Medicare isn't only for people 65 and older. People under 65 can qualify because of a disability, ALS or end-stage renal disease (ESRD). The path to Medicare through Social Security Disability Insurance (SSDI) has its own timeline, and under-65 enrollees face decisions about Medigap, Extra Help, the Oregon Health Plan and returning to work. Oregon's Medigap rules are stronger than federal law for people under 65.
How disability leads to Medicare
Medicare under 65 is usually tied to SSDI, the federal program that pays monthly benefits to people who can't work because of a disability and who have enough work credits (or to adult children and widows or widowers on a worker's record). Social Security decides SSDI claims.
SSDI benefits normally begin after a five-month waiting period from the date Social Security finds your disability began. Medicare then starts after you have been entitled to SSDI for 24 months. Social Security enrolls you in Part A and Part B automatically and mails your Medicare card about three months before.
SSI alone doesn't qualify you for Medicare. Supplemental Security Income is a needs-based program. In Oregon, people with SSI generally qualify for the Oregon Health Plan (OHP).
The 24-month waiting period
The 24-month wait is in federal law and applies no matter how serious the disability is. While you wait, coverage options include:
- The Oregon Health Plan, if your income qualifies. See Oregon Health Plan and Medicare.
- COBRA from a former employer. If Social Security finds you were disabled within the first 60 days of COBRA, federal law lets you extend COBRA from 18 to 29 months. Ask the plan administrator.
- A plan from the Health Insurance Marketplace (in Oregon, through HealthCare.gov), with savings based on income.
- A spouse's employer plan, if one is available.
ALS and ESRD: different timelines
- Amyotrophic lateral sclerosis (ALS): there is no 24-month wait. Medicare starts the first month you get SSDI benefits, and since 2020 people with ALS also skip SSDI's five-month waiting period.
- End-stage renal disease (ESRD): you can get Medicare at any age if you need regular dialysis or have had a kidney transplant and have enough work history (yours, a spouse's or a parent's). Medicare usually starts the first day of the fourth month of dialysis; it can start the first month if you train for home dialysis, or the month you are admitted for a transplant.
What Medicare covers under disability
Disability-based Medicare has the same parts and the same costs as Medicare at 65:
- Part A (hospital, skilled nursing, home health, hospice): premium-free when you qualify through SSDI.
- Part B (doctors and outpatient care): the standard premium is $202.90 a month in 2026, with a $283 yearly deductible. You can turn Part B down, but a late-enrollment penalty may apply if you sign up later without other coverage from current work.
- Part D (drugs): optional, but a late-enrollment penalty applies if you go 63 days or more without creditable drug coverage. In 2026 your out-of-pocket drug costs are capped at $2,100.
- Medicare Advantage (Part C): available to you on the same terms as people 65 and older.
- Medigap: Oregon guarantees under-65 access (see below).
Oregon Health Plan and disability
Many people on SSDI also qualify for OHP or a Medicare Savings Program. Once Medicare starts, people with both are dual eligible: see our dual eligible guide. OHP pays second to Medicare and adds services such as dental care and rides to appointments; Medicaid long-term services, such as in-home care, are decided by ODHS Aging and People with Disabilities.
Oregon also runs Employed Persons with Disabilities (EPD), a Medicaid program for people who meet Social Security's definition of disability and work. There is no minimum number of hours or earnings, income and resource limits are higher than for other Medicaid programs, and members pay a monthly fee based on income (OAR 461-135-0725). Apply with the regular ONE application or through your local ODHS Aging and People with Disabilities office.
Medigap under 65 in Oregon
Federal law gives a guaranteed Medigap open enrollment period only to people 65 and older. Oregon goes further. Under OAR 836-052-0138:
- Six-month open enrollment: it starts the first day of the first month you are enrolled in Part B. During it, a company can't deny you, delay your coverage or charge more because of your health.
- Any policy, any age: companies must offer every Medigap policy they currently sell in Oregon, regardless of your age, not just Plan A.
- Same price as at 65: during this window the premium can't be more than the company charges people who are 65.
- A second window at 65: if you enrolled in Part B before 65, you get another six-month open enrollment period when you turn 65.
- Moving to Oregon: if you have Medicare because of a disability and move from a state without under-65 Medigap rights, you have guaranteed issue for 63 days after you become an Oregon resident.
