Generally, Medicare coverage is available to disabled adults who are under the age of 65 and have received Social Security Disability Insurance (SSDI) benefits for 24 months. The 24-month waiting period for Medicare coverage begins the first month the disabled individual was entitled to a disability payment. There is an exception to the 24-month waiting period for disabled adults who have End Stage Renal Disease (ESRD) or Amyotrophic Lateral Sclerosis (ALS, also known as Lou Gehrig’s disease).
Beneficiaries with ALS/Lou Gehrig’s disease are eligible for Medicare coverage as soon as their SSDI application is approved. For individuals with ESRD, however, Medicare eligibility generally begins after three (3) months of dialysis in a dialysis facility or same month the beneficiary is admitted to a Medicare-approved hospital for a kidney transplant. Under limited circumstances, Medicare coverage for individuals with ESRD can begin as early as the first month of dialysis or two months before a kidney transplant.
Unlike SSDI, Supplemental Security Income (SSI) does not come with Medicare coverage. This means disabled adults receiving SSI only typically do not receive Medicare coverage before age 65. However, since SSI is a need-based program, SSI recipients are usually eligible for Medicaid. Individuals who receive both SSDI and SSI may also be eligible for programs to help pay the cost of Medicare premiums, Medicare prescription drug plans, and/or prescription drug costs.