
Medicare is a crucial healthcare program in the United States (US) that provides coverage for millions of Americans. However, many people wonder: Can I apply for Medicare if I am under 65 years in the United States (US)? While Medicare is generally associated with individuals aged 65 and older, certain circumstances allow people under 65 to qualify for coverage.
In this comprehensive guide, we will explore the eligibility criteria, the different parts of Medicare, and the options available for individuals under 65. If you are asking, “Can I apply for Medicare if I am under 65 years in the United States (US)?” this article will provide the detailed answers you need.
What Is Medicare In The United States (US)?
Medicare is a federal health insurance program in the United States (US) primarily designed for individuals aged 65 and older. It also provides coverage to certain younger individuals with disabilities or specific medical conditions. Administered by the Centers for Medicare & Medicaid Services (CMS), Medicare helps cover various healthcare expenses, including hospital stays, doctor visits, and prescription drugs.
Medicare in the United States (US) is divided into several parts:
- Medicare Part A (Hospital Insurance): Covers inpatient hospital stays, skilled nursing facility care, hospice, and some home healthcare services.
- Medicare Part B (Medical Insurance): Covers outpatient care, doctor visits, preventive services, and medical supplies.
- Medicare Part C (Medicare Advantage): Private insurance plans that offer the benefits of Parts A and B, often with additional coverage like vision, dental, and prescription drugs.
- Medicare Part D (Prescription Drug Coverage): Helps pay for prescription medications.
If you are under 65 and wondering, “Can I apply for Medicare if I am under 65 years in the United States (US)?” the answer depends on specific eligibility conditions.
Who Can Apply For Medicare If Under 65 Years In The United States (US)?
While Medicare is mainly for people aged 65 and older, certain groups under 65 can qualify for coverage. If you are asking, “Can I apply for Medicare if I am under 65 years in the United States (US)?” you may be eligible if you meet one of the following conditions:
- You Have A Qualifying Disability: If you have received Social Security Disability Insurance (SSDI) benefits for at least 24 months, you automatically qualify for Medicare, regardless of age.
- You Have End-Stage Renal Disease (ESRD): If you have ESRD (permanent kidney failure requiring dialysis or a kidney transplant), you may qualify for Medicare.
- You Have Amyotrophic Lateral Sclerosis (ALS): Also known as Lou Gehrig’s disease, individuals diagnosed with ALS qualify for Medicare immediately upon receiving SSDI benefits.
If you meet any of these conditions, you may be eligible to apply for Medicare before turning 65 in the United States (US).
How Do I Apply For Medicare If I Am Under 65 Years In The United States (US)?
If you are eligible for Medicare under 65 due to a disability or medical condition, you will typically be enrolled automatically. However, in some cases, you may need to apply manually.
Steps To Apply For Medicare If Under 65
- Check Your Eligibility: Confirm that you qualify based on disability, ESRD, or ALS.
- Contact Social Security: You can apply through the Social Security Administration (SSA) online, by phone, or in person.
- Choose Your Medicare Coverage: Decide whether to enroll in Original Medicare (Part A & B) or a Medicare Advantage (Part C) plan.
- Consider Additional Coverage: Look into Medicare Part D (prescription drug coverage) or a Medicare Supplement (Medigap) plan to cover additional costs.
If you are still wondering, “Can I apply for Medicare if I am under 65 years in the United States (US)?” you can check your eligibility through the SSA website or by speaking with a Medicare representative.
What Are The Costs Of Medicare If I Am Under 65 Years In The United States (US)?
Medicare costs vary depending on the type of coverage you choose. If you are under 65 and eligible for Medicare, here’s what you might pay:
- Medicare Part A: Many people qualify for premium-free Part A, but if you do not, you may have to pay a monthly premium.
- Medicare Part B: Most enrollees pay a standard monthly premium, which is adjusted annually.
- Medicare Part C & Part D: Costs vary depending on the private insurance provider and plan.
Additionally, Medicare under 65 may have different rules for Medigap (supplemental) coverage, and costs could be higher for those with disabilities.
What Are The Differences Between Medicare And Medicaid In The United States (US)?
Many people confuse Medicare with Medicaid, but they are different programs:
- Medicare: A federal program primarily for people aged 65+ and certain individuals under 65 with disabilities.
- Medicaid: A state and federal program providing health coverage to low-income individuals and families, regardless of age.
Some people qualify for both Medicare and Medicaid, known as dual eligibility, which can help reduce healthcare costs.
Can I Get Medicare Advantage If I Am Under 65 Years In The United States (US)?
Yes, but availability depends on your state and disability status. Medicare Advantage (Part C) plans are offered by private insurers and may include extra benefits like vision, dental, and prescription drug coverage. Not all states require insurers to offer Medicare Advantage to people under 65, so check with providers in your area.
