People with certain disabilities can become eligible for Medicare, even if they’re not yet 65 years old. Over 7 million people with disabilities have Medicare benefits as of 2025, according to the Centers for Medicare & Medicaid Services (CMS). That’s roughly 1 in every 10 Medicare beneficiaries.
To get Medicare under age 65, you generally need to qualify for the Social Security Disability Insurance (SSDI) program. The Social Security Administration (SSA) uses a strict definition of disability that considers your condition’s severity, how long it will last and whether it prevents you from working.
You’ll also need to meet work history requirements, and most people face a two-year waiting period before coverage kicks in. Here’s what you should know about how people with disabilities can qualify for Medicare, and how Medicare coverage works for people under age 65.
Quick note: SSDI vs. SSI
The Social Security Administration has two income assistance programs for people with disabilities. But only one leads to Medicare.
- SSDI (Social Security Disability Insurance): Can qualify you for Medicare under age 65.
- SSI (Supplemental Security Income): Can qualify you for Medicaid, not Medicare, in most states.
The SSA’s list of disabilities that might qualify
There’s no exhaustive list of conditions that do or don’t qualify for SSDI. For adults, the SSA has a list of impairments in 14 categories that might qualify for SSDI if they’re sufficiently severe.
Not having a condition on the list doesn’t mean you can’t qualify. There’s a process to determine whether other conditions are severe enough to meet the SSA’s requirements.
The 14 impairment categories, with examples
According to the SSA, having a condition in one of these categories doesn't automatically qualify you. You still have to meet specific severity criteria.
- Musculoskeletal disorders: Limb amputations, spinal disorders such as spinal stenosis, and joint or bone injuries that severely limit movement.
- Special senses and speech: Severe loss of vision, hearing or speech.
- Respiratory disorders: Chronic obstructive pulmonary disease (COPD), severe asthma and cystic fibrosis.
- Cardiovascular conditions: Chronic heart failure, coronary heart disease and recurrent arrhythmias.
- Digestive disorders: Chronic liver disease, inflammatory bowel disease and complications requiring organ transplant.
- Kidney and urinary disorders: Chronic kidney disease and kidney transplant.
- Hematological (blood) disorders: Sickle cell disease, severe anemia and bone marrow failure.
- Skin disorders: Severe burns, epidermolysis bullosa and chronic conditions with extensive skin lesions.
- Endocrine disorders: Serious complications of diabetes, thyroid, pituitary or adrenal gland disorders.
- Congenital disorders that affect multiple body systems: Non-mosaic Down syndrome.
- Neurological disorders: Epilepsy, multiple sclerosis, Parkinson's disease, ALS, traumatic brain injury and stroke.
- Mental health conditions: Schizophrenia, severe mood disorders, PTSD, autism and intellectual disability.
- Cancer: Most cancers that are inoperable, recurrent or have spread, plus blood cancers like leukemia and lymphoma.
- Immune system disorders: Lupus, HIV, rheumatoid arthritis and systemic sclerosis.
5 questions to determine whether your condition qualifies
There’s a five-step process to determine whether your condition meets the required definition to qualify for the SSDI program. If you qualify for SSDI, you can later become eligible for Medicare based on disability.
Here are the five questions the SSA uses to evaluate the disability status for SSDI applicants:
1. Are you working?
If you’re working, there’s an income cap to qualify for SSDI. In 2026, you generally can’t make more than $1,690 per month. If you’re blind, it’s $2,830 per month.
2. Is your condition 'severe'?
You must be unable to work for at least 12 months because of changes to things like strength, mobility or memory.
3. Is your condition found in the list of disabling conditions?
The SSA lists medical conditions potentially severe enough to prevent you from working.
If your condition is on the list and you said yes to the first two questions, you have a qualifying disability. The next questions don’t apply, which can speed up the application process.
If your condition isn’t on the list, you’re not necessarily disqualified. The SSA will use the next two questions to determine whether your condition is severe. If so, you will continue through the process.
