Medicare is not only an age-65 program. You may get it earlier if you have a disability, ALS (Lou Gehrig's disease), or End-Stage Renal Disease (ESRD). The clocks are different. Disability generally has a 24-month Medicare wait after you are entitled to Social Security disability benefits. ALS waives that wait. ESRD uses dialysis and transplant rules, not the disability wait, and people with ESRD can choose Original Medicare or Advantage.
Federal law generally does not require companies to sell Medigap to people under 65. Some states do. 02110, Section 6, lists those states at the time of printing. Confirm with your State Insurance Department.
I have spent 18 years inside consumer marketing and lead generation in insurance and health, the same markets behind Medicare Advantage, drug plans, and final-expense offers. That is operator experience, not a counseling credential and not a license. This page is SSA and Medicare.gov, not a recommendation to apply for disability or to enroll.
Disability: 24 months of entitlement, then Medicare
SSA.gov disability research: everyone eligible for Social Security Disability Insurance (SSDI) is also eligible for Medicare after a 24-month qualifying period. The first 24 months of disability benefit entitlement is the waiting period for Medicare. During that period you may have health insurance through a former employer.
Medicare.gov "When can I sign up?": if you have Medicare due to a disability or ALS, you already have Part A. You are first eligible for Medicare after you have been getting disability benefits for 24 months, or as soon as you start getting disability benefits if you have ALS.
SSA POMS HI 00801.146: in most cases, hospital insurance for the disabled begins after the person has been entitled (or deemed entitled) to disability benefits for 24 months, the first day of the 25th month of disability entitlement.
SSA's disability qualifying page, opened this session: there is generally a five-month waiting period for SSDI cash benefits; the first benefit is paid in the sixth full month after the date SSA finds the disability began. That five-month cash wait is not the same as the 24-month Medicare wait. ALS is an exception to both (see below).
If you are under 65 and have a disability, 12026: you will automatically get Part A and Part B after you get disability benefits from Social Security or certain disability benefits from the Railroad Retirement Board for 24 months.
Part B still has a premium. The 2026 standard is $202.90. You can delay Part B in limited current-employment situations; see working past 65 and Medicare.gov's disability branches of the sign-up tool. If you miss Part B at first eligibility without an SEP, you may wait and pay a late penalty until you turn 65. Medicare.gov: the penalty goes up the longer you wait.
You still need Part D or creditable drug coverage to avoid a Part D late penalty. Extra Help can waive that Part D penalty while you have Extra Help.
ALS: the 24-month Medicare wait is waived
SSA POMS: since July 1, 2001, the 24-month waiting period for Medicare is waived for disabled claimants with ALS. The date of Medicare entitlement is the date of entitlement to disability insurance benefits (DIB), disabled widow(er) benefits (DWB), or childhood disability benefits (CDB) based on ALS, or July 1, 2001, whichever is later.
Medicare.gov sign-up tool treats "disability or ALS" as already having Part A, and says you are first eligible as soon as you start getting disability benefits if you have ALS.
SSA also notes ALS as a Compassionate Allowance example (with acute leukemia and pancreatic cancer) that can be allowed as soon as the diagnosis is confirmed. That speeds the disability *decision*. The Medicare waiver is a separate statutory rule for ALS.
This page does not extend the ALS waiver to other conditions. SSA: currently the law only applies to individuals diagnosed with ALS.
ESRD: different eligibility, different start dates
Medicare.gov ESRD page: ESRD is permanent kidney failure that requires a regular course of dialysis or a kidney transplant. You can get Medicare no matter how old you are if:
- Your kidneys no longer work,
- You need regular dialysis or have had a kidney transplant, and
- One of these applies: you have worked the required amount of time under Social Security, RRB, or as a government employee; you are already getting or eligible for Social Security or RRB benefits; or you are the spouse or dependent child of someone who meets either requirement.
Sign up by contacting Social Security (1-800-772-1213; TTY 1-800-325-0778). If you qualify for Part A, you can also get Part B. You need both for full dialysis and transplant benefits under Original Medicare. Signing up is your choice, but think carefully if you have a group health plan (below).