Conclusion
If you are wondering, “Can I apply for Medicare if I am under 65 years in the United States (US)?” the answer is yes—if you meet certain eligibility requirements. Individuals with disabilities, ESRD, or ALS can qualify for Medicare before turning 65. Understanding your options and costs can help you make the best healthcare decisions.
Frequently Asked Questions
1. Can I Apply For Medicare If I Am Under 65 Years In The United States (US)?
Yes, you can apply for Medicare if you are under 65 years in the United States (US) under specific conditions. Medicare primarily serves individuals aged 65 and older, but younger individuals with disabilities or certain medical conditions can qualify. If you have received Social Security Disability Insurance (SSDI) for at least 24 months, you will be automatically enrolled in Medicare. Additionally, people with End-Stage Renal Disease (ESRD) or Amyotrophic Lateral Sclerosis (ALS) qualify without a waiting period. If you are not eligible through these conditions, you cannot apply for Medicare under 65. However, Medicaid may be an alternative option for those with limited income and resources. Understanding your eligibility ensures that you access the right healthcare coverage at the right time.
2. Who Is Eligible To Apply For Medicare If Under 65 Years In The United States (US)?
Individuals under 65 can apply for Medicare in the United States (US) if they meet one of the following criteria:
- They have received SSDI benefits for 24 months: After this period, Medicare enrollment is automatic.
- They have End-Stage Renal Disease (ESRD): This condition requires dialysis or a kidney transplant. Patients can apply without waiting 24 months.
- They have Amyotrophic Lateral Sclerosis (ALS): Also known as Lou Gehrig’s disease, individuals with ALS qualify for Medicare immediately upon receiving SSDI benefits.
If none of these apply, you must wait until you turn 65 to apply for Medicare. Some states offer Medigap plans to individuals under 65, but availability varies. Medicaid may be an alternative option for those who do not qualify.
3. How Can I Apply For Medicare If I Am Under 65 Years In The United States (US)?
If you are under 65 and eligible for Medicare, you can apply through the Social Security Administration (SSA). The application process depends on how you qualify:
- If you receive SSDI: Medicare enrollment is automatic after 24 months of disability benefits. You will receive a Medicare card before your coverage begins.
- If you have ESRD: You can apply through SSA or your healthcare provider. Coverage usually starts after three months of dialysis treatment.
- If you have ALS: Enrollment is automatic when you start receiving SSDI benefits.
To apply, visit ssa.gov, call 1-800-772-1213, or visit a local SSA office. You may also need to choose a Medicare plan, such as Original Medicare (Part A and Part B) or Medicare Advantage (Part C).
4. What Medical Conditions Qualify Me To Apply For Medicare If I Am Under 65 Years In The United States (US)?
The medical conditions that allow individuals under 65 to qualify for Medicare in the United States (US) include:
- End-Stage Renal Disease (ESRD): Permanent kidney failure requiring dialysis or a kidney transplant.
- Amyotrophic Lateral Sclerosis (ALS): Also known as Lou Gehrig’s disease, this condition grants immediate Medicare eligibility.
- Disabling conditions recognized by the Social Security Administration (SSA): If you receive SSDI for 24 months, you automatically qualify for Medicare, regardless of the specific medical condition. These may include severe neurological disorders, heart disease, chronic respiratory failure, or cancer.
To determine eligibility, you must apply for SSDI first. Once approved and receiving benefits for 24 months, you can apply for Medicare under 65.
5. Do I Automatically Get Medicare If I Am Under 65 Years In The United States (US) And Receiving Disability Benefits?
Yes, if you receive Social Security Disability Insurance (SSDI), you will be automatically enrolled in Medicare after receiving benefits for 24 months. The SSA will notify you before your coverage starts, and you will receive a Medicare card in the mail.
However, if you have ALS, you qualify for Medicare immediately when you start receiving SSDI benefits—there is no 24-month waiting period. If you have ESRD, you must manually apply for Medicare, as enrollment is not automatic.
Medicare under 65 includes Parts A and B, but you may need to enroll separately in a Medicare Advantage (Part C) or Medicare Part D (prescription drug coverage) plan.
6. What Are The Costs If I Apply For Medicare Under 65 Years In The United States (US)?
The costs of Medicare under 65 depend on your eligibility:
- Medicare Part A: Most people receive it premium-free if they or their spouse paid Medicare taxes for at least 10 years. If not, the monthly premium in 2024 can be up to $505.
- Medicare Part B: Most beneficiaries pay a standard premium, which in 2024 is $174.70 per month. Higher-income earners may pay more.
- Medicare Advantage (Part C) and Part D: Costs vary depending on the plan and provider. Private insurers set their premiums, deductibles, and out-of-pocket costs.
- Medigap (Medicare Supplement Insurance): If available in your state for those under 65, these plans may have higher premiums than for those 65 and older.