⚡ Fast-tracking your application
The real fast lane to approval is the SSA’s Compassionate Allowances program. The SSA’s system automatically flags about 300 of the most serious conditions for quicker processing. The list includes many aggressive cancers, brain disorders and rare genetic disorders.
If your diagnosis is on that list, your approval wait time could be days rather than months. (Although this speeds up the SSDI decision, the standard waiting period for Medicare still applies in most cases.)
4. Can you do the work you did before?
If your condition isn’t on the list, the SSA considers whether it prevents you from performing any of the work you’ve done in the past. If so, you continue through the process.
5. Can you do any other type of work?
If your condition prevents you from doing work you’ve done before, the SSA also considers whether there are other kinds of work you could still do.
Your medical condition isn’t the only factor here. The SSA also considers age, education, work experience and skills.
If there’s no other work you could do, then you have a qualifying disability.
Shopping for Medicare plans? We have you covered.
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Medicare disability work requirements
Having a qualifying disability isn’t enough on its own. SSDI also has requirements for your work history, a hurdle that can come as a surprise to people with minimal work history.
To qualify for SSDI and Medicare due to disability, you generally have to pass two work tests:
- Duration work test. This measures your total lifetime working years, regardless of when they happened. If you developed your disability after age 60, you’ll generally need 10 years of work history to qualify. This requirement decreases if you developed your disability at a younger age. If you’re 42, for example, you’ll only need five years of work history.
- Recent work test. Most people also have to meet a recency requirement. If you became disabled at 31 years or older, you generally need to have worked at least five years within the last 10 years. If you’re under 31, this requirement is reduced.
What are 'work credits' and how are they calculated?
The SSA uses work credits to measure your work history. These are the same work credits it uses for Social Security retirement benefits.
A work credit is a metric used by the federal government to measure time in the workforce. But the calculation is based on your annual earned income rather than the number of hours you spent working.
You can earn a maximum of four credits per year. In 2026, you earn one credit for every $1,890 in wages or self-employment income. You would need to make $7,560 to earn all four credits in 2026.
The Medicare disability waiting period is two years for most people
Once you’re eligible for SSDI benefits, you usually have to wait 24 months before you qualify for Medicare.
While you wait, you might be able to qualify for other health care, including:
- Medicaid: In many states, you can qualify for Medicaid if you receive either SSDI or Supplemental Security Income (SSI). Each state administers its own Medicaid program, so you’ll need to check your state’s rules to see how to qualify.
- Marketplace coverage: You can buy private health insurance on the health insurance marketplace. Depending on your income, you might qualify for reduced-cost coverage — but note that your SSDI income counts toward those limits.
There are special exceptions for people who receive SSDI benefits and have certain conditions.
The wait is shorter if you have ALS or ESRD
Lou Gehrig’s disease, or amyotrophic lateral sclerosis (ALS)
You become eligible for Medicare the first month you receive SSDI benefits.
End-stage renal disease (ESRD)
You generally become eligible for Medicare on the first day of the fourth month of your dialysis treatments. It could be sooner if you undergo training for home dialysis.
Kidney transplant due to ESRD
You become eligible for Medicare the month you’re admitted to a Medicare-certified hospital for the transplant. You’re covered for up to two months before the transplant. If the transplant is delayed, your eligibility might change.
Only Medicare Part A is free
Medicare Part A is free if you get SSDI. Medicare Part B is optional and comes with monthly premiums. You can opt out and delay Part B coverage. But turning it down could trigger late enrollment penalties if you don't have qualifying coverage from an employer.
Medicare Advantage, Medicare Part D prescription drug plans and Medigap also charge monthly premiums.
If you can’t afford Medicare, look into your state’s Medicare Savings Programs. If you meet the income and resources requirements, they can help pay for your Medicare costs. For help with prescription drug plan costs, see if you qualify for Medicare Extra Help.
