Yes — there are three ways to get Medicare before 65

Most people think of Medicare as a program you join at 65, but federal law opens the door earlier for people with disabilities. Here in Charlotte and across North Carolina, we regularly help people in all three situations below. Eligibility is not based on income — it is based on your disability status.

1. Disability (SSDI) — the 24-month rule

If you are under 65 and receiving Social Security Disability Insurance (SSDI) benefits, you become eligible for Medicare automatically after you have received disability benefits for 24 months. Those 24 months do not have to be consecutive. Medicare Part A and Part B then start automatically in month 25 — you do not have to apply, and your Medicare card arrives in the mail.

2. ALS (Lou Gehrig's disease) — no waiting period

If you have ALS, there is no 24-month wait. You get Medicare automatically the same month your Social Security disability benefits begin.

3. ESRD (End-Stage Renal Disease) — any age, but you must sign up yourself

If you have permanent kidney failure requiring regular dialysis or a kidney transplant, you can qualify for Medicare at any age — but enrollment is not automatic. You must sign up yourself. For dialysis, coverage usually begins on the first day of the fourth month of dialysis treatments, and that clock runs even if you have not yet enrolled — so it pays to apply early. Coverage can start sooner in some situations, such as a home-dialysis training program or a transplant, so anyone with ESRD should confirm their exact start date at Medicare.gov or by calling 1-800-MEDICARE.

What "automatic" means — and what still isn't

For SSDI (after 24 months) and ALS, Part A and Part B enrollment happens on its own. But even when the core coverage is automatic, several decisions are never made for you:

  • Prescription drug coverage (Part D) — Original Medicare does not cover most drugs you take at home, so you have to choose a drug plan or a Medicare Advantage plan that includes one.
  • Medicare Advantage vs. Original Medicare — you can keep Original Medicare or enroll in a Medicare Advantage plan; neither happens automatically.
  • Keeping or declining Part B — if you have other coverage, this decision deserves care, because dropping Part B without the right kind of coverage in place can lead to a late enrollment penalty later (10% per full 12 months, for life).

ESRD is the exception on every front: the whole enrollment is a self-sign-up through Social Security.

You get the same Medicare as someone who is 65

Medicare under 65 is not a lesser version of the program. You get the same Part A (hospital) and Part B (medical) coverage, and the same costs apply. In 2026, Part A is premium-free for most people, the standard Part B premium is $202.90 per month, and the Part B annual deductible is $283. If you're unsure of your own Part A premium status, confirm it with Social Security or call 1-800-MEDICARE. After the deductible, Original Medicare generally pays 80% of the approved amount and you pay 20% — with no annual out-of-pocket cap on Parts A and B. If you add drug coverage, Part D plans in 2026 carry a $2,100 annual out-of-pocket cap on covered drugs, after which you pay $0 for covered drugs the rest of the year.

One honest caution: Medigap under 65 works differently

Because Original Medicare has no out-of-pocket cap, many people pair it with a Medicare Supplement (Medigap) policy. Here is the trade-off to understand: the guaranteed 6-month Medigap Open Enrollment Period — the window where you cannot be turned down or charged more for health reasons — begins when you are 65 or older and enrolled in Part B. If you are on Medicare before 65, that protected window has not opened yet, and Medigap availability and pricing for people under 65 can be limited. It does open when you turn 65, which makes your 65th birthday an important second look at your whole setup. Many North Carolinians under 65 look closely at Medicare Advantage plans instead, since every Medicare Advantage plan is required to have an annual out-of-pocket cap on covered Part A and Part B services. Neither route is universally better — it depends on your doctors, your medications, and your budget.

Help is available if money is tight

Disability and limited income often go together, and there are real programs built for exactly that:

  • Medicaid and dual eligibility — it is possible to have both Medicare and Medicaid. "Dual eligible" beneficiaries have Medicare pay first, with Medicaid picking up costs Medicare doesn't cover.
  • D-SNP plans — Dual Eligible Special Needs Plans are Medicare Advantage plans built specifically for people with both Medicare and Medicaid, and they can coordinate the two programs through a single plan.
  • Extra Help (Low-Income Subsidy) — a federal program that lowers Part D drug plan premiums, deductibles, and copays. You are automatically enrolled if you have full Medicaid, SSI, or a Medicare Savings Program.
  • Medicare Savings Programs (QMB, SLMB, QI) — state-run programs that help pay the Part B premium, and in the case of QMB, deductibles, coinsurance, and copays too. Income and resource limits are set by the state and change yearly, so check with the NC Medicaid office, Medicare.gov, or 1-800-MEDICARE for the current figures.

What happens when you turn 65

Turning 65 while already on disability Medicare is a genuine fresh-start moment. Your Medigap Open Enrollment Period opens because you are now 65 and enrolled in Part B, and it is the right time to re-check whether your current plan still fits your doctors, your prescriptions, and your travel. Whatever you chose at 55 or 60 should not be assumed correct at 65 — this is exactly the kind of review worth putting on the calendar.

How The Jordan Insurance Agency helps

The Jordan Insurance Agency is an independent, full-time, licensed insurance agency based in Charlotte, serving all of North Carolina. Because we are independent, we represent multiple carriers rather than one company's lineup — which matters a lot for under-65 beneficiaries, where plan availability, D-SNP options, and drug formularies vary widely. Our agents complete annual AHIP and carrier certifications, carry errors-and-omissions coverage, and review your plan every year at renewal so your coverage keeps up as your health and medications change. If you are approaching your 25th month of SSDI, managing ESRD enrollment timing, or coming up on 65 after years on disability Medicare, we can walk through your options in plain English. And it costs you nothing to work with us — the carrier pays the agent, and your premium is the same whether you enroll on your own or with our help.

Plan availability & disclaimer

We do not offer every plan available in your area. Any information we provide is limited to those plans we do offer in your area. Please contact Medicare.gov or 1-800-MEDICARE to get information on all of your options. The Jordan Insurance Agency is not connected with or endorsed by the United States government or the federal Medicare program.