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Medicare Insurance Eligibility for Those Under 65

Medicare is a government-operated health insurance program dating back to the 1960s. It was originally intended to help retirees 65 and older manage their health care expenses by providing various forms of coverage for things including doctor visits, hospitalizations, and prescription drugs.

In the early 1970s, the program was expanded to also cover certain groups of the population who were not yet 65. You might qualify for Medicare if you are younger than 65 if you have a particular disability or medical condition according to Clearmatch Medicare.

What It Covers

The government put together this program as a menu of options, so you can get various services from each part. Five common examples include:

  1. Part A: The primary part of the program offers coverage for hospital services and inpatient stays.
  2. Part B: This part of the program covers doctor visits and many outpatient services.
  3. Part C: Known as Medicare Advantage, this is typically a bundle of insurance combining services from A, B, and D. However, Part C is not available in every region of the country.
  4. Part D: Coverage listed under this name is primarily responsible for prescription drug coverage.
  5. Medigap:This is supplemental coverage to handle certain medical services, deductibles, and co-pays that the first four parts do not.

When you qualify for the program, you can possibly pick the individual components that you want, or you can take the bundle route.

Qualifying Under the Age of 65

You can qualify for Medicare under the age of 65 in four primary ways:

  1. Qualify for SSDI
  2. ESRD
  3. ALS
  4. Other conditions mean a waiting period

Social Security Disability Insurance

If you are a recipient of SSDI, then look up how many months that you have been getting it. Once you hit 25 consecutive months after the first Social Security Disability Insurance check you get, you’ll be enrolled into the program automatically. Nearly 9 million people who have disabilities receive insurance coverage through the program.

SSDI is a program offering government assistance to those with certain disabilities. It is a benefit that you need to apply for. If approved, you’ll be paid benefits. Certain members of your family might also get benefits. Individuals who apply usually have to worked a certain amount of time as adults first. There are varying rules about how much they paid in Social Security taxes and how recently they did it, too. This program handles benefits for adults and also children who have disabilities but also limited resources and income of their own.

The first thing you have to do is collect the related information and documents necessary for application. The government has an adult disability checklist available online that can help direct you in assembling all of this. Once you complete the application, you submit it to the government. They review for basic requirements necessary for potential disability benefits. They also determine if you worked enough for qualification and your current work activities, if any. Once processed, the case is sent to a disability determination service office in the state you live in. They make the final call.

End-Stage Renal Disease

End-stage renal disease is also known as ESRD. This can qualify you for early coverage provided three conditions are met:

  • A medical professional has diagnosed you with ESRD
  • You have received a kidney transplant or are currently on dialysis
  • You can receive SSDI or Railroad Retirement benefits

In order to qualify for the program’s coverage, you need to wait three months after your kidney transplant or you start regular dialysis. Your coverage can start the fourth month’s first day following the beginning of any dialysis treatment you are getting. However, you can also go through a program-approved training program that leads to your own dialysis treatment at home. Doing that will let you get coverage during your first month of treatment.
Estimates suggest that approximately half-a-million people in the program are diagnosed with ESRD. Statistical research indicates that the ESRD assistance provided by this insurance program prevents over 500 deaths every single year.

Lou Gehrig’s Disease

Lou Gehrig’s disease is a group of words that make the informal name of amyotrophic lateral sclerosis, or ALS. This progressive disease frequently means sufferers need medical support for nutrition, mobility, and even breathing. If you suffer from this disease, you’ll qualify for insurance coverage from the government the first month that you are approved for your SSDI benefits.

Two-Year Waiting Period

At the time of writing, ALS and ESRD are the only pair of medical conditions that qualify people under the age of 65 for program coverage without going through a two-year waiting period. There are other conditions that can qualify for SSDI, however, after a waiting period:

  • Cancer
  • Injuries
  • Mental health disorders
  • Musculoskeletal system/connective tissue disorders

Spouses of Those 65 or More Who Have Medicare

If you’re married, then you might be able to get coverage once you turn 65 yourself, provided their working history was enough. On the other hand, you can’t qualify early for benefits this way if you are still under 65, no matter if your spouse has attained that age.

Enrollment Deadlines

Despite the qualification times listed earlier, not everyone under the age of 65 who qualifies for Medicare is automatically enrolled in the program. Once you do qualify, if you need to enroll manually, then you’ll need to be mindful of the enrollment deadlines that apply to participants of all ages. Late fees and penalties might apply for certain people and deadlines.

  • October 15th through December 7th is typically the open enrollment period.
  • January 1st through March 31st is usually general enrollment for the program and open enrollment for Part C.
  • April 1st through June 30th is when someone can add Part D or Medicare Advantage and have coverage begin July 1st.
  • Initial enrollment happens around the time of your 65th birthday if you haven’t qualified and enrolled already. There is a seven-month window centered on your birthday month but also including the three months before and after it.

Who to Talk To

Given how certain diseases and disabilities are all the primary triggers for early program coverage and qualification, your personal doctor or family physician is who you should talk to about this. They can guide you in the right direction if you think that you might qualify or deserve benefits from this program while you are 64 or younger.

In Conclusion

Even though this is a government program, not everyone qualifies for it. Even people that turn 65 don’t automatically qualify, as they must have participated in paying certain taxes enough during their working years. Qualifying for it under the age of 65 is much harder to do, given the narrow exceptions. However, they do exist and have been listed for you in this content.
Getting coverage you need if you fall into any of these groups can relieve you of quite a bit of financial burden.

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