Can I Get Medicare Under 65 in 2026?

Full answer: Yes. Medicare covers people under 65 in three situations: you have received Social Security Disability Insurance (SSDI) for 24 months, you have End-Stage Renal Disease (ESRD) requiring dialysis or a kidney transplant, or you have been diagnosed with ALS (amyotrophic lateral sclerosis). SSDI recipients face a 24-month waiting period before Part A and Part B begin. ESRD and ALS have no waiting period. In all three cases the 2026 Part B premium is $202.90 per month unless income-adjusted.

Most people know Medicare starts at 65, but roughly 9 million Americans under 65 are enrolled in Medicare today. Federal law creates three pathways to Medicare before age 65: long-term disability through the Social Security Disability Insurance program, End-Stage Renal Disease requiring ongoing dialysis or kidney transplant, and ALS (Lou Gehrig's disease). Each pathway has different rules about when coverage starts, what it costs, and how to enroll.

This guide covers all three under-65 Medicare pathways for 2026: the SSDI 24-month waiting period, the ESRD and ALS immediate-coverage rules, what Parts A, B, C, and D cost under 65, and the exact steps to enroll through Social Security. For a comparison of what Medicare pays versus what Medicaid covers, see can I have both Medicare and Medicaid.

Coverage Breakdown

Coverage by type
Qualifying Pathway	Medicare Eligibility	Waiting Period	Automatic Enrollment
SSDI (Social Security Disability Insurance)	Yes	24 months after SSDI cash benefits begin	Yes (auto-enrolled in month 25)
ESRD (End-Stage Renal Disease)	Yes	No waiting period (coverage begins as early as month 1 of dialysis)	No (must apply actively)
ALS (Amyotrophic Lateral Sclerosis / Lou Gehrig's disease)	Yes	No waiting period (Medicare begins same month as SSDI approval)	Yes (auto-enrolled)
Age 65+	Yes	No waiting period	Yes (if receiving Social Security retirement)

SSDI recipients are automatically enrolled in Original Medicare (Part A and Part B) beginning the 25th month of receiving disability benefits. ESRD patients must apply through their local Social Security office. ALS patients receive automatic Medicare enrollment when SSDI is approved. Source: medicare.gov, SSA.gov.

Source: Medicare.gov Eligibility and Premium, SSA.gov Medicare Under 65, CMS 2026

Direct Answer: Three Ways to Get Medicare Under 65 in 2026

Yes. Federal Medicare law covers people under 65 through three specific pathways: SSDI disability benefits after a 24-month waiting period, End-Stage Renal Disease with no waiting period, and ALS with no waiting period. Once enrolled, under-65 beneficiaries get the same Part A hospital coverage, Part B medical coverage, and access to Part D drug plans and Medicare Advantage as people over 65.

SSDI Pathway: The 24-Month Waiting Period Explained

Social Security Disability Insurance is the most common pathway to Medicare under 65. To qualify, you must have a medically documented disability that prevents substantial gainful activity and is expected to last at least 12 months or result in death. The Social Security Administration determines SSDI eligibility based on your work history (work credits) and your medical records.

The waiting period works as follows: Medicare coverage begins in month 25 after the month your SSDI cash benefit payments started. The Social Security Administration automatically enrolls you in Medicare Part A and Part B at that point. You do not need to file a separate Medicare application. The 2026 Part B premium is $202.90 per month, automatically deducted from your SSDI payment. If your income is low enough, a Medicare Savings Program can cover this premium (see the "Low-Income Help" section below).

One important exception: if your SSDI disability stems from ALS, the 24-month waiting period is waived entirely. ALS patients receive Medicare the same month their SSDI is approved.

ESRD Pathway: Immediate Medicare for Kidney Failure (No Wait)

Unlike the SSDI pathway, ESRD Medicare enrollment is not automatic. You must apply through your local Social Security Administration office or online at ssa.gov. Your dialysis center can help coordinate this application and often has a social worker who handles Medicare ESRD enrollment. You need Part A and Part B to get full ESRD dialysis coverage. Most ESRD patients under 65 are also eligible for Medicare Advantage plans, though plan availability in your area may be limited.

