Medicare is a government-sponsored healthcare program that’s usually for those ages 65 and older, but there are some exceptions. A person may qualify for Medicare at a younger age if they have certain medical conditions or disabilities.
Read on to learn about some of the age exceptions for Medicare coverage.
The following are some circumstances in which you might qualify for Medicare before age 65.
Receiving Social Security for disability
If you’ve received Social Security Disability Insurance (SSDI) for 24 months, you’ll automatically be enrolled in Medicare on the 25th month after your first SSDI check was received.
According to the Centers for Medicare & Medicaid Services (CMS), in 2019 there were 8.6 million people with disabilities on Medicare.
End stage renal disease (ESRD)
You can qualify for early Medicare coverage if you:
- have received a diagnosis of kidney failure from a medical professional
- are on dialysis or have had a kidney transplant
- are able to receive SSDI, Railroad Retirement benefits, or qualify for Medicare
You must wait 3 months after starting regular dialysis or receiving a kidney transplant to qualify for Medicare coverage.
Providing coverage to those with medical disabilities and some chronic health conditions has increased access to healthcare and reduced the number of deaths.
For example, an estimated 500,000 people with Medicare have ESRD, according to a 2017 article. The researcher determined that the ESRD Medicare program prevents up to 540 deaths from ESRD per year.
Amyotrophic lateral sclerosis (ALS or Lou Gehrig’s disease)
If you have ALS, you would qualify for Medicare immediately after collecting SSDI benefits.
ALS is a progressive disease that often requires support for mobility, breathing, and nutrition.
Currently, ESRD and ALS are the only medical conditions that qualify for Medicare coverage without an extended waiting period.
According to the Kaiser Family Foundation, the following is a breakdown of conditions that qualified for SSDI in 2014:
- 34 percent: mental health disorders
- 28 percent: musculoskeletal system and connective tissue disorders
- 4 percent: injuries
- 3 percent: cancer
- 30 percent: other illnesses and conditions
Disabilities can affect your ability to work and get appropriate medical care. Qualifying for Medicare can help, but those with disabilities still report concerns over cost and access to care, according to the Kaiser Family Foundation.
Spouses of people 65 and older on Medicare
One spouse’s working history can help the other spouse obtain Medicare coverage once they turn 65.
However, a spouse who’s younger than 65 can’t qualify for early Medicare benefits, even if their older spouse is 65 or older.
Here’s an example: Jim and Mary are married. Jim is turning 65 and Mary is 60. Mary worked for more than 20 years, paying Medicare taxes while Jim didn’t work.
When Jim turns 65, Mary’s work history means Jim can qualify for Medicare Part A benefits for free. However, Mary can’t qualify for benefits until she turns 65.
You can qualify for premium-free Medicare Part A if you’re 65 or older and you (or your spouse) worked and paid Medicare taxes for at least 10 years’ time. The years don’t have to be consecutive to qualify.
You can also qualify for Medicare at age 65 if you meet the following criteria:
- You’re currently receiving retirement benefits from the Social Security Administration or the Railroad Retirement Board.
- You could be eligible for benefits from the above organizations but aren’t yet receiving them.
- You or your spouse were a Medicare-covered government employee.
You can still qualify for Medicare Part A when you turn 65 if you didn’t pay Medicare taxes. However, you may be responsible for paying a monthly premium for coverage.
The federal government designed the Medicare program to be like an a la carte menu of options. Each aspect of Medicare provides coverage for different types of medical services.
- Medicare Part A covers hospital and inpatient coverage.
- Medicare Part B covers medical visit coverage and outpatient medical services.
- Medicare Part C (Medicare Advantage) is a “bundled” plan that provides parts A, B, and D services.
- Medicare Part D provides prescription drug coverage.
- Medicare supplement plans (Medigap) provide additional coverage for copayments and deductibles as well as some other medical services.
Some people choose to get each individual Medicare portion while others prefer the bundled approach to Medicare Part C. However, Medicare Part C isn’t available in all parts of the country.
Important Medicare enrollment deadlines
Some people have to pay penalties if they enroll late in Medicare services. Keep these dates in mind when it comes to Medicare enrollment:
- Oct. 15 to Dec. 7: Annual Medicare open enrollment period.
- Jan. 1 to March 31: Medicare Advantage (Part C) open enrollment.
- April 1 to June 30: A person can add a Medicare Advantage plan or Medicare Part D plan that will start coverage on July 1.
- 65th birthday: You have 3 months before you turn 65, your birth month, and 3 months after your birth month to sign up for Medicare.
Some circumstances exist when a person can qualify for Medicare before age 65. If you or a loved one has been diagnosed with a chronic health condition or have an injury that keeps you from working, talk to your doctor about if or when you could qualify for Medicare.
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