Medicare is federal health insurance for seniors age 65 or older, but did you know that some Americans can get Medicare long before they reach that age? It’s true. Some disabilities and health conditions allow younger people, even children, to get Medicare coverage. If you’re wondering if you might be able to get Medicare before you turn 65, keep reading.
How do you qualify for Medicare under 65?
If you haven’t turned 65, you still may qualify for Medicare if you are disabled or have End-Stage Renal Disease, meaning you have permanent kidney failure that requires dialysis or a kidney transplant.
Can I get Medicare at age 62?
No. Although you can start collecting Social Security retirement benefits when you turn 62, you don’t qualify for Medicare until age 65. The only way you can get Medicare early is to have a disability.
What disabilities qualify for Medicare under 65?
To qualify for Medicare before age 65, generally, you have to get Social Security Disability benefits for at least 24 months, but there are two important exceptions:
- If you have amyotrophic lateral sclerosis (ALS or Lou Gehrig’s disease), you can apply for disability benefits and Medicare immediately after diagnosis.
- If you have End-Stage Renal Disease, Medicare usually starts on the first day of the fourth month of your dialysis treatments or the month you’re admitted to a Medicare-certified hospital for a kidney transplant.
You can get disability benefits if you have worked jobs covered by Social Security and have a medical condition that meets the Social Security Administration’s definition of strict disability, meaning all of the following apply:
- You can’t work and engage in substantial gainful activity because of your medical condition.
- You can’t do work you did previously or adjust to other work because of your medical condition.
- Your condition has lasted or is expected to last for at least one year or to result in death.
The Social Security Administration has a comprehensive list of medical conditions that qualify a person for disability benefits and make them eligible for Medicare before they turn 65.
Do I need to enroll?
If you are getting disability benefits, the Social Security Administration will automatically enroll you in Medicare Part A (hospital insurance) and Part B (medical insurance) when you qualify after 24 months.
What happens if I go back to work?
If you return to work, you can keep your Medicare coverage for up to 8 ½ years without paying a premium for Part A, as long as you still have a disabling impairment. If you get medical coverage through your employer, Medicare may become your secondary payer.
After 8 ½ years, as long as you still have a disabling impairment, you can purchase Part A and Part B coverage. You can buy Part A by itself, but you can only buy Part B if you also have Part A.
Can children qualify for Medicare?
Yes, in some situations children can qualify for Medicare when they have End-Stage Renal Disease. Both you and your child have to meet certain conditions to receive coverage.
To qualify, you or your spouse must meet one of the following criteria:
- You have earned at least 6 credits within the last 3 years by working and paying Social Security taxes
- You are getting, or are eligible for, Social Security or Railroad Retirement Board benefits
Your child also has to meet conditions to qualify:
- Your child needs regular dialysis because their kidneys no longer work
- Your child has had a kidney transplant
A child is defined as an unmarried person younger than 22, but that window can be extended to age 26 under certain situations. The child also must be your biological child, adopted child, stepchild, grandchild or step-grandchild.
Where can I find a primary care physician who accepts Medicare patients?
Once you have Medicare, you’ll want to find a quality primary care doctor near you. NewPrimaryCare.com™ can help. Our partner providers practice value-based care, meaning Medicare rewards them for helping their patients get better.
With a value-based care doctor, you have someone who will take the time to get to know you and your circumstances, including your disabling health condition. Also, you can expect quicker appointment scheduling, shorter waits at the doctor’s office and a meaningful connection with your physician.
Use our Find Your Doctor tool to search for and compare value-based care providers near you.