- Retroactive Part B: if Social Security approves your Part B back to an earlier date, the six months run from the first day of the month after you get written notice.
If you join a Medicare Advantage plan instead, you may later need a guaranteed-issue right or Oregon's yearly birthday rule to switch Medigap policies. See Medigap in Oregon and Can I get Medigap under 65 in Oregon?
Extra Help and Medicare Savings Programs
Under-65 enrollees can qualify for Extra Help, which lowers Part D premiums and copays, and for a Medicare Savings Program (QMB, SMB or SMF in Oregon), which pays the Part B premium and sometimes more. Oregon has no asset limit for its Medicare Savings Programs. See Extra Help in Oregon and Medicare Savings Programs in Oregon.
Working while on Medicare disability
Social Security's work incentives let you try working without losing Medicare right away:
- Trial work period: nine months (not necessarily in a row, within a rolling five-year window) in which you keep your full SSDI benefit no matter how much you earn.
- Extended period of eligibility: for 36 months after the trial work period, you get SSDI for any month your earnings fall below Social Security's substantial gainful activity level.
- Extended Medicare coverage: premium-free Part A can continue for at least 93 months after the trial work period ends, as long as you are still disabled. You keep paying the Part B premium. After that, you may be able to buy Part A, and a Medicare Savings Program may help with the cost.
- EPD in Oregon: keeps Oregon Medicaid while you earn more, for a monthly fee.
Before a big work change, talk with a Work Incentives Planning and Assistance (WIPA) benefits counselor; Social Security's Ticket to Work help line, 1-866-968-7842, can connect you.
What changes at 65
- Medicare continues. Your eligibility shifts from disability to age; you don't reapply.
- New Medigap open enrollment. Oregon gives you another six-month window at 65 if you were already in Part B.
- Penalties reset. If you paid a Part B or Part D late-enrollment penalty under disability-based Medicare, it ends at 65, though a new one can apply if you don't enroll on time then.
- SSDI becomes retirement benefits at your full retirement age; the amount generally stays the same.
To compare Medigap, Medicare Advantage or Part D plans from the companies they work with, you can request a call from a licensed insurance agent.
Related guides
Dual eligible in Oregon
Medicare and OHP together.
Extra Help in Oregon
Lower Part D costs.
Can I get Medicare under 65 on disability?
The short answer.
Sources
- Social Security Administration — Disability Evaluation: General Information
- Social Security Administration — Medicare
- Social Security Administration — The Red Book: A Guide to Work Incentives
- Medicare.gov — I’m getting Social Security benefits before 65
- Medicare.gov — Medicare Coverage of Kidney Dialysis & Kidney Transplant Services (PDF)
- OAR 836-052-0138 — Medicare supplement open enrollment (Cornell LII)
- ODHS — OAR 461-135-0725, OSIPM-EPD (PDF)
- U.S. Department of Labor — COBRA continuation coverage
Frequently asked questions
Do I qualify for Medicare under 65?
Usually only if you have received Social Security Disability Insurance (SSDI) or a Railroad Retirement disability benefit for 24 months, or you have ALS or end-stage renal disease. Supplemental Security Income (SSI) alone doesn't make you eligible for Medicare.
Are ALS and ESRD exceptions to the 24-month wait?
Yes. With ALS, Medicare starts the first month you get SSDI benefits. With end-stage renal disease, Medicare usually starts the fourth month of dialysis, or earlier if you train for home dialysis or get a kidney transplant.
Can I buy Medigap if I'm under 65 in Oregon?
Yes. Under OAR 836-052-0138, Medigap companies must offer you every policy they sell in Oregon during the six months after your Part B starts, without health questions, and can't charge you more than they charge people who are 65. You get another open enrollment period when you turn 65.
Will Medicare end if I go back to work?
Not right away. SSDI's trial work period lets you test working for nine months, and Social Security says premium-free Part A can continue for at least 93 months after the trial work period ends, as long as you are still disabled.
What happens to my Medicare when I turn 65?
Your Medicare continues without a break; you don't reapply. You get a new Medigap open enrollment period at 65, and if you have a Medicare late-enrollment penalty because of disability-based Medicare, it ends when you turn 65.
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