Eligibility

Medicare Disability Under 65 in Washington

You can get Medicare before 65 after 24 months of Social Security disability benefits, right away with ALS, or with end-stage renal disease. In Washington, Apple Health can help during the wait and alongside Medicare, but state law doesn't require insurers to sell Medigap to people under 65, so your choices may be limited until you turn 65.

By the Benefits Life Editorial Team, licensed insurance agents · Reviewed November 9, 2026

Three paths to Medicare before 65

Path	Waiting period	Coverage starts
SSDI (most common)	24 months of Social Security (or certain Railroad Retirement) disability benefits	Automatically, in your 25th month of disability benefits
ALS (Lou Gehrig's disease)	None	The month your disability benefits begin
ESRD (kidney failure)	Usually 3 months of regular dialysis	The fourth month of dialysis, or earlier with home dialysis training or a kidney transplant

Medicare for SSDI and ALS starts automatically; your card arrives in the mail. With ESRD you sign up through Social Security.

The SSDI 24-month waiting period

For most Washington residents with a disability, the 24-month wait between the start of SSDI benefits and Medicare is the hardest part. You're disabled enough to qualify for SSDI, but you wait two years for Medicare (and SSDI itself usually starts after a 5-month waiting period).

Ways to bridge the gap in Washington:

Apple Health (Medicaid). Many people qualify during the waiting period because of low income. Adults under 65 can apply through Washington Healthplanfinder; disability-based Apple Health programs are handled through Washington Connection. See Apple Health in Washington.
Apple Health for Workers with Disabilities (HWD). If you work despite a disability, HWD offers Apple Health coverage with a monthly premium based on income and no income or asset limit to qualify.
A spouse's employer coverage. You may be able to join as a dependent.
COBRA from a former employer. Usually up to 18 months, which can be extended to 29 months if Social Security finds you were disabled within the first 60 days of COBRA. It can be expensive, but it's continuous.
Washington Healthplanfinder plans. You can enroll during open enrollment or after a qualifying life event, such as losing other coverage, and you may get help with premiums based on income.

Once Medicare starts: what's different from Medicare at 65

Medicare under 65 works much like Medicare at 65: the same Parts A, B, C and D, the same costs (the 2026 standard Part B premium is $202.90) and the same kinds of plans. But some rules differ:

Medigap may be hard to buy. Federal law guarantees a 6-month Medigap open enrollment period only once you're 65 and have Part B. Washington law doesn't require insurance companies to sell Medigap to people under 65, and the Office of the Insurance Commissioner warns that you might not be able to buy the plan you want, or any plan, until you turn 65. If you do have a policy, Washington lets you switch to another plan B through N (or Plan A to Plan A) at any time without health questions (RCW 48.66.045). See Medigap in Washington.
Medicare Advantage is another option. You can join a Medicare Advantage plan when you first get Medicare, with networks and rules that vary by plan. See Original Medicare vs. Medicare Advantage.
D-SNPs if you also have Apple Health. If you have both Medicare and Apple Health, a Dual Eligible Special Needs Plan (D-SNP) coordinates the two programs. See D-SNPs in Washington.
You get a fresh start at 65. When you turn 65, you get your 6-month Medigap open enrollment period, when companies must sell you a policy regardless of your health.

ALS: no waiting period

If you have ALS (amyotrophic lateral sclerosis, or Lou Gehrig's disease), Medicare starts the month your disability benefits begin, with no 24-month wait. A 2020 federal law (the ALS Disability Insurance Access Act) also removed the 5-month waiting period for SSDI benefits for people with ALS, so coverage can start soon after you're approved.

Ask your ALS care team's social worker about Medicare coverage for equipment such as wheelchairs and communication devices, and about Apple Health if you qualify.

ESRD: kidney failure and Medicare

End-stage renal disease means permanent kidney failure that requires regular dialysis or a kidney transplant. Medicare for ESRD has its own rules:

Dialysis at a facility: Medicare usually starts the fourth month of dialysis.
Home dialysis training: Medicare can start the first month of dialysis if you start a home dialysis training program and expect to finish it.
Kidney transplant: Medicare can start the month you're admitted to a Medicare-certified hospital for a transplant, if the transplant happens that month or within the next 2 months. If the transplant is delayed longer, coverage can start 2 months before the transplant.
When ESRD-only Medicare ends: if you have Medicare only because of ESRD, it ends 12 months after you stop dialysis or 36 months after a successful kidney transplant. Since 2023, people who had Medicare because of ESRD at the time of their transplant can get a Part B benefit that covers only immunosuppressive drugs after that coverage ends (with its own premium), if they don't have certain other coverage for these drugs.
Employer coverage first: if you have an employer group plan, it generally pays first for the first 30 months of ESRD Medicare.

Medicare and Apple Health together

Many Washington residents with disabilities qualify for both Medicare and Apple Health (dual eligibility). When that happens:

Medicare pays first; Apple Health may pay some of what's left
Medicare Savings Programs can pay your Part B premium and, for some people, Medicare deductibles and coinsurance. See Medicare Savings Programs in Washington.
Apple Health covers some services Medicare doesn't, such as long-term services and supports, for people who qualify
People with full Apple Health or a Medicare Savings Program automatically qualify for Extra Help with drug costs
You may be able to join a D-SNP that coordinates both programs

More on D-SNPs in Washington · Medicare vs. Apple Health comparison

Working with a disability, and Medicare

If you go back to work while you have a disability:

SSDI trial work period. You can test your ability to work for 9 months (they don't have to be in a row) and keep your full SSDI benefits. Medicare continues.
Extended period of eligibility. For 36 months after the trial work period, you can get benefits for any month your earnings fall below Social Security's substantial gainful activity level.
Extended Medicare coverage. If your cash benefits stop because of work, Social Security says most people keep Medicare for at least 93 months (7 years and 9 months) after the trial work period, as long as the disability continues.
Buying Medicare after that. If you still have a disability when that coverage ends, you can buy Part A (up to $565 a month in 2026) and Part B. If your income and resources are limited, the Qualified Disabled and Working Individuals program, one of the Medicare Savings Programs, may pay the Part A premium.
Apple Health for Workers with Disabilities. Lets you keep or get Apple Health while you work, with a premium based on income.

Resources for Washington residents with disabilities

Social Security, for SSDI and Medicare questions: 1-800-772-1213 or ssa.gov
1-800-MEDICARE (1-800-633-4227, TTY 1-877-486-2048) and Medicare.gov
Washington Health Care Authority, for Apple Health and Apple Health for Workers with Disabilities: hca.wa.gov
DSHS Aging and Long-Term Support Administration and Community Living Connections, for long-term services and supports and care coordination
Disability Rights Washington, the state's protection and advocacy organization, if you're being denied services you need
A licensed insurance agent with Benefits Life, at (206) SENIORS (206-736-4677), TTY 711, at no cost to you, to talk through Medicare Advantage, