Medicare on Disability

Under 65 and Disabled on Medicare

How do people under age 65 with disabilities qualify for Medicare?

People under age 65 become eligible for Medicare if they have received SSDI payments for 24 months. Because people are required to wait five months before receiving disability benefits, SSDI recipients must wait a total of 29 months before their Medicare coverage begins. People under age 65 who are diagnosed with end-stage renal disease (ESRD) or amyotrophic lateral sclerosis (ALS) automatically qualify for Medicare upon diagnosis without a waiting period. 

Of those who were receiving SSDI in 2014, 34% qualified due to mental disorders, 28% due to diseases of the musculoskeletal system and connective tissue, 4% due to injuries, 3% due to cancer, and 30% due to other diseases and conditions.

What disabilities qualify for Medicare under 65?

  These include:

  • Musculoskeletal problems
  • Cardiovascular conditions
  • Speech and sense impairments
  • Respiratory illnesses
  • Neurological disorders
  • Mental disorders
  • Immune system disorders
  • Various syndromes such as Marfan Syndrome and Sjogren’s Syndrome
  • Skin disorders such as dermatitis
  • Digestive tract problems
  • Kidney disease and genitourinary problems
  • Cancer
  • Hematological disorders
  • Bone marrow disorders

When can someone under 65 receive Medicare benefits?

People who qualify for Social Security Disability benefits should receive a Medicare card in the mail when the required time period has passed. If this does not happen or other questions arise, contact the local Social Security office.

If you qualify for Medicare coverage based on your Social Security disability status, you will automatically be enrolled in Part A and Part B of Medicare after first receiving disability benefits for 24 months.

You will receive your Medicare card in the mail approximately three months before your 25th month of receiving disability benefitIf you have Amyotrophic lateral sclerosis (ALS, or Lou Gehrig’s disease), you typically will be enrolled in Medicare the same month that your disability benefits begin. There isn’t a 24 month waiting period as with other disabilities.

If you have End-Stage Renal Disease (ESRD), you typically will be able to enroll in Medicare three months after a course of regular dialysis begins, or after you receive a kidney transplant.

Those with ESRD generally must manually enroll in Medicare.

Three Steps all Disabled Folks on Medicare should take.

First Step is to immediately apply for Extra Help for Prescription Drugs:

Extra Help is a federal program that helps pay for some to most of the out-of-pocket costs of Medicare prescription drug coverage. It is also known as the Part D Low-Income Subsidy (LIS).

Extra Help eligibility

  1. If your monthly income is up to $1,903 in 2024 ($2,575 for couples) and your assets are below specified limits, you may be eligible for Extra Help (see the Extra Help income and asset limit chart below for details). These limits include a $20 income disregard that the Social Security Administration (SSA) automatically subtracts from your monthly unearned income (e.g., retirement income).

    Even if your income or assets are above the eligibility limits, you could still qualify for Extra Help because certain types of income and assets may not be counted, in addition to the $20 mentioned above.

  2. If you are enrolled in Medicaid, Supplemental Security Income (SSI), or a Medicare Savings Program (MSP), you automatically qualify for Extra Help regardless of whether you meet Extra Help’s eligibility requirements. You should receive a purple-colored notice from the Centers for Medicare & Medicaid Services (CMS) informing you that you do not need to apply for Extra Help.

Extra Help benefits

The Extra Help program (also called the Part D Low-Income Subsidy) offers the following benefits:

Depending on your income and assets, you may qualify for Extra Help. To receive such assistance, your prescriptions should be on your plan’s formulary and you should use pharmacies in your plan’s network.

Remember that Extra Help is not a replacement for Part D or a plan on its own: You must still have a Part D plan to receive Medicare prescription drug coverage and Extra Help assistance. If you do not choose a plan, you will in most cases be automatically enrolled in one.

The Extra Help program (also called the Part D Low-Income Subsidy) offers the following benefits:

Depending on your income and assets, you may qualify for Extra Help. To receive such assistance, your prescriptions should be on your plan’s formulary and you should use pharmacies in your plan’s network.