» MORE: What you'll pay for Medicare
Signing up for Medicare based on disability
Your enrollment window starts at month 22
Whether you qualify based on age or disability, you enter an initial enrollment period when you become eligible for Medicare. During this period, you choose what kind of Medicare coverage to get.
The initial enrollment period begins before your 24-month waiting period is over. It starts the 22nd month you have SSDI benefits and lasts for seven months.
You get Original Medicare automatically, but you can switch
If you qualify based on disability, you’ll start out on Original Medicare. Original Medicare includes Medicare Part A (hospital insurance) and Medicare Part B (medical insurance). However, you’re not required to stick with it.
You’ll need to sign up for Medicare if you want to add or switch to one or more of these options:
- Medicare Advantage, also called Medicare Part C, plans.
- Medicare Part D prescription drug plans.
- Medicare Supplement Insurance, or Medigap.
Medicare special needs plans
You may qualify to buy a special kind of Medicare Advantage plan called a special needs plan (SNP). SNPs offer benefits tailored to specific groups’ unique needs for care. Since all SNPs are Medicare Advantage plans, they come with a cap on how much you can spend out-of-pocket each year. And many of them have a $0 premium.
But there are limitations to choosing Medicare Advantage over Original Medicare. You’ll usually have to use your plan’s doctor networks for the most affordable care. And prior authorization is often required for certain services and treatments.
There are three types of SNPs.
- Chronic Condition SNPs: Plans for people with certain severe chronic conditions. Roughly 62% of Chronic Condition SNPs charge no premium, according to NerdWallet analysis of CMS data.
- Institutional SNPs: Plans for people who need nursing-home-level care, or who will live in a care facility for at least 90 days in a row.
- Dual-Eligible SNPs (D-SNPs): Plans for people who qualify for both Medicare and Medicaid. They coordinate benefits between the two programs.
You can find information on SNPs available in your area at medicare.gov/plan-compare.
Medigap is harder to get if you’re under 65
If you have Original Medicare (Part A and Part B), you might want to buy a Medigap plan to help with out-of-pocket expenses. However, insurance companies might not be willing to sell a Medigap policy to you if you’re under age 65.
Your state’s laws might determine which Medigap policies — if any — are available to you, if you qualify for Medicare for reasons other than age:
- In about a third of states, there’s no law on the books requiring companies to sell Medigap to beneficiaries under age 65.
- The other two-thirds of states require companies to sell at least one kind of Medigap plan to certain Medicare beneficiaries under age 65. However, the specifics vary. Not all beneficiaries may qualify, and not all policy types may be required.
Insurance companies can still choose to sell you a Medigap policy in states where it’s not mandatory. So it’s still worth looking at what’s available in your area.
🤓Nerdy Tip
If Medigap isn't available to you in your state, we recommend getting a Medicare Advantage plan. Medicare Advantage plans come with an out-of-pocket maximum, which is the only way to cap your costs without Medigap. Original Medicare doesn't have a spending cap.What happens to Medicare disability benefits when you turn 65?
You’ll have another opportunity to make coverage decisions when you qualify for Medicare based on age. Even if you already had Medicare, you get another seven-month initial enrollment period around your 65th birthday. That period starts three months before the month you turn 65, includes your birthday month, and ends three months after the month you turn 65.
This also means you get another shot at buying a Medigap plan. Once you’re 65 and enrolled in Part B, you get a six-month Medigap open enrollment period. During this period, insurers must sell you any Medigap policy they offer. They can’t reject you or charge you more for health reasons.
Article sources
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- 3.Social Security Administration. Disability Benefits: Are You Working?. Accessed Aug 7, 2026.
- 4.Social Security Administration. Social Security Credits. Accessed Aug 7, 2026.
- 5.Social Security Administration. Medicare Information. Accessed Aug 7, 2026.
- 6.Medicare.gov. Special Needs Plans (SNP). Accessed Aug 7, 2026.
- 7.Centers for Medicare & Medicaid Services. CY2026 Landscape 202603. Accessed Aug 7, 2026.
