Your Situation
On Disability and Under 65 — Your Medicare Guide
Medicare isn't only for people 65 and older. If you receive Social Security Disability Insurance (SSDI), you'll get Medicare too — after a waiting period. Your choices look a little different than they do at 65, and some programs can help a lot with costs.
When Your Medicare Starts
Most people: after 24 months of SSDI
Medicare starts automatically in your 25th month of disability benefits. Your Medicare card arrives about 3 months before. Since SSDI itself has a 5-month waiting period, that's usually about two and a half years after your disability began.
ALS (Lou Gehrig's disease)
Medicare starts the same month your disability benefits start — there's no 24-month wait.
Kidney failure (ESRD)
If you need regular dialysis or a kidney transplant, you may qualify for Medicare under separate rules, often within a few months of starting dialysis.
Supplemental Security Income (SSI) alone doesn't lead to Medicare, but it usually qualifies you for Medicaid.
Your Coverage Choices
You'll be enrolled in Parts A and B. Then you choose how to fill the gaps — the same two paths as everyone else, with one difference.
Medicare Advantage
Available to you under 65, just like at 65. Often a low monthly premium, with drug coverage and a yearly limit on what you pay.
Medicare Supplement + Part D
Federal law doesn't require insurers to sell Medicare Supplements to people under 65. Options and prices can differ from what's offered at 65, so it's worth checking what Wisconsin insurers offer you.
Programs That Lower Your Costs
Medicare Savings Programs
Wisconsin may pay your Part B premium, and sometimes your deductibles and copays, if your income and savings are limited.
Extra Help
Lowers what you pay for prescriptions. If you qualify for a Medicare Savings Program, you get Extra Help automatically.
Medicaid and Special Needs Plans
If you have both Medicare and Medicaid, you may qualify for a Special Needs Plan built for people with both.
Medicaid Purchase Plan (MAPP)
A Wisconsin program that lets people with disabilities who work keep Medicaid coverage, sometimes for a monthly premium.
If You Go Back to Work
Returning to work doesn't mean losing Medicare right away. After a trial work period, Medicare can generally continue for at least 7 more years (93 months) as long as your disability continues. If you have health coverage through a job, the size of the employer can affect whether Medicare or the job's plan pays first.
When You Turn 65, You Get a Fresh Start
You get a new Initial Enrollment Period, so you can make new choices about your coverage.
You get a new 6-month Medicare Supplement open enrollment. Insurers can't turn you down for health reasons, even if you were denied before.
If you've been paying a Part B late penalty, it ends.
Put it on the calendar. That second Medicare Supplement window at 65 is easy to miss because nothing changes automatically. If you'd like a Supplement, plan ahead for it.
Still have questions? Talk with Marit.
Licensed Wisconsin agent in downtown Appleton. No cost to talk, no pressure to enroll.
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