollment assistance. Your local State Health Insurance Assistance Program is also dedicated to helping individuals navigate Medicare. 

What Medicare Benefits Are Available for People with Disabilities?

Part A covers hospitalization and Part B covers physician care. However, you may also receive home health services under Part A if you are housebound and need assistance with dressing, bathing, and other daily necessities. While typically covered under Part B, many disabled enrollees qualify for Part A coverage of home health services in their own residences and skilled nursing facilities. Those eligible for Parts A and B are then also eligible for Medicare Part C, also known as Medicare Advantage.  

Have more questions about eligibility for Medicare? Contact us and a licensed insurance agent from Baylor Scott & White Health Plan can help you.  

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