How do I get Medicare if I'm under 65 and have a disability?

When does Medicare start if I have a disability?

If you're under 65 and have a disability, you get Part A and Part B automatically after you've received disability benefits for 24 months, either from Social Security or certain disability benefits from the Railroad Retirement Board (RRB). Your red, white and blue Medicare card comes in the mail 3 months before your 25th month of disability benefits.

If you have ALS (amyotrophic lateral sclerosis, also called Lou Gehrig's disease), you get Part A and Part B automatically the month your Social Security disability benefits begin. Permanent kidney failure has its own rules, and you sign up through Social Security; see Medicare with kidney failure (ESRD). In every case you must meet certain other eligibility requirements to get Medicare.

Do I have to sign up for Medicare, or is it automatic?

It's automatic once your disability benefits have run long enough, and you don't pay a premium for Part A when you get Medicare this way. Most people keep Part B. If you don't want Part B, let Medicare know before the coverage start date on your Medicare card; if you do nothing, you keep Part B and the premium comes out of your Social Security or RRB benefits.

If you turn down Part B and want it later, you may wait for coverage because you can sign up only at certain times, and you may pay a late enrollment penalty for as long as you have Part B. See Medicare's late enrollment penalties. If you live in Puerto Rico, you get Part A automatically but must sign up for Part B with a Request for Enrollment in Medicare Part B (Form CMS-40B).

What are my Medicare coverage choices under 65?

Once you have Medicare because of a disability, you choose how to get your coverage, the same as people who qualify at 65:

• Original Medicare (Part A and Part B), where most people add drug coverage by joining a Medicare drug plan (Part D), and some add a Medigap policy if they can buy one.
• A Medicare Advantage plan instead of Original Medicare. Medicare Advantage plans must cover what Original Medicare covers, and some offer extra benefits; rules and costs vary by plan.

Can I buy a Medigap policy if I'm under 65?

Maybe, depending on your state. If you're under 65 and have Medicare because of a disability or End-Stage Renal Disease (ESRD), you might not be able to buy the Medigap policy you want, or any Medigap policy, until you turn 65, or you may have to pay more, even in your first 6 months with Medicare. Federal law generally doesn't require insurance companies to sell Medigap policies to people under 65.

Some states require insurance companies to offer at least one kind of Medigap policy to people with Medicare under 65; some give that right to everyone under 65 with Medicare, and others only to people with Medicare because of a disability or ESRD. In other states, some companies may sell Medigap policies to people under 65 voluntarily, but they'll probably cost more and probably use medical underwriting. Your State Insurance Department can tell you the rules where you live.

When you turn 65, you get a Medigap Open Enrollment Period even if you already have Part B. During it, insurance companies can't refuse to sell you any Medigap policy because of a disability or other health problem, or charge you more because of your health than they charge other people who are 65. If you had Medicare for more than 6 months before you turned 65, you may not have a pre-existing condition waiting period.

How does Medicare work with employer coverage if I have a disability?

If you're under 65 with a disability and have group health coverage from your own or a family member's current job, the size of the employer decides which coverage pays first:

• Employer with fewer than 100 employees: Medicare pays first.
• Employer with fewer than 100 employees that's part of a multi-employer plan with 100 or more employees in total: the employer plan pays first.
• Employer with 100 or more employees: the employer plan pays first.
• If you delayed Part B because of that coverage, you can sign up any time you're still covered, or during the 8 months that begin the month after the job or the coverage ends, whichever happens first, usually without a late enrollment penalty.