Medicare for People Under 65: What Benefits and Plans Are Available
When most people think of Medicare, they think of individuals turning 65. But Medicare also covers millions of Americans under age 65 who qualify due to disability or specific medical conditions. Because understanding benefits and plan options is essential to getting the best possible care, we will discuss Medicare for people under 65.
Who Qualifies for Medicare Under Age 65
You may be eligible for Medicare before turning 65 if:
- You’ve been receiving Social Security Disability Insurance (SSDI) for 24 months (consecutive or non-consecutive).
- You have Amyotrophic Lateral Sclerosis (ALS); you automatically get Medicare the same month your SSDI benefits begin.
- You have End-Stage Renal Disease (ESRD); you may qualify for Medicare without waiting 24 months, depending on your treatment and transplant status.
What Medicare Benefits Do You Get
Medicare coverage for those under 65 generally includes:
- Part A (Hospital Insurance): Covers inpatient care, skilled nursing facility care, hospice, and some home health care. Usually premium-free if you worked 40 quarters (or qualify through a spouse).
- Part B (Medical Insurance): Covers doctor visits, outpatient care, preventive services, and durable medical equipment. You pay a monthly premium (standard amount is $174.70/month in 2025, though income can affect this).
- Part D (Prescription Drug Coverage): You can enroll in a standalone drug plan or get drug coverage through a Medicare Advantage plan.
Medicare Advantage (Part C) Plans for People Under 65
Private insurance companies offer Medicare Advantage plans. These plans must cover everything Original Medicare covers and often more, like dental, vision, hearing, gym memberships, and over-the-counter allowances.
Important notes:
- Not every state or county offers Medicare Advantage plans for beneficiaries under 65.
- You must be enrolled in both Part A and Part B to join a Medicare Advantage plan.
- Availability can depend on your ZIP code and health condition.
Some Advantage plans are designed for people with chronic conditions (C-SNPs), which could be a great fit for those with a qualifying illness.
Watch a YouTube video on Chronic Condition MAPD Plans
Medicare Supplement (Medigap) Plans for Individuals Under 65
Medicare Supplement plans (also called Medigap) help pay out-of-pocket costs like deductibles, copays, and coinsurance. They work with Original Medicare (not with Advantage plans).
Here’s the catch:
- Federal law does not require insurance companies to sell Medigap plans to people under 65. But many states do require it.
- If your state allows it, premiums may be higher than for people 65 and older.
- You may not be offered the full range of plans (A–N), and plan availability is very limited and varies widely by state.
Important: Even if you’re under 65 now, you’ll get another Medigap Open Enrollment Period when you turn 65; at that point, you can enroll in any plan with guaranteed issue rights and generally at lower rates.
Prescription Drug Coverage for Under-65 Beneficiaries
If you’re on Original Medicare, you’ll need a standalone Part D plan to cover your medications. These plans vary by region and formulary, so it’s important to review which plan best fits your prescriptions and pharmacy preferences.
If you choose a Medicare Advantage plan with prescription coverage, you don’t need to enroll in a separate Part D plan.
Don’t skip drug coverage! If you delay enrolling in Part D when first eligible and don’t have other credible coverage, you may face a late enrollment penalty later.
Getting Help with Costs: Extra Help & Medicaid
If you’re under 65 and have limited income or resources, you may qualify for:
- Medicare Savings Programs (help pay for Part A and B premiums and other costs)
- Extra Help with prescription drug costs
- State Medicaid programs, which can provide additional services and cost coverage
Medicare for people under 65 can be complex, but it’s also a lifeline. Plan options may differ from those turning 65, especially when it comes to Medigap and Medicare Advantage availability. It’s essential to:
- Review your state-specific rules
- Check if you’re eligible for Extra Help or Medicaid
- Compare Medicare Advantage vs. Original Medicare + Medigap carefully
Remember; coverage options may improve (and become more affordable) when you reach age 65, so be sure to reassess at that time.
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Need help understanding your Medicare options under 65? Contact a licensed Medicare agent who can walk you through what’s available in your area and help you make the most of your benefit.