When coverage starts if you are on dialysis. Usually the first day of the fourth month of dialysis treatments. That 4-month waiting period starts even if you have not signed up. Example from Medicare.gov: start dialysis July 1, coverage begins October 1.
Coverage can begin as early as the first month of regular dialysis if you participate in a home dialysis training program at a Medicare-certified facility during the first 3 months, your doctor expects you to finish training and do your own dialysis at home, and you maintain a regular course of dialysis. Medicare will not cover surgery to prepare for dialysis (like a fistula) *before* coverage begins, unless you complete home dialysis training, in which case coverage starts the month you begin regular dialysis and those services could be covered. If you already have Medicare due to age or disability, Medicare will cover physician-ordered fistula placement before dialysis.
Transplant. Coverage can begin the month you are admitted to a Medicare-certified hospital for a kidney transplant (or for care you need before it) if the transplant is that month or within the next 2 months. If the transplant is delayed more than 2 months after admission, coverage can begin 2 months before the transplant.
If you are eligible based on ESRD and do not sign up right away, coverage could start up to 12 months before the month you apply (retroactive coverage).
When ESRD-only Medicare ends. 12 months after the month you stop dialysis, or 36 months after the month of a kidney transplant. It can resume if you start dialysis again or get another transplant within those windows.
Advantage. People with ESRD can choose Original Medicare or a Medicare Advantage Plan. 12026: you can join Advantage even if you have ESRD. Check that your dialysis facility and kidney doctor, and a future transplant specialist, are in the plan's network. C-SNPs can include ESRD as a chronic condition if offered where you live.
30-month coordination with group health plans. Once you are eligible for Medicare because of permanent kidney failure, your employer or union plan generally pays first for 30 months and Medicare pays second. The 30-month clock starts the first month you would be eligible (usually the fourth month of dialysis), even if you have not signed up yet. After 30 months, Medicare pays first. There is a separate 30-month period each time you sign up based on kidney failure. Employer size does not change this ESRD coordination rule the way the 20-employee / 100-employee rules work at 65 or for disability.
You are not required to take Medicare while a group plan is paying. Medicare.gov: if you delay during the coordination period, your Part B premium will not be higher because you delayed in this situation. After 30 months, sign up. Immunosuppressive drugs after a transplant have their own rules; ESRD-only Medicare including those drugs ends 36 months after a successful transplant, with a separate immunosuppressive-drug benefit (2026 premium $121.60 or higher based on income; deductible $283). Call SSA at 1-877-465-0355 for that benefit. It is not full Medicare.
Medigap under 65
02110, Section 6: if you are under 65 and have Medicare because of a disability or ESRD, you might not be able to buy the Medigap policy you want, or any Medigap policy, until you turn 65. Federal law generally doesn't require insurance companies to sell Medigap policies to people who are under 65. However, some states require companies to offer at least one kind of Medigap policy to people with Medicare under 65.
At printing, 02110 lists: Arkansas, California, Colorado, Connecticut, Delaware, Florida, Georgia, Hawaii, Idaho, Illinois, Kansas, Kentucky, Louisiana, Maine, Maryland, Massachusetts, Michigan, Minnesota, Mississippi, Missouri, Montana, New Hampshire, New Jersey, New York, North Carolina, Oklahoma, Oregon, Pennsylvania, South Dakota, Tennessee, Texas, Vermont, Wisconsin.
Some states give the right to all people with Medicare under 65; others only to disability or ESRD. Even if your state is not listed, some companies may voluntarily sell under-65 policies, often at higher premiums, often with medical underwriting. Check your State Insurance Department. SHIP can help.
When you turn 65 you still get a Medigap Open Enrollment Period, 6 months from the first month you have Part B and are 65 or older, even if you already had Medicare under 65. During that window companies cannot refuse you or charge more because of disability or health problems. Because Medicare is creditable coverage, if you had Medicare more than 6 months before 65, you may not have a pre-existing-condition waiting period on the new policy.
Who pays first under 65
If you have Medicare because of a disability (not ESRD) and group coverage based on current employment, the large-group threshold is 100 employees: large group pays first, Medicare second; smaller group, Medicare first. ALS is grouped with disability on the who-pays-first tool. ESRD uses the 30-month rule above, regardless of employer size.