Remember that Extra Help is not a replacement for Part D or a plan on its own: You must still have a Part D plan to receive Medicare prescription drug coverage and Extra Help assistance. If you do not choose a plan, you will in most cases be automatically enrolled in one.

How to apply for Extra Help

If you do not have Medicaid, Supplemental Security Income (SSI), or a Medicare Savings Program (MSP), you can apply for the Extra Help program through the Social Security Administration (SSA) using either the agency’s print or online application. (If you have Medicaid, SSI, or an MSP, you should be automatically enrolled in Extra Help.) To apply online, visit www.ssa.gov. Depending on processes in your state, this application can also serve to screen you for a Medicare Savings Program, which helps pay your Medicare costs. Be sure to complete the entire application and provide accurate information so you get all the benefits for which you qualify.

Remember, Extra Help reduces your prescription drug costs only for drugs covered by your Part D plan. If you do not have a Part D plan but are eligible for Extra Help, you can use the Special Enrollment Period (SEP) to enroll in Part D drug coverage.

If your application for Extra Help is denied, you can appeal to SSA. Your will have the opportunity to submit information about why you qualify when you appeal.

Important Extra Help Reminders:

It is important to understand if you are married but not living together you should check that box rather than married. Or click separated or married but not living together.

If you are married but not living together they will only count your income and not both your spouses and yours. If you and your spouses income is under $1903 but combined you and your spouse’s income are over $2575 per month, you will not extra help even though you are under the limit on your own.

Once you have been accepted for extra help it is very important to reevaluate your medicare advantage plan because some plans offer extra benefits for those on extra help and most do not.

Our medicare experts can help you fill out the application correctly to make certain you are entitled to the benefits you deserve and we can look at all advantage plans to make sure you get grocery cards, utility help and most importantly the drugs you take are on the plans formulary.

Just because you have extra help does not mean your drugs are covered by that particular plan. Be sure to work with a medicare advocate with experience in working with disabled on medicare folks.

Many medicare advantage plans will offer ALL DRUGS covered on their formulary regardless of whether they are expensive brand name drugs or simply generic ones a zero cost for all drugs on their formulary regardless of what tier drug you are on.


Click Here to Apply or Extra Help on you Own.


Click Here if You need our Help Applying for Extra Help


Or Call Our Extra Help Assistant Ms. Gray at 229-325-6548

Second Step is to Apply for a Medicare Savings Plan: (Medicaid or Partial Medicaid)

Medicare Savings Program Basics (This Program put $174.70 back into your disability or social security check)

Medicare Savings Programs (MSPs), also known as Medicare Buy-In programs or Medicare Premium Payment Programs, help pay your Medicare costs if you have limited income and savings. There are three main programs, each with different benefits and eligibility requirements.*

  1. Qualified Medicare Beneficiary (QMB): Pays for Medicare Parts A and B premiums. If you have QMB, typically you should not be billed for Medicare-covered services when seeing Medicare providers or providers in your Medicare Advantage Plan’s network.
  2. Specified Low-income Medicare Beneficiary (SLMB): Pays for Medicare Part B premium.
  3. Qualifying Individual (QI) Program: Pays for Medicare Part B premium.

If you enroll in an MSP, you will also automatically get Extra Help, the federal program that helps pay your Medicare prescription drug (Part D) plan costs.

How to qualify for a Medicare Savings Plan (medicaid)

To qualify for an MSP, you must have Medicare Part A and meet income and asset guidelines (note that these guidelines vary by state, and some states do not count assets when determining MSP eligibility). If you do not have Part A but meet QMB eligibility guidelines, your state may have a process to allow you to enroll in Part A and QMB. Many states allow this throughout the year, but others limit when you can enroll in Part A.

Remember, states use different rules to count your income and assets to determine if you are eligible for an MSP. Examples of income include wages and Social Security benefits you receive. Examples of assets include checking accounts and stocks. Certain income and assets may not count when determining your MSP eligibility. And some states do not have an asset limit.

If your income or assets seem to be above the MSP guidelines, you should still apply if you need the help.


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