Medicaid may help cover Medicare costs for eligible low-income individuals.
7. Can I Apply For Medicare Advantage If I Am Under 65 Years In The United States (US)?
Yes, but not all states require insurance companies to offer Medicare Advantage (Part C) plans to people under 65. Medicare Advantage plans are private insurance alternatives to Original Medicare, often including extra benefits like vision, dental, and prescription drug coverage.
To qualify, you must first enroll in Medicare Part A and Part B. Then, you can choose a Medicare Advantage plan through a private insurance company. Availability varies by location, and not all providers offer coverage to younger Medicare beneficiaries.
If you are under 65 and qualify for Medicare due to a disability, compare Medicare Advantage plans in your area to see what options are available. Some states offer special enrollment rights for disabled individuals.
8. Can I Apply For Medicare Part D If I Am Under 65 Years In The United States (US)?
Yes, Medicare Part D (prescription drug coverage) is available to all Medicare beneficiaries, including those under 65. Once you enroll in Medicare Part A or Part B, you can choose a standalone Part D plan from a private insurer.
Costs for Part D plans vary based on the provider, coverage options, and medications needed. If you delay enrollment without other prescription coverage, you may face a late enrollment penalty.
People with limited income may qualify for Extra Help, a federal program that assists with Part D costs, including premiums, deductibles, and copayments. To apply for Medicare Part D under 65, compare plans on Medicare.gov or speak with a Medicare representative.
9. Can I Get A Medigap Plan If I Apply For Medicare Under 65 Years In The United States (US)?
Yes, but Medigap (Medicare Supplement Insurance) plans are not required to be offered to people under 65 in all states. Medigap helps cover out-of-pocket costs like deductibles and copayments.
Some states require insurers to sell at least one Medigap plan to Medicare beneficiaries under 65, but the costs may be higher than for those 65 and older. You can check your state’s Medigap rules on Medicare.gov.
If Medigap is unavailable, you may consider a Medicare Advantage (Part C) plan, which often includes extra benefits. Medicaid may also help cover costs if you qualify.
10. Does Every State Allow People Under 65 To Apply For Medicare In The United States (US)?
Yes, people under 65 can apply for Medicare in every state in the United States (US) if they meet the eligibility criteria (SSDI for 24 months, ESRD, or ALS). However, the availability of Medicare Advantage (Part C) and Medigap (Supplemental) plans for those under 65 varies by state.
Some states require private insurers to offer at least one Medigap plan to individuals under 65, while others do not. Similarly, Medicare Advantage plan availability differs based on location. To determine your options, visit Medicare.gov or contact your State Health Insurance Assistance Program (SHIP). If Medicare options are limited, Medicaid may help with healthcare costs for eligible low-income individuals.
11. What Happens If I No Longer Qualify For Disability After I Apply For Medicare Under 65 Years In The United States (US)?
If you no longer qualify for Social Security Disability Insurance (SSDI), your Medicare coverage may continue for a limited time. Generally, Medicare extends for up to 93 months (7 years and 9 months) after your SSDI payments stop due to returning to work.
After this period, you can:
- Purchase Medicare Part A and Part B if you are still disabled but no longer eligible for SSDI.
- Enroll in an employer’s health plan if you have started working.
- Apply for Medicaid if you meet income requirements.
If you reach age 65 during this period, you will transition to regular Medicare eligibility without losing coverage.
12. Can I Apply For Medicare If I Am Under 65 Years In The United States (US) And Have End-Stage Renal Disease (ESRD)?
Yes, if you have End-Stage Renal Disease (ESRD), you can apply for Medicare under 65 in the United States (US). Medicare coverage for ESRD is not automatic—you must apply through the Social Security Administration (SSA).
Coverage generally begins:
- The first day of the fourth month after starting dialysis treatment.
- Immediately if you receive a kidney transplant (if you had Medicare before the transplant).
Medicare for ESRD includes Part A (hospital coverage), Part B (doctor visits), and the option for Part D (prescription drugs). You may also qualify for Medicaid to help cover costs. If you recover and no longer need dialysis or a transplant, Medicare may end.
13. Can I Apply For Medicare If I Am Under 65 Years In The United States (US) And Have ALS?
Yes, individuals with Amyotrophic Lateral Sclerosis (ALS), or Lou Gehrig’s disease, qualify for Medicare immediately upon receiving Social Security Disability Insurance (SSDI) benefits. Unlike other disabilities that require a 24-month waiting period, Medicare coverage for ALS starts the same month your SSDI benefits begin.
Medicare for ALS includes Part A (hospital coverage) and Part B (medical services). You can also enroll in:
- Medicare Advantage (Part C), if available in your area.
- Medicare Part D, for prescription drugs.
- Medigap, if available in your state.
