Medicare Under 65: Disability, ESRD and ALS Explained

Yes, you can get Medicare under 65. People younger than 65 usually qualify in one of three ways: they’ve received Social Security disability benefits for 24 months, they have ALS (amyotrophic lateral sclerosis, also called Lou Gehrig’s disease), or they have End-Stage Renal Disease (ESRD), which is permanent kidney failure that needs dialysis or a transplant. When your coverage starts depends on which of these applies to you.

Once you have Medicare, you face many of the same choices as people who are 65, with a few important differences, especially in California.

When Medicare under 65 starts

Your situation	How you get Medicare	When coverage usually starts
Social Security Disability Insurance (SSDI)	Enrolled automatically	After you’ve received 24 months of disability benefits
Certain Railroad Retirement disability benefits	Enrolled automatically	After 24 months of disability benefits
ALS	Comes with your disability benefits	The month your disability benefits start
End-Stage Renal Disease (ESRD)	You apply through Social Security	Usually the fourth month of dialysis; can be earlier with home-dialysis training or a transplant

Medicare for disability: the 24-month wait

If you get Social Security Disability Insurance, you’re automatically enrolled in Medicare after you’ve received disability benefits for 24 months. The same is true for certain Railroad Retirement disability benefits. You don’t need to file a separate Medicare application in these cases.

The 24 months are counted in months of disability benefits, so the count begins once your benefits start. If you need health coverage while you wait, you can ask your county social services office whether you may qualify for Medi-Cal.

ALS

People with ALS don’t have the 24-month wait. Medicare starts the month your disability benefits start.

Medicare ESRD rules

With End-Stage Renal Disease, you sign up for Medicare through Social Security, by calling 1-800-772-1213 (TTY 1-800-325-0778) or visiting a local office. Coverage usually starts the fourth month of dialysis. It can start earlier if you take part in a home-dialysis training program, or if you get a kidney transplant.

Since 2021, people with ESRD can join Medicare Advantage plans. If you’re thinking about one, check that your dialysis facility and kidney doctor are in the plan’s network before you enroll.

Your choices once you have Medicare

When you have Medicare under 65, you choose how to get your coverage, just like people who are 65 or older. There are two main paths.

Original Medicare, plus Medigap and Part D

• You can see any doctor or hospital in the US that accepts Medicare.
• A Medicare Supplement (Medigap) policy can help with costs Original Medicare doesn’t pay, like deductibles and coinsurance.
• Medigap doesn’t include drug coverage, so you would add a stand-alone Part D plan.

Medicare Advantage (Part C)

• Plans are offered by private companies that contract with Medicare and usually include drug coverage.
• HMO plans generally require you to use in-network providers and often need referrals. PPO plans let you go out of network at a higher cost.
• Each plan has a yearly out-of-pocket maximum for covered Part A and Part B services.
• You still pay your Part B premium.

If you also have Medi-Cal

Some people under 65 with Medicare also have Medi-Cal. If you have both Medicare and full Medi-Cal, you may be able to join a Medi-Medi Plan, a type of Medicare Advantage plan that coordinates both programs in one plan. Joining is voluntary. Since 2025, people with Medi-Cal or Extra Help can also make a change once a month: move into Original Medicare with a stand-alone drug plan, or switch between stand-alone drug plans.

Our article on Medicare Advantage vs. Medigap in California compares the two paths in more depth. If your income is limited, you may also qualify for Extra Help or a Medicare Savings Program to help with costs.

Medigap under 65 in California

Medigap rules for people under 65 vary from state to state. California requires Medigap insurers to offer at least some of their plans to people under 65 who have Medicare because of a disability.

Keep these points in mind:

• ESRD alone isn’t covered by this rule. It applies to people who have Medicare because of a disability, not to people who have Medicare only because of ESRD.
• Premiums may be higher. Premiums for people under 65 may be higher than for people 65 and older.
• Your choice of plans may be narrower. Insurers must offer at least some plans, which may not include each plan they sell to people 65 and older.

For the plans open to you and when to apply, contact the California Department of Insurance, or HICAP, California’s Health Insurance Counseling & Advocacy Program (1-800-434-0222), which offers counseling at no charge.

What changes when you turn 65

Your Medicare generally continues when you turn 65, so you don’t start over. But turning 65 can open new options:

• A new Medigap open enrollment period. At 65 you get a new 6-month Medigap open enrollment period, which starts the month you’re 65 and enrolled in Part B. During it, there are no medical questions, so you may be able to buy a Medigap policy you couldn’t get before 65, or could only get at a higher price.
• A fresh look at your options. Many people review whether Original Medicare with Medigap or a Medicare Advantage plan fits them better at this point. Our Turning 65 checklist covers the timing.
• Yearly reviews still matter. Each fall, during the Annual Enrollment Period from October 15 to December 7, you can review and change your health and drug coverage for the next year.

If you plan to use the new Medigap window, mark the month you turn 65 on your calendar so the 6 months don’t pass by.

Frequently asked questions

Can I get Medicare before 65 if I’m on disability?

Yes, if you get Social Security Disability Insurance or certain Railroad Retirement disability benefits. You’re automatically enrolled after 24 months of disability benefits. People with ALS get Medicare the month their disability benefits start.

Can I get a Medigap plan under 65 in California?

If you have Medicare because of a disability, California requires Medigap insurers to offer you at least some plans. Premiums may be higher than for people 65 and older. This rule doesn’t apply if you have Medicare because of ESRD alone.

Can people with ESRD join a Medicare Advantage plan?

Yes. Since 2021, people with End-Stage Renal Disease can join Medicare Advantage plans. Check that your dialysis center and kidney doctor are in the plan’s network before you enroll.

When does Medicare start for someone on dialysis?

Coverage usually starts the fourth month of dialysis. It can start earlier with home-dialysis training or a kidney transplant. You sign up through Social Security.

What happens to my Medigap options when I turn 65?

You get a new 6-month Medigap open enrollment period that starts the month you’re 65 and enrolled in Part B. There are no medical questions during that window, which can open up more choices.

Talk with a licensed Boomers agent

A licensed Boomers agent can go over the Medicare plans we represent in your area and check them against your doctors and prescriptions, whether you’re under 65 now or getting ready to turn 65. Our help is at no cost to you.

Find a licensed agent near you · See upcoming Medicare events

Or call 1-800-815-1943 (TTY 711), Monday – Friday, 9 AM – 5 PM Pacific.

Sources

• When can I sign up for Medicare? (Medicare.gov)
• End-Stage Renal Disease (ESRD) (Medicare.gov)
• Medicare Supplement Insurance (Medigap) (Medicare.gov)
• Medicare (SSA.gov)
• Disability benefits (SSA.gov)
• Health coverage for seniors (California Department of Insurance)
• Medicare counseling: HICAP (California Department of Aging)