Medicare under 65: disability, kidney failure and ALS

Disability benefits

When it starts

After you've been entitled to Social Security disability benefits for 24 months, Medicare starts in the 25th month. Railroad Retirement disability works similarly for many people, but not every railroad disability annuity qualifies; ask the Railroad Retirement Board (1-877-772-5772).

Automatic

You're enrolled in Part A and Part B, and your card arrives about 3 months before coverage starts. You can turn Part B down. If you don't have coverage from a current job (yours or a family member's) that pays first, turning it down can mean a gap in coverage and a late penalty until you turn 65.

The real wait

Benefits usually start after a 5-month waiting period, so Medicare often begins about 2½ years after the disability began.

Earlier periods count

Months from an earlier period of disability benefits can count toward the 24 in some cases. Ask Social Security.

ALS

With ALS (Lou Gehrig's disease), there's no 24-month wait: you get Part A and Part B automatically the month your disability benefits start. Since July 2020 the 5-month wait for those benefits doesn't apply either, so Medicare starts the same month your disability benefits do, which can be before the date you're approved.

Kidney failure (ESRD)

You can get Medicare at any age if your kidneys no longer work and you need regular dialysis or have had a kidney transplant, and you've worked long enough under Social Security, the railroad system or as a government employee, or you already get (or can get) Social Security or railroad benefits. Spouses and dependent children of people who qualify can also get it. You have to apply through Social Security; your dialysis center helps with the form.

Dialysis

Coverage usually starts the first day of the fourth month of dialysis, or the first month if you start a home dialysis training program in the first 3 months.

Transplant

Coverage can start the month you're admitted for the transplant, if it happens that month or within the next 2.

Backdating

Coverage can go back up to 12 months before the month you apply.

With job coverage

For the first 30 months you're eligible for Medicare (even if you haven't signed up), a group health plan from a current or former job pays first and Medicare pays second.

When it ends

12 months after dialysis stops, or 36 months after a successful transplant, unless you have Medicare another way.

Medicare Advantage

Since 2021, people with ESRD can join. Check that your dialysis center, kidney doctor and transplant center are in the plan's network.

After a transplant: when ESRD Medicare ends 36 months after a kidney transplant, a separate Part B benefit can keep covering only your immunosuppressive drugs, if you don't have other coverage for them. In 2026 it costs $121.60 a month (more with higher income), with a $283 deductible and then 20%. Sign up by calling Social Security at 1-877-465-0355 (TTY 1-800-325-0778).

Going back to work

Medicare doesn't stop the moment you earn money again.

1. 1

   Trial work period

   You can test working for 9 months (within a rolling 5 years) and keep your benefits. A month counts if you earn more than $1,210 in 2026 ($1,270 in 2027).
2. 2

   Extended Medicare

   If your disability continues but your benefits stop because you earn more than the limit ($1,690 a month in 2026, $1,770 in 2027), your Medicare continues for at least 93 months after the trial work period. Part A stays premium-free; you keep paying the Part B premium.
3. 3

   After that

   If you're still disabled, you can pay a premium to keep Part A, and keep Part B too if you buy Part A. Sign up in the window Social Security tells you about. A Medicare Savings Program called QDWI can pay the Part A premium if your income and savings are limited.

If the coverage comes from your or a family member's current job at an employer with 100 or more employees (or a multi-employer plan that size), the job's plan pays first while you're under 65 on disability; otherwise Medicare pays first.

Choosing coverage before 65

Drug coverage and Medicare Advantage

You get the same 7-month window as everyone, around the month Medicare starts.

Extra Help and Medicaid

No age limit. Many people on disability qualify for help with premiums and drug costs. Extra Help and Savings Programs.

Medigap

Federal law doesn't require insurers to sell Medigap to people under 65; your state's rules decide, and prices can be higher. Your state's rules.

When you turn 65

A new Medigap window

You get a 6-month Medigap Open Enrollment Period starting the month you turn 65, when insurers can't turn you down or charge more for your health.

Penalties end

A Part B late penalty drops off the month you turn 65. A Part D penalty ends 3 months before your 65th-birthday month, when a new enrollment window opens.

A new drug plan window

A new 7-month window around your 65th birthday lets you join or change a Medicare drug plan.

• Put a reminder 3 months before your 65th birthday: that's when the new windows open.

Common questions

Keep reading

• Medigap if you're under 65: what each state requiresFederal law doesn't guarantee Medigap to people under 65 with Medicare, but many states do. Every state's rule for people on Medicare because of a disability, ESRD or ALS, with what they can charge.
• Extra Help and Medicare Savings Programs: who qualifies and how to applyTwo programs that cut Medicare costs for people with limited income: Extra Help for drug costs and state Medicare Savings Programs for premiums. The 2026 limits, what they pay, and how to apply for both at once.
• Have Medicare and Medicaid? What changes, and how an agent can helpIf you qualify for both Medicare and Medicaid, you have extra help with costs, special plans, and more chances to change coverage. What to know, the 2025 rule changes, and what to watch for.