In-center dialysis: Medicare coverage starts the first day of the 4th month of dialysis treatments. If you complete home dialysis training, coverage can start as early as the first month.
Home dialysis: Medicare coverage can begin as early as month 1 if you start home dialysis and complete the training program.
Kidney transplant: Medicare coverage begins the month of the transplant and covers 36 months of immunosuppressive drug coverage under Part B after a successful transplant.

ALS Pathway: Medicare Starts the Same Month SSDI Is Approved

ALS (amyotrophic lateral sclerosis, also called Lou Gehrig's disease) is the one SSDI disability where Congress eliminated the 24-month waiting period entirely. Once the Social Security Administration approves your SSDI claim based on ALS, Medicare Part A and Part B begin the very same month, retroactive to the date of your SSDI entitlement. There is no separate Medicare application for ALS patients. The Social Security Administration automatically triggers Medicare enrollment.

ALS patients also have the right to join a Medicare Advantage plan if one is available in their area, or to add a Part D prescription drug plan. Because ALS progresses rapidly and requires expensive multidisciplinary care, Medicare coverage from day one of SSDI approval is critical. The 2026 Part A inpatient deductible of $1,736 per benefit period still applies, as does the 2026 Part B deductible of $283 per year.

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What Original Medicare Covers for Under-65 Enrollees in 2026

Original Medicare for under-65 beneficiaries works identically to Medicare for those 65 and over. Part A covers inpatient hospital stays, skilled nursing facility care after a 3-day hospital stay, hospice care, and limited home health services. The 2026 Part A inpatient deductible is $1,736 per benefit period. Most people with at least 40 work credits pay $0 in Part A premium. Under-65 SSDI recipients with fewer than 30 work credits pay the full 2026 Part A premium of $518 per month.

Part B covers physician visits, outpatient hospital care, durable medical equipment, preventive services, and home health care not covered under Part A. The standard 2026 Part B premium is $202.90 per month for all Medicare beneficiaries, including those under 65. Higher-income beneficiaries pay an Income-Related Monthly Adjustment Amount (IRMAA) surcharge on top of this. The 2026 Part B deductible is $283 per year, after which Medicare covers 80% of approved costs.

Part D and Medicare Advantage Under 65

Under-65 Medicare beneficiaries can enroll in a Medicare Advantage (Part C) plan or a standalone Part D prescription drug plan during the standard enrollment windows. Medicare Advantage plans available to under-65 enrollees vary significantly by region. Some plans specifically market to younger disabled beneficiaries and include dental, vision, and hearing benefits that Original Medicare does not cover. Part D plans cover prescription drugs. The 2026 Part D out-of-pocket cap is $2,100 per year under the Inflation Reduction Act, and insulin is capped at $35 per month for all Part D enrollees regardless of age.

ESRD patients have some restrictions on Medicare Advantage participation. Before 2021, ESRD patients could not join most Medicare Advantage plans. The 21st Century Cures Act changed that rule; ESRD patients can now join Medicare Advantage plans that operate in their service area. Not all plans accept ESRD patients, so confirm with specific plans before enrolling.

Low-Income Help: Medicare Savings Programs and Medicaid Dual Eligibility

Many under-65 SSDI recipients have limited income. Four Medicare Savings Programs can help pay the 2026 Part B premium of $202.90 per month, the Part A deductible, Part B deductible, and cost-sharing. The programs are the Qualified Medicare Beneficiary (QMB) program, the Specified Low-Income Medicare Beneficiary (SLMB) program, the Qualifying Individual (QI) program, and the Qualified Disabled and Working Individual (QDWI) program. Eligibility is based on income and assets and administered through state Medicaid offices.

About 12 million Americans are dual-eligible, meaning they have both Medicare and Medicaid. For under-65 beneficiaries, Medicaid can cover the Part B premium, deductibles, and co-pays that Medicare does not cover. If you receive SSDI and your income is near or below the federal poverty level, contact your state Medicaid office to see if you qualify for full Medicaid or a Medicare Savings Program. In 2026 this can save more than $2,400 per year in Part B premiums alone. Learn more at can I have both Medicare and Medicaid.

How to Enroll in Medicare Under 65

SSDI and ALS recipients do not need to apply for Medicare separately; the Social Security Administration automatically enrolls them and mails the Medicare card about 3 months before coverage begins. ESRD patients must actively apply. All other under-65 enrollment goes through the Social Security Administration, not the Medicare program directly.

