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By Your Best Editorial Team · Updated October 28, 2026 · How we rank

Guide · Medicare.gov & SSA rules

Medicare Under 65 on Disability: When It Starts and What to Choose

If you get Social Security or Railroad Retirement disability benefits, Medicare starts on its own after a waiting period. Your choices about Part B, drug coverage and a Medigap or Advantage plan work a little differently before 65. Here is what to expect and what to check.

24 monthsof disability benefits before Medicare starts automatically

100+employees: then a current job’s group plan pays before Medicare

93 monthsof premium-free Part A after the trial work period, for most who return to work

When Medicare starts

You get Part A and Part B automatically after you’ve received Social Security or Railroad Retirement Board disability benefits for 24 months. Your Medicare card arrives in the mail; you don’t need to apply.

ALS (Lou Gehrig’s disease): no waiting period. Medicare starts the month your disability benefits start.
End-stage renal disease: separate rules. When coverage starts depends on whether you’re on dialysis or getting a transplant.

Part A is premium-free. Part B has a monthly premium ($202.90 in 2026 for most people). You can turn Part B down, for example if you have coverage from a current job, but if you keep the card, you keep Part B and its premium.

Your coverage choices

Original Medicare plus a Part D drug plan. You can see any provider that takes Medicare. Compare drug plans in our Part D rankings by state.
Medicare Advantage. Once you have Part A and Part B, you can join an Advantage plan at any age, including $0-premium plans in many counties. See Advantage plans by state, and Special Needs Plans if you also have Medicaid or a qualifying chronic condition.
Medigap. This is where under-65 rules differ. Federal law doesn’t require insurers to sell Medigap to people under 65. Some states let anyone with Medicare under 65 buy a policy; some allow it only for people with Medicare because of disability or end-stage renal disease. Elsewhere, insurers don’t have to sell you one. Check your state in our Medigap by state guide.

A second chance at 65. When you turn 65, you get a new 6-month Medigap Open Enrollment Period, starting the month you’re 65 and have Part B. During it, insurers can’t turn you down or charge more because of your health. See Medigap Open Enrollment.

Working with a disability

Who pays first. If you have group health coverage through your own or a family member’s current job and the employer has 100 or more employees, the group plan pays first and Medicare pays second. With fewer employees (and no multi-employer plan that includes a larger employer), Medicare pays first.
Delaying Part B. With coverage from a current job, you can drop or delay Part B and sign up later in a Special Enrollment Period without a penalty. COBRA and retiree coverage don’t count as coverage from a current job.
Keeping Medicare when you go back to work. Most people who return to work keep premium-free Part A, and Part B and Part D if enrolled, for at least 93 months after a 9-month trial work period, as long as they still have a disabling condition. Medicare.gov describes this as about 8½ years without a Part A premium. After that, you may be able to buy Part A, and Part B with it.

Help with costs

Many people on disability benefits have limited income. Medicare Savings Programs can pay your Part B premium, and Extra Help lowers Part D premiums and copays. If you also qualify for Medicaid, it can cover costs Medicare doesn’t, and a D-SNP can coordinate both.

Questions

How long do you have to be on disability to get Medicare?

24 months of Social Security or Railroad Retirement Board disability benefits. People with ALS get Medicare the month their disability benefits start.

Can I get Medigap under 65?

It depends on your state. Federal law doesn’t require insurers to sell Medigap to people under 65, but some states do. Everyone gets a Medigap Open Enrollment Period at 65.

Can I have Medicare and job coverage at the same time?

Yes. With 100 or more employees at the job that provides the coverage, the group plan pays first. You can also delay Part B while you have that coverage and sign up later without a penalty.

Will I lose Medicare if I go back to work?

Usually not right away. Most people keep Medicare for at least 93 months after the trial work period while they still have a disabling condition.

Sources

Checked October 28, 2026.

Medicare.gov, “How do I sign up for Medicare?” (24 months, ALS, ESRD) — medicare.gov; “Information for my situation” (returning to work) — medicare.gov.
Medicare.gov, “How Medicare Works with Other Insurance” (who pays first under 65 with a disability) — medicare.gov PDF.
Social Security, “Medicare Information” for people with disabilities who work — ssa.gov.
Medicare.gov, “When can I buy Medigap?” (under 65, Open Enrollment at 65) — medicare.gov; Part B SEP and COBRA — medicare.gov.

Educational information, not legal or financial advice. Social Security and Medicare decide your eligibility. Free one-on-one help: your State Health Insurance Assistance Program. · Advertiser disclosure