Paul Sanchez
Medicare is a health insurance program for people aged 65 and older, certain disabled people under 65, and people with end-stage renal disease. To be eligible for Medicare disability insurance, individuals must have received Social Security Disability Insurance (SSDI) benefits for 24 months, have End-Stage Renal Disease (ESRD), or Amyotrophic Lateral Sclerosis (ALS). There is a 9-month trial work period where the ability to perform work will not disqualify an individual from receiving benefits. After this period, individuals with a continued disabling impairment can receive at least 93 months of hospital and medical insurance.
| Characteristics | Values |
|---|---|
| Age | Under 65 years old |
| Work status | Employed |
| Medical condition | Disabled |
| Time period | 9 months trial work period, 7 and three-quarter years (93 months) after the trial work period, indefinite period following 93 months |
| Medicare Parts | Part A (hospital insurance), Part B (medical insurance) |
| Costs | $240 per month with 30 quarters of coverage, $437 per month with less than 30 quarters of coverage |
| Additional costs | Deductibles and coinsurance costs |
| Waiting period | 24 months (2 years) |
| Exceptions | End-Stage Renal Disease (ESRD), Amyotrophic Lateral Sclerosis (ALS) or Lou Gehrig's Disease |
| Common disabling conditions | Musculoskeletal conditions, mental disorders, intellectual/developmental disorders |
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What You'll Learn
Age requirements
Medicare is a health insurance program for people aged 65 and above, some disabled people under 65, and people with end-stage renal disease (permanent kidney failure treated with dialysis or a transplant). While there is no age requirement for Medicare disability coverage, individuals under 65 with a disability can qualify for Medicare.
To be eligible for Medicare disability coverage, individuals under 65 must have received Social Security Disability Insurance (SSDI) benefits for 24 months, except for those with Amyotrophic Lateral Sclerosis (ALS) or End-Stage Renal Disease (ESRD). ALS, also known as Lou Gehrig's disease, qualifies individuals for Medicare coverage in the first month of receiving SSDI benefits. ESRD patients who are not receiving SSDI benefits can also qualify for Medicare.
During the 24-month waiting period for Medicare coverage, SSDI beneficiaries may be eligible for health insurance through a former employer. Additionally, Medicare offers a trial work period of nine months for disabled individuals who obtain a job. During this trial period, individuals can continue to receive Social Security and Medicare benefits, as their ability to work will not disqualify them from being considered disabled. After the trial work period, individuals with disabilities can continue to receive Medicare benefits for 93 months (7 and three-quarter years) and an indefinite period following those 93 months, as long as they meet the medical standard for being considered disabled.
Once the 8.5-year period of extended Medicare coverage ends, working individuals with disabilities who are under 65 will have to pay premiums for Part A and Part B. The Part A premium cost depends on the number of quarters of work in which the individual or their spouse has paid into Social Security. Low-income individuals with limited resources may be eligible for state assistance with these expenses through programs such as the Qualified Disabled Working Individual program.
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Qualifying conditions
Medicare is a health insurance program for people aged 65 and older, some disabled people under 65, and people with end-stage renal disease (permanent kidney failure treated with dialysis or a transplant). Qualifying for Medicare disability coverage depends on meeting the medical standard for being considered disabled under Social Security rules.
To qualify for Medicare disability coverage, an individual must have a disability and have been approved for Social Security Disability Insurance (SSDI). In most cases, there is a two-year waiting period for Medicare coverage, which begins the first month an individual receives a Social Security benefit check. At the start of the 25th month of SSDI coverage, they are automatically enrolled in Medicare. The two common disabling conditions among disabled beneficiaries are musculoskeletal conditions (30%) and mental disorders (16%).
There are two exceptions to the two-year waiting period. Firstly, if an individual has end-stage renal disease (ESRD) but does not receive SSDI, they can still qualify for Medicare. Secondly, if an individual has amyotrophic lateral sclerosis (ALS), also known as Lou Gehrig's Disease, they will be enrolled in coverage in the first month they receive SSDI.
Medicare eligibility for working people with disabilities falls into three distinct time frames. The first is the trial work period, which extends for nine months after a disabled individual obtains a job. During this time, the ability to perform work will not disqualify the individual from being considered disabled and receiving benefits. However, if there is independent evidence that the individual is no longer disabled, their benefits may end during this period. After the trial work period, an individual may receive at least 93 months of hospital and medical insurance as long as they still have a disabling impairment. Finally, there is an indefinite period following those 93 months, during which an individual can continue to receive benefits as long as they remain medically disabled.
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Enrollment periods
Medicare is a health insurance program for people aged 65 and older, some disabled people under 65, and people with end-stage renal disease (permanent kidney failure treated with dialysis or a transplant). People with these and other long-term conditions are entitled to coverage if the care ordered by their doctors meets Medicare criteria.