Step 1: Confirm your qualifying pathway (SSDI 24-month mark, ESRD diagnosis with dialysis start, or ALS SSDI approval).
Step 2: ESRD patients apply at their local Social Security office or at ssa.gov/medicare/. SSDI and ALS recipients wait for automatic enrollment.
Step 3: Once enrolled in Original Medicare, decide whether to stay in Original Medicare with a Part D plan or switch to a Medicare Advantage plan. Compare plans at medicare.gov/plan-compare.
Step 4: If income is limited, apply for a Medicare Savings Program through your state Medicaid office to help with the 2026 Part B premium of $202.90 per month.
Step 5: After Medicare enrollment, the Annual Enrollment Period runs October 15 to December 7 each year to make plan changes for the following year.

Frequently Asked Questions

Can I get Medicare if I am under 65 and on disability?

Yes. If you have been receiving Social Security Disability Insurance (SSDI) cash payments for 24 months, Medicare Part A and Part B begin automatically in month 25. You do not need to file a separate Medicare application. The 2026 Part B premium of $202.90 per month is deducted from your SSDI payment. If you have ALS, the 24-month waiting period is waived.

How long is the Medicare waiting period for SSDI recipients?

The SSDI Medicare waiting period is exactly 24 months, counted from the first month you receive an SSDI cash benefit payment, not from the date of disability onset or the date of approval. This is often called the 29-month wait in practice because SSDI itself has a 5-month waiting period before cash payments begin. The only exceptions are ALS (no wait) and ESRD (no wait after dialysis starts).

Does ESRD qualify for Medicare under 65?

Yes, with no waiting period. End-Stage Renal Disease Medicare begins as early as the first month of home dialysis or the 4th month of in-center dialysis. You must actively apply through the Social Security Administration at ssa.gov or by calling 1-800-772-1213. Your dialysis center social worker can often help coordinate the application. ESRD Medicare covers dialysis, kidney transplants, and 36 months of immunosuppressive drugs post-transplant.

Is there a waiting period for Medicare if I have ALS?

No. ALS is the one disability condition where Congress eliminated the 24-month waiting period entirely. Medicare Part A and Part B begin the same month your SSDI is approved, retroactive to the SSDI entitlement date. The Social Security Administration triggers enrollment automatically. No separate Medicare application is needed. The 2026 Part B premium of $202.90 per month still applies.

What does Medicare cost under 65 in 2026?

Most under-65 SSDI recipients pay the same 2026 Part B premium as older beneficiaries: $202.90 per month. Part A is premium-free if you or a spouse have at least 40 work credits (most SSDI recipients qualify). The 2026 Part A inpatient deductible is $1,736 per benefit period. The 2026 Part B deductible is $283 per year. Low-income beneficiaries can apply for Medicare Savings Programs to reduce or eliminate these costs.

Can I get Medicare Advantage under 65?

Yes. Under-65 Medicare beneficiaries can join Medicare Advantage (Part C) plans during their Initial Enrollment Period and during the Annual Enrollment Period (October 15 to December 7). Plan availability varies by area. ESRD patients were previously restricted but can now join Medicare Advantage plans under the 21st Century Cures Act. ALS and SSDI-based enrollees have full Medicare Advantage access.

What is the difference between Medicare and Medicaid for disabled people under 65?

Medicare is a federal health insurance program you earn through SSDI work credits; it covers hospital, medical, and drug costs after premiums and deductibles. Medicaid is a separate state-federal program based on income and assets, not work history. Many under-65 SSDI recipients qualify for both (dual eligibility), which can eliminate most out-of-pocket costs. About 12 million Americans receive both Medicare and Medicaid.

Can I work part-time and keep Medicare under 65?

Yes, within limits. SSDI allows a Trial Work Period where you can test your ability to work for up to 9 months while keeping SSDI and Medicare. After the Trial Work Period, the Extended Period of Eligibility gives you 36 more months where Medicare continues even if your SSDI payments stop due to earnings above Substantial Gainful Activity ($1,690 per month in 2026). After that, a Medicare Continuation Period allows you to buy Medicare coverage for up to 93 months.