Medicare Eligibility Under 65: Disabilities That Qualify

Most people think Medicare is only for those 65 and older, but that’s not the case. If you have certain disabilities, you can qualify for Medicare coverage well before your 65th birthday. Understanding which conditions qualify and how the process works can help you access the healthcare coverage you need.

At The Keener Law Firm, we’ve helped countless clients understand their Medicare eligibility options through disability claims. Our extensive experience with Social Security Disability cases has shown us that many people don’t realize they may qualify for Medicare coverage years before turning 65.

What Is the Basic Requirement for Disability Medicare Coverage?

To qualify for Medicare under 65 due to disability, you must first be approved for Social Security Disability Insurance (SSDI) benefits. Everyone eligible for Social Security Disability Insurance (SSDI) benefits is also eligible for Medicare after a 24-month qualifying period. This means you’ll need to wait two full years after your SSDI benefits begin before Medicare coverage starts.

The connection between SSDI and Medicare is straightforward: if the Social Security Administration determines you’re disabled enough to receive monthly benefits, they also recognize you’ll need healthcare coverage to manage your condition.

Are There Any Conditions That Qualify for Medicare Immediately Without Waiting?

Yes, there are two specific conditions that allow immediate Medicare enrollment without the typical 24-month waiting period. People under age 65 who are diagnosed with end-stage renal disease (ESRD) or amyotrophic lateral sclerosis (ALS) automatically qualify for Medicare upon diagnosis without a waiting period.

End-stage renal disease means your kidneys have permanently failed and you need regular dialysis or a kidney transplant to survive. ALS, also known as Lou Gehrig’s disease, is a progressive neurological condition that affects nerve cells controlling voluntary muscle movement.

These exceptions exist because both conditions are life-threatening and require immediate, ongoing medical intervention that would be financially devastating without insurance coverage.

How Does the Social Security Administration Define Disability?

The Social Security Administration strictly defines disability for SSDI purposes:

A qualifying disability is a medically determinable physical or mental impairment that lasts or is expected to last 12 months (or end in death) and which prevents the claimant from performing substantial gainful activities (SGAs).

In 2025, a Substantial Gainful Activity is recognized as an ability to earn more than $1,620 per month, or $2,700 per month for individuals who are blind.

This definition is more restrictive than other disability programs. Your condition must be severe enough to prevent you from performing any work that exists in significant numbers in the national economy, not just your previous job.

Which Specific Medical Conditions Automatically Qualify?

The Social Security Administration maintains an important “Blue Book” listing of impairments that qualify for disability benefits. While any condition can potentially qualify if it meets the severity requirements, certain conditions are more easily approved.

For both SSDI and SSI, musculoskeletal system diseases and mental disorders are the most common qualifying conditions.

• Musculoskeletal disorders are the leading cause of disability claims for both SSDI and SSI, accounting for approximately 30% of all approved claims.

Common examples include:

• Arthritis
• Back injuries
• Degenerative disc disease
• Fibromyalgia
• Osteoarthritis
• Scoliosis

• Mental and behavioral disorders are the second most common category, making up about 25% of SSDI claims and a significant portion of SSI claims as well.

Common qualifying mental disorders include:

• Depression
• Anxiety disorders
• Bipolar disorder
• Schizophrenia
• Autism spectrum disorders
• Intellectual disabilities

The Blue Book organizes major body systems including musculoskeletal disorders, cardiovascular conditions, respiratory illnesses, neurological disorders, mental health conditions, immune system disorders, kidney disease, blood disorders, cancer, endocrine disorders, and other conditions that can affect multiple body systems.

What Types of Evidence Do You Need to Prove Your Disability?

When applying for SSDI benefits that include Medicare coverage, you’ll need thorough medical documentation. That means detailed medical records from all treating physicians, diagnostic tests results, like X-rays or MRIs, laboratory test results, and statements from your doctors about your limitations.

The SSA also considers non-medical evidence, like statements from your former employers about your work performance, education records, and daily activity reports that show how your condition affects your ability to perform routine tasks.

Your medical records should clearly document when your condition began to limit your functions, its progression over time, treatments you’ve tried, and how it interferes with your ability to work. The more detailed and consistent your medical evidence, the stronger your disability claim will be. The Keener Law Firm knows how proper documentation can make the difference between approval and denial in disability cases.

How Long Does the Application Process Take?

The SSDI application process can be time consuming, frequently taking months to over a year for you to receive an initial decision. If your claim is denied initially, which happens to many applicants, you can appeal for reconsideration, an administrative law judge hearing, and then to an Appeals Council review.

Working with an experienced disability attorney who understands the system and help you gather all the evidence you need, and then presents your case, relieves you of a huge burden you might otherwise have to do yourself. Our team at The Keener Law Firm has guided clients through every stage of the disability appeals process, helping them secure the benefits they deserve. While you wait for approval, it’s important to continue receiving medical treatment and following your doctors’ recommendations.

What Should You Do While Waiting for Medicare to Begin?

During the 24-month waiting period for Medicare (or while waiting for SSDI approval), you shouldn’t go without health insurance. You could be eligible for Medicaid depending on your income and disability status. Some states have expanded Medicaid programs that provide coverage for disabled individuals.

If you’re still employed when you become disabled, you might be able to continue your employer’s health insurance through COBRA coverage. However, you’ll need to pay the full premium. You can also explore marketplace insurance plans, which can also be expensive without employer contributions.

How The Keener Law Firm Can Help with Medicare Under 65

Getting Medicare coverage through disability benefits requires successfully getting SSDI approval first, and this process can be complex and overwhelming if you try to do it alone. The Keener Law Firm concentrates on helping disabled individuals under age 65 secure the Social Security benefits that unlock their Medicare eligibility. Our experienced attorneys understand exactly what evidence the Social Security Administration needs to see and how to present your case for the best chance of approval.

We guide you through every step of the process, from gathering comprehensive medical documentation to representing you at administrative hearings if your initial claim is denied. Our team knows which medical conditions usually qualify and how to highlight the specific ways your disability prevents you from working. With our help, you can focus on managing your health while we handle the legal details of your disability claim.

Don’t let the intimidating application process prevent you from claiming the Medicare coverage you need. Contact The Keener Law Firm today for a consultation about your disability case and learn how we can help you secure both your SSDI benefits and future Medicare eligibility.