Medicare Before 65 With a Disability: The 24-Month Wait

You get Medicare before 65 once you have received Social Security disability benefits for 24 months. Medicare starts in your 25th month of benefits, and Social Security signs you up for Part A and Part B on its own. People with ALS do not wait.

Key takeaways

• Medicare starts in the 25th month of Social Security or Railroad Retirement Board disability benefits.
• You are signed up for Part A and Part B on your own, and your card comes in the mail.
• People with ALS get Medicare the month their disability benefits begin.
• Medicare covers the same services for you as for people 65 and older.
• Supplemental Security Income alone does not lead to Medicare.

Who can get Medicare before 65?

There are three main paths to Medicare before 65:

• Disability benefits. You get disability benefits from Social Security or the Railroad Retirement Board (the agency that pays benefits to railroad workers) for 24 months.
• ALS. You have ALS (amyotrophic lateral sclerosis, also called Lou Gehrig's disease) and get disability benefits.
• Kidney failure. You have ESRD (end-stage renal disease, which is permanent kidney failure needing dialysis or a transplant).

Social Security Disability Insurance, or SSDI, is the disability benefit based on your work record. This is the benefit that leads to Medicare.

Supplemental Security Income, or SSI, is a separate program for people with limited income and resources. SSI on its own does not lead to Medicare. It can lead to Medicaid instead.

How does the 24-month wait work?

The 24 months count from the first month you are entitled to disability benefits. They do not count from the day you applied or the day your disability began.

For most people, disability benefits begin after a 5-month waiting period. So Medicare often starts about 29 months after the disability began. Months count even if you were paid for them later as back pay.

The 24 months do not have to be in a row. If your benefits stopped and started again, earlier months may still count. Social Security tracks these months for you.

Who does not have to wait?

People with ALS get Medicare the same month their disability benefits start. There is no 24-month wait.

People with ESRD follow rules based on treatment instead. With dialysis at a center, Medicare usually starts in the 4th month of dialysis. It can start sooner if you train for home dialysis or get a kidney transplant.

How do you sign up?

In most cases, you do nothing. Social Security signs you up for Part A and Part B. Your Medicare card arrives in the mail before your coverage starts.

You can keep Part B or turn it down by following the steps sent with your card. If you turn it down and have no other health coverage, a late penalty may apply if you sign up later.

The Part B penalty adds 10% to your premium for each full 12-month period you could have had Part B but did not. With the 2026 standard Part B premium of $202.90, a 10% penalty is about $20.30 a month in 2026. For people under 65, this penalty ends at 65.

What does Medicare cover for you?

Medicare covers the same services for you as for anyone 65 or older. Part A helps pay for hospital stays, skilled nursing care, hospice and some home health care. Part B helps pay for doctor visits, outpatient care, tests and medical equipment.

Most people pay no Part A premium, since disability benefits are based on work. In 2026, the Part A hospital deductible is $1,736 per benefit period. The 2026 Part B premium is $202.90 a month, and the Part B deductible is $283. All are set each year.

People with limited income may get help with these costs. Medicare Savings Programs (state programs that help pay Medicare premiums) can pay the Part B premium for people who qualify.

Do you need drug coverage?

Part A and Part B do not cover most drugs you fill at a pharmacy. For those, you join a Part D drug plan or a Medicare Advantage plan with drug coverage. You get a 7-month window to join, built around your 25th month of disability benefits.

A late penalty may apply if you go 63 or more days in a row without Part D or other creditable drug coverage (drug coverage at least as good as Medicare's). Drug coverage from a job or union, TRICARE or the VA often counts as creditable. That coverage sends a yearly notice saying whether it does, so keep it.

The penalty adds 1% of the national base premium for each month without coverage. For 14 months, that is 14% of $38.99, or about $5.50 a month in 2026. People who get Extra Help pay no Part D late penalty. See avoiding Part D late penalties.

In 2026, the Part D out-of-pocket cap is $2,100 a year; it is set each year. Extra Help lowers drug costs for people with 2026 income below $23,475 a year and resources below $18,090, if single.

Can you buy Medigap before 65?

Federal law does not require insurers to sell Medigap policies (private insurance that helps pay Original Medicare's costs) to people under 65. Some states do require it. Where it is sold, premiums for people under 65 can be higher.

At 65, you get the Medigap Open Enrollment Period. It lasts 6 months and starts the month you are 65 or older and have Part B. During it, an insurer must sell you any Medigap policy it offers. Learn what happens after that window in Medical Underwriting for Medigap.

You can also join a Medicare Advantage plan before 65. Premiums, networks and costs vary by plan, location and carrier.

What changes when you turn 65?

Your Medicare continues at 65 without a break. You get a new Initial Enrollment Period: the 3 months before, the month of, and the 3 months after your 65th birthday month.

Any Part B late penalty from your disability years ends at 65. If you turned Part B down, you can sign up then without that old penalty. For every sign-up window, see Medicare enrollment periods.

If you go back to work while on disability, Medicare can continue. Under Social Security's work rules, Part A with no premium can last at least 93 months after your trial work period ends.

Have questions? Call 1-877-443-3251 to talk it through with a licensed insurance agent. You never pay the agent; the plans they represent do, and the decision stays yours.

We do not offer every plan available in your area. Please contact Medicare.gov or 1-800-MEDICARE to get information on all of your options. Medicare has neither reviewed nor endorsed this information.