If you get Social Security disability benefits, Medicare starts after 24 months of benefits. Before then, a Marketplace plan through HealthCare.gov can fill the gap, often with savings based on income. Once you have Medicare Part A or Part C, you no longer qualify for Marketplace savings, and Marketplace coverage doesn't end automatically, so you must cancel it. For most people, Medicare becomes the better and required choice once it starts. Here is how the two compare and how to time the switch.
Can I get Medicare before 65 if I'm on disability?
Yes. People under 65 generally become eligible for Medicare after receiving Social Security or Railroad Retirement Board disability benefits for 24 months. If you already get those benefits, HealthCare.gov says you'll automatically get Medicare when you're eligible. People with end-stage renal disease or ALS follow different rules and can qualify sooner. Our page on turning 65 after Medicare on disability explains what changes at 65.
What coverage can I use while I wait for Medicare?
The months before Medicare starts are the gap people worry about most. Common options include a spouse's employer plan, COBRA from your last job, Medicaid if your income qualifies, or a Marketplace plan. Marketplace plans can come with premium savings based on household income, which can make a big difference while you're living on disability benefits. Our page on coverage until Medicare starts on disability covers each option in more depth.
Losing other coverage, such as job-based insurance after you stop working because of a disability, usually opens a Marketplace Special Enrollment Period, which gives you 60 days to pick a plan. Marketplace Open Enrollment runs November 1 through January 15. When you apply, report your expected income for the year carefully. Disability benefits often lower household income compared with a working year, which can raise the savings you qualify for. Report changes during the year, including back payments, so your savings stay accurate.
How do Medicare and a Marketplace plan compare?
| Question | Marketplace plan | Medicare |
|---|---|---|
| When it is available | Before Medicare starts; enroll during Open Enrollment or a Special Enrollment Period | After 24 months of disability benefits, or sooner for ESRD or ALS |
| Income-based savings | Yes, if you qualify and don't have Medicare | Not on premiums, but Extra Help and Medicare Savings Programs can help |
| Doctor choice | Plan network | Any provider that accepts Medicare with Original Medicare, or a network with Medicare Advantage |
| Drug coverage | Included in the plan | Part D plan or Medicare Advantage with drug coverage |
| What happens when the other starts | Doesn't end automatically; you must update your application | Becomes your main coverage |
| Penalties | None for leaving | Late enrollment penalties if you delay Part B or Part D without other qualifying coverage |
What happens to my Marketplace plan when Medicare starts?
HealthCare.gov is direct about two things. First, once you have Part A or Part C, you won't qualify for any savings to help lower the cost of a Marketplace plan. Second, Marketplace coverage doesn't end automatically when Medicare starts. You need to update your Marketplace application to end coverage for the person starting Medicare. If you don't, you could keep paying a full-price premium for coverage you no longer need, or owe back savings at tax time.
If other family members are on the same Marketplace plan and aren't getting Medicare, update the application so only your coverage ends and theirs continues.
Should I delay Medicare to keep my Marketplace plan?
For most people, no. HealthCare.gov warns that if you delay Medicare, in most cases you'll also have to pay monthly late enrollment penalties for Part B and Part D, and the penalties go up the longer you wait. You would also lose Marketplace savings once Part A starts. Since disability-based Medicare usually starts automatically, the practical step is to plan for it: know the month it begins and line up drug coverage and any supplemental coverage for that date.
Social Security usually mails your Medicare card a few months before your coverage starts. When it arrives, note the Part A and Part B start dates printed on it. That date is your cue to cancel the Marketplace plan for the following month, choose a Part D or Medicare Advantage plan, and decide about a Medicare Supplement if your state offers one under 65. Doing all three in the same week keeps the handoff clean. Keep copies of the cancellation confirmation and your new plan's welcome letter in case a premium or claim is billed to the wrong coverage during the first month.
What Medicare coverage can I get under 65?
Under 65, you can choose Original Medicare with a Part D plan, or a Medicare Advantage plan. Medicare Supplement access under 65 depends on your state, because federal law doesn't guarantee it. Our pages on Medicare Supplement under 65 on disability, Medicare Advantage under 65 and what Medicare costs under 65 walk through the choices.
How does this work in North Carolina, South Carolina and Tennessee?
Medicare and Marketplace rules are federal, but the plans and state help vary. All three states use HealthCare.gov for Marketplace coverage, and plan options differ by county. North Carolina expanded Medicaid to adults ages 19 through 64 with household income up to 138% of the federal poverty level, which can cover some people during the waiting period. South Carolina's Healthy Connections Medicaid and Tennessee's TennCare have their own rules. Each state also has its own rules for Medicare Supplement access under 65. If you live near Charlotte, check which state your home address is in before comparing plans.
How The Jordan Insurance Agency can help
The switch from a Marketplace plan to Medicare is a handoff with several moving parts: the Medicare start date, cancelling Marketplace coverage, choosing a drug plan and deciding on Medicare Advantage or a supplement. We help with both Marketplace and Medicare coverage, so we can plan the handoff end to end and make sure nothing lapses or gets paid twice. Schedule Your Consultation to review your options.
Reviewed by Billy Jordan Jr., licensed insurance agent · Licensing & Credentials · Last reviewed November 12, 2026 · Sources are linked in the answer above.
Licensing: Billy Jordan Jr. is licensed in 23 states, including North Carolina, South Carolina and Tennessee. See Licensing & Credentials.
Office: North Carolina and South Carolina clients are served by the Charlotte office, 3540 Toringdon Way, Suite 200, Charlotte, NC 28277, (704) 926-7565. Tennessee clients are served by the Nashville office, 159 4th Ave N, Suite 100, Nashville, TN 37219, (615) 558-6082.
Medicare disclaimer: We do not offer every plan available in your area. Currently we represent 8 organizations which offer 91 products in North Carolina, 7 organizations which offer 70 products in South Carolina, and 7 organizations which offer 65 products in Tennessee. Please contact Medicare.gov or 1-800-MEDICARE to get information on all of your options. Read the full Medicare disclaimer.
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