Generally, Medicare is a health insurance program for people 65 and older. However, some people with specific disabilities and health conditions can be eligible for Medicare under 65. If you’re looking to qualify for Medicare under 65, it’s important to know which disabilities count towards Medicare eligibility. So, what disabilities qualify for Medicare under 65?
Social Security Disability Insurance (SSDI)
SSDI is a federal health insurance program for those with certain disabilities. To qualify for Medicare under 65, someone must have received benefits from the Social Security Disability Insurance (SSDI) program for at least 24 months.
Medicare Automatic Enrollment
After someone has been receiving SSDI benefits for 24 months, Social Security (SS) will automatically enroll them in Medicare Part A and Part B. Once they have Part A and Part B, they can consider signing up for additional Medicare plans, including a Supplement or Advantage plan. Medigap plans tend to be a popular choice, but they can be expensive for people under 65: boomerbenefits.com/medigap-plan-f-vs-plan-g-vs-plan-n/
However, to qualify for SSDI, people must meet specific requirements set in place by SS. If someone isn’t eligible for SSDI, they cannot sign up for Medicare under 65. So, let’s take a look at the SSDI approval process.
Income Level
First, someone’s income level must not be above a specific amount. SS uses people’s income levels to determine if they can engage in substantial gainful activity (SGA). So, if someone’s earnings are too much, they may not qualify for SSDI.
Severe Determination
If someone can pass this first step, SS will send their application to the Disability Determination Services (DDS) office. DDS then decides if they consider that person’s disability “severe.” A disability is severe if it keeps someone from performing basic work functions like walking, standing, remembering, and more for at least 12 months.
Disabling Conditions List
Third, a person’s disability must be found on SS’s list of disabling conditions. If not, the person’s limitations must be equal to another disability on the list. If their disability is found on the list or is equal to another, they should qualify for SSDI. If not, the person must meet additional requirements.
Previous Work
At this step, DDS will determine if someone’s medical limitations keep them from successfully engaging with work they were previously capable of doing. If DDS determines someone is still capable of performing past work duties, that person may not qualify for SSDI. If they are not capable, they proceed to the last determination step.
Other Work
Even if someone cannot complete the work they did in the past, DDS will see if they can successfully engage in other types of work. They will consider various factors during this step, including someone’s age, skills, education, and more. If DDS determines someone cannot complete other types of work, that person should qualify for SSDI.
Waiting Period
Even if someone qualifies for SSDI, they must wait five months before their SSDI benefits begin, also known as a waiting period. However, there are some exceptions to this rule. For example, if someone has Amyotrophic Lateral Sclerosis (ALS), also known as Lou Gehrig’s disease, they may start their SSDI benefits automatically.
Medicare Automatic Enrollment
Some people can also be eligible for Medicare under 65 if they have certain health conditions. For example, people with end-stage renal disease (ESRD), also known as kidney failure, can qualify for Medicare under 65 if they meet all the requirements.
Final Thoughts
There is a wide range of disabilities that can qualify someone for SSDI and, as a result, Medicare. However, becoming eligible for Medicare under 65 takes some time. There may be other SSDI requirements, so people looking into this process for themselves or someone else should make sure they understand the process before beginning.