COBRA: if you have Medicare based on disability, Medicare is generally primary vs COBRA; if Medicare is based on ESRD, COBRA/group is primary for the 30-month coordination period.
Confirm with SSA and Medicare.gov
- Disability Medicare wait: SSA and Medicare.gov sign-up
- ESRD: Medicare.gov ESRD
- Medigap under 65: 02110 Section 6 and your State Insurance Department
- SHIP: shiphelp.org
This page will not file a disability claim and will not pick a Medigap letter.
This is education, not advice
Three doors into Medicare before 65, three clocks. Confirm yours with SSA and Medicare.gov. State Medigap rules differ. Costs and rules can change after they are printed.
Labeled marketplace placements, when they exist, sit after the last decision section and before FAQ. Until a licensed partner link is live, that slot stays empty. This page will not rank carriers or treat a marketplace quote as a CMS or SSA figure.
Childhood disability and Disabled Adult Child Medicare
SSA: an adult with a disability that began before age 22 may get benefits on a parent's record if the parent is deceased or collecting retirement or disability. That is a "child's" benefit paid on the parent's earnings, Disabled Adult Child (DAC). The DAC must be unmarried (with limited exceptions) and meet the adult disability definition. DAC benefits generally cannot be applied for online. If the DAC is already on SSI, turning 18 is a time to ask whether DAC on a parent's record pays more and whether Medicare entitlement is possible.
CDB (childhood disability benefits) Medicare: SSA POMS notes CDB entitlement can begin no earlier than age 18, so hospital insurance based on CDB generally cannot begin before age 20, or age 18 if the disability is ALS.
Those rules are easy to get wrong in an ad. Confirm with SSA.
Part B late penalties until 65
Medicare.gov's disability branch: if you do not sign up for Part B when you first get Medicare, you might wait and pay a monthly penalty until you turn 65. The penalty goes up the longer you wait. That is a different end date than the "as long as you have Part B" language used at 65. Confirm on the live sign-up page for your situation. Medicare Savings Programs can pay Part B premiums if you qualify; Extra Help does not pay Part B.
FAQ
How long after SSDI do I get Medicare?
Generally after 24 months of disability *entitlement*. Coverage starts the first day of the 25th month. ALS: no 24-month Medicare wait; Medicare starts with disability entitlement.
Does ALS also skip the five-month SSDI cash wait?
SSA policy for ALS waives the 5-month and 24-month waits. Confirm with SSA on a live claim. Do not assume other diagnoses get the same waiver.
Can I join Medicare Advantage if I have ESRD?
Yes. Medicare.gov and 12026. Check dialysis and transplant providers in the plan network.
Can I buy Medigap under 65?
Federal law generally does not require it. Some states do. 02110 lists states at printing. You get a federal Medigap Open Enrollment at 65.
Is Extra Help available under 65?
Yes, Extra Help is a Part D subsidy based on income and resources, not age. See Extra Help.
SSA, Medicare.gov, 02110, and 12026 are the records. Confirm the current text with them.
About the author
Keith Guirao is founder and editor of Savvy Senior Central (Maven Media). He has spent about 18 years in consumer marketing and lead generation across insurance and health. That is operator experience, not a license to sell insurance, counsel Medicare, practice medicine, or give financial advice. Contact and bio: About · LinkedIn · Contact.
Disclaimer
Savvy Senior Central is not a licensed insurance agency. This article is for general educational purposes only and is not insurance, Medicare, legal, clinical, or financial advice. Confirm the current rule with the official sources linked below, 1-800-MEDICARE, SSA, your plan's Evidence of Coverage if you have Advantage, your state regulator, or SHIP. Costs and rules can change after agencies print them.
Sources
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Every figure traces to a government record. Figures last verified September 27, 2026 (Europe/Berlin).
- Medicare.gov: When can I sign up for Medicare?
- SSA: Medicare information (disability research)
- Medicare.gov: ESRD / related CMS pages
- CMS/NAIC: Choosing a Medigap Policy (02110) Section 6 (under-65 Medigap)
- *Medicare & You 2026*
- SHIP: shiphelp.org
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