For those under 65, Medicare eligibility for working people with disabilities falls into three distinct time frames. The first is the trial work period, which extends for nine months after a disabled individual obtains a job. During this time, the ability to work will not disqualify the individual from being considered disabled and receiving benefits. However, independent evidence that the individual is no longer disabled could result in the termination of benefits.
The second time frame is the 8.5 years (93 months) after the trial work period. During this period, individuals who still have a disabling impairment but have earned income that meets or exceeds the "Substantial Gainful Activity" level can continue to receive Medicare health insurance. They do not pay a premium for hospital insurance (Part A), although cash benefits may cease.
Finally, there is an indefinite period following those 8.5 years. Individuals under 65 with a disability will have to pay the premium for Part A as well as the premium for Part B. The amount of the Part A premium will depend on the number of quarters of work in which the individual or their spouse paid into Social Security.
Individuals with low incomes and limited resources may be eligible for state assistance with these expenses. For example, individuals whose income is low and who have resources under $4,000 ($6,000 for a couple) can get help with payment under a state-run buy-in program for Qualified Disabled and Working Individuals.
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Costs and coverage
Medicare is a health insurance program for people aged 65 and older, some disabled people under 65, and people with end-stage renal disease (permanent kidney failure treated with dialysis or a transplant).
Medicare has two parts: hospital insurance (Part A) and medical insurance (Part B). Most people do not have to pay for Part A, but most people do pay monthly for Part B. Medicare Parts A and B have different costs and rules. For example, in 2025, the standard Part A premium is either $285 or $518 each month, depending on how long you or your spouse are married, worked, and paid Medicare taxes.
During the initial enrollment period, which is the month an individual is notified about the end of their premium-free health insurance and the following seven months, individuals can sign up for Medicare. There is also an annual general enrollment period from January 1 to March 31 each year, and a special enrollment period for those covered under an employer group health plan.
Individuals who are still medically disabled but return to work after the trial work period will not have to pay a premium for Part A for 8.5 years. After this period, if they are still under 65, they will have to start paying the Part A premium.
Individuals with low incomes and limited resources may be eligible for state assistance with these expenses. For example, individuals whose income is low, and who have resources under $4,000 ($6,000 for a couple), can get help with payment of these premiums under a state-run buy-in program for Qualified Disabled and Working Individuals.
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Eligibility criteria
Medicare is a health insurance program for people aged 65 and older, certain disabled people under 65, and people with end-stage renal disease (permanent kidney failure treated with dialysis or a transplant). To be eligible for Medicare due to a disability, you must continue to meet the medical standard for being considered disabled under Social Security rules.
You can qualify for Medicare if you have a disability and have been approved for Social Security Disability Insurance (SSDI). There is a two-year waiting period that begins the first month you receive a Social Security benefit check. At the start of your 25th month of SSDI coverage, you'll be automatically enrolled in Medicare. There are two exceptions to the two-year waiting period. Firstly, if you have a disability and work, you can keep your Medicare coverage for at least 8.5 years after you return to work, as long as your disabling condition still meets the rules. Secondly, if you have amyotrophic lateral sclerosis (ALS), also known as Lou Gehrig's Disease, you'll be enrolled in coverage in the first month you receive SSDI.
In the SSDI program, musculoskeletal conditions are the most common disabling conditions among disabled beneficiaries (30%), followed by other mental disorders (16%) and intellectual/developmental disorders (14%). For SSI beneficiaries, intellectual and developmental disorders are the most common disabling conditions (33%), followed by other mental disorders (19%) and musculoskeletal disorders (12%).
Medicare has two parts. Part A is hospital insurance, for which most people do not have to pay. Once your premium-free Medicare Part A coverage ends, you will receive a notice that will tell you when you can file an application to purchase Medicare coverage. The Part A premium in 2025 is either $285 or $518 each month, depending on how long you or your spouse are married, worked, and paid Medicare taxes. Part B is medical insurance, for which most people pay monthly.
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Frequently asked questions
Medicare is a health insurance program for people 65 years of age and older, some disabled people under 65, and people with end-stage renal disease.
Eligibility for Medicare disability insurance is determined by a person's ability to perform work and their specific medical condition. The most common disabling conditions among beneficiaries include musculoskeletal conditions, mental disorders, and intellectual/developmental disorders.
There is a two-year waiting period between receiving SSDI benefits and becoming eligible for Medicare. This waiting period begins the first month you receive an SSDI benefit check.
Most people pay monthly for Part B (medical insurance). However, you won't have to pay a premium for Part A (hospital insurance) for 8.5 years if you are under 65 and return to work.
Yes, you can keep your Medicare coverage as long as you still meet the medical standard for being considered disabled.
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