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Medicare Part D for people under 65

If you qualify for Medicare through disability, ALS, or ESRD, here's how Part D works for you — and the cost-saving programs you should know about.

Who qualifies for Medicare under 65

Most people get Medicare at 65, but there are three ways to qualify earlier:

  • Social Security Disability Insurance (SSDI) — after receiving SSDI for 24 months, you automatically get Medicare Parts A and B. The 24-month wait starts from when your SSDI benefits begin, not when you applied.
  • ALS (Amyotrophic Lateral Sclerosis / Lou Gehrig's disease) — Medicare begins the same month your SSDI benefits start. There is no 24-month waiting period for ALS.
  • End-Stage Renal Disease (ESRD) — Medicare begins the 4th month of dialysis (or earlier if you complete a self-care training program). For kidney transplant recipients, Medicare begins the month of the transplant.

How Part D works for under-65 beneficiaries

If you have Medicare under 65, your Part D options are identical to people 65 and older. You can:

  • Enroll in any standalone Part D plan available in your area
  • Enroll in a Medicare Advantage plan with drug coverage (MA-PD)
  • Choose a Special Needs Plan (SNP) if you qualify based on a chronic condition or dual eligibility

Your Initial Enrollment Period (IEP) for Part D is the 7-month window around when you first become eligible for Medicare — 3 months before, the month of, and 3 months after.

If you miss your enrollment window

Just like beneficiaries 65 and older, you can face a permanent late enrollment penalty if you don't enroll in Part D when first eligible — unless you have other creditable drug coverage. Make sure to enroll during your IEP, or have proof of creditable coverage from another source (like Medicaid, employer coverage, or VA benefits).

Extra Help is especially important for disability beneficiaries

Many people on SSDI have limited income, which means they likely qualify for Extra Help (also called the Low-Income Subsidy or LIS). Extra Help can dramatically reduce or eliminate your Part D costs:

  • $0 or very low premiums
  • $0 or very low deductible
  • Maximum copays of about $4.90 generic / $12.15 brand-name in 2026
  • No coverage gap or out-of-pocket cap to worry about

The 2026 income limit for Extra Help is approximately $23,475 for individuals or $31,725 for married couples. Resource limits also apply but are relatively generous.

If you get Medicaid, Supplemental Security Income (SSI), or have a Medicare Savings Program, you automatically qualify for Extra Help and don't need to apply.

Learn more about Extra Help eligibility →

Medigap and disability — the catch

One important difference for under-65 beneficiaries: federal law does not guarantee you the right to buy a Medigap policy if you're under 65. About half of states have their own laws requiring insurers to offer Medigap to disability beneficiaries, but pricing and availability vary widely. Many states allow insurers to charge under-65 beneficiaries significantly higher premiums.

Because of this, many disability beneficiaries choose Medicare Advantage plans (which have a $0 monthly premium in many areas) instead of Original Medicare with a Medigap policy. Learn more about when to buy Medigap →

State pharmaceutical assistance programs

Many states have State Pharmaceutical Assistance Programs (SPAPs) that provide additional help paying for prescription drugs beyond what Part D and Extra Help cover. These programs typically have income limits but are worth checking. Your state's SHIP counselor can tell you what programs are available where you live.

Special Needs Plans for chronic conditions

If you have a qualifying chronic condition like diabetes, heart failure, or HIV, you may be able to enroll in a Chronic Condition Special Needs Plan (C-SNP). These are Medicare Advantage plans designed specifically for people with that condition, with formularies and provider networks tailored to your needs.

Dual Eligible Special Needs Plans (D-SNPs) are available if you qualify for both Medicare and Medicaid. These plans coordinate benefits between the two programs.

Frequently asked questions

How do I get Medicare under 65?

There are three ways: (1) receive Social Security Disability Insurance (SSDI) for 24 months, (2) be diagnosed with ALS — Medicare starts immediately when SSDI begins, or (3) have End-Stage Renal Disease (ESRD) — Medicare begins the 4th month of dialysis.

Is Part D the same for under-65 beneficiaries?

Yes. If you have Medicare under 65, you have access to all the same Part D plans, Medicare Advantage plans, and Special Needs Plans as people 65 and older.

Can I buy a Medigap policy if I'm under 65?

Federal law doesn't require insurers to sell Medigap to people under 65, but about half of states have their own laws requiring it. Premiums for under-65 Medigap policies are often significantly higher than for 65+ enrollees.

Do I qualify for Extra Help?

If you have Medicaid, Supplemental Security Income, or a Medicare Savings Program, you automatically qualify. Otherwise, the 2026 income limit is approximately $23,475 for individuals or $31,725 for couples. Many SSDI beneficiaries qualify.

When does Medicare start for ALS patients?

For people diagnosed with ALS, Medicare starts the same month your SSDI benefits begin — there is no 24-month waiting period.