Medicare eligibility under 65.
You can qualify for Medicare before 65 through three paths: long-term Social Security disability, ESRD, or ALS. Here is how each works.
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SSDI — 24-month waiting period
If you have been receiving Social Security Disability Insurance (SSDI) for 24 months, you automatically qualify for Medicare on the 25th month. The waiting period starts when SSDI benefits begin, not when you applied.
You will receive your Medicare card automatically about 3 months before your 25th month of SSDI.
ESRD — End-Stage Renal Disease
If you have ESRD requiring dialysis or a kidney transplant, you can qualify for Medicare at any age. Coverage typically starts the fourth month of dialysis — or earlier if you complete training for home dialysis or receive a transplant.
ALS — Amyotrophic Lateral Sclerosis
If you are approved for SSDI benefits because of ALS (Lou Gehrig's disease), Medicare starts the same month your SSDI benefits begin. There is no 24-month waiting period for ALS.
What plans you can choose under 65
You can choose Original Medicare, Medicare Advantage, or Original + Medigap (Medigap availability for under-65 enrollees varies by state — see your state's SHIP). Drug coverage works the same way as for 65+ enrollees.
Once you turn 65, you get a fresh Medigap Open Enrollment Period regardless of prior enrollment, so even people who joined Medicare early get the no-underwriting window at 65.