If you qualify, you should receive your Medicare card in the mail shortly after your SSDI approval.
14. How Long Does It Take To Get Medicare If I Apply Under 65 Years In The United States (US)?
The timeline for receiving Medicare under 65 depends on how you qualify:
- Social Security Disability (SSDI) recipients must wait 24 months after receiving SSDI before Medicare starts. Enrollment is automatic.
- ALS patients get Medicare immediately upon SSDI approval.
- ESRD patients can apply anytime, and Medicare typically starts on the first day of the fourth month of dialysis.
If you qualify automatically, your Medicare card arrives before your coverage starts. If you must apply manually (as with ESRD), processing times vary but typically take a few weeks to a few months after submitting your application.
15. Can I Get Medicaid If I Apply For Medicare Under 65 Years In The United States (US)?
Yes, you can qualify for both Medicare and Medicaid if you meet your state’s Medicaid income and resource limits. This is called dual eligibility and can help cover Medicare premiums, deductibles, and copays.
If you are under 65 and on SSDI, ESRD, or ALS Medicare, Medicaid may help with:
- Medicare Part B premiums (Medicare Savings Programs).
- Medicare Part D prescription drug costs (Extra Help).
- Long-term care services, like nursing homes or in-home care.
To apply for Medicaid, visit Medicaid.gov or your state’s Medicaid website. Dual-eligible individuals may have access to Special Needs Plans (SNPs) under Medicare Advantage.
16. What Services Are Covered If I Apply For Medicare Under 65 Years In The United States (US)?
Medicare under 65 offers the same coverage as Medicare for those 65 and older. This includes:
- Part A (Hospital Insurance): Inpatient hospital stays, skilled nursing facility care, hospice, and some home healthcare.
- Part B (Medical Insurance): Doctor visits, outpatient services, preventive care, and durable medical equipment.
- Part D (Prescription Drug Coverage): Available through private insurance plans.
If you enroll in Medicare Advantage (Part C), you may get additional benefits like dental, vision, and hearing coverage. Medigap plans (if available in your state) can help with out-of-pocket costs.
17. Will I Pay More For Medicare If I Apply Under 65 Years In The United States (US)?
If you qualify for Medicare under 65 due to disability, you will generally pay the same standard premiums as those 65 and older:
- Part A: Usually free if you or your spouse paid Medicare taxes for 10+ years.
- Part B: Standard premium of $174.70/month (2024), but may be higher for high-income earners.
- Part D: Costs vary by plan.
However, Medigap policies for those under 65 may be more expensive or unavailable in some states. Medicaid may help with Medicare costs if you qualify.
18. Can I Apply For Medicare If I Am Under 65 Years In The United States (US) And Still Working?
Yes, if you qualify due to disability, ESRD, or ALS, you can apply for Medicare even if you are still working. If you have employer-sponsored insurance, Medicare may become:
- Your primary coverage (if your employer has fewer than 100 employees).
- Secondary coverage (if your employer has 100+ employees, and you have group health insurance).
You can delay enrolling in Part B if you have creditable employer coverage without facing a penalty.
19. Can My Family Members Get Coverage If I Apply For Medicare Under 65 Years In The United States (US)?
No, Medicare does not provide coverage for family members. It is an individual health insurance program. However:
- Spouses may qualify separately if they meet Medicare eligibility rules.
- Dependent children do not receive Medicare under a parent’s plan.
If family coverage is needed, Medicaid, employer-sponsored plans, or the Affordable Care Act (ACA) marketplace may offer alternatives.
20. How Do I Change My Medicare Plan After I Apply Under 65 Years In The United States (US)?
You can change your Medicare plan during these periods:
- Medicare Open Enrollment (Oct 15 – Dec 7): Switch Medicare Advantage/Part D plans.
- Medicare Advantage Open Enrollment (Jan 1 – Mar 31): Switch Medicare Advantage plans or return to Original Medicare.
- Special Enrollment Periods (SEPs): Allowed for certain life events (moving, Medicaid eligibility, etc.).
Visit Medicare.gov to compare plans and make changes.
Further Reading
- What Does Medicare Cover In The United States (US)?
- What Are The Eligibility Requirements For Patients To Have Medicare In The United States (US)?
- Are Medicare And Medicaid The Same In The United States (US)?
- How Do I Qualify For Both Medicare And Medicaid In The United States (US)?
- Who Is Eligible For Both Medicare And Medicaid In The United States (US)?
- How Do I Qualify For Medicare In The United States (US)?
- How Do I Qualify For Medicare Advantage In The United States (US)?
- Who Is Eligible For Medicare Advantage In The United States (US)?
- How To Apply For Medicare Advantage Plans In The United States (US)
- What Are The Advantages And Disadvantages Of Medicare Advantage Plans In The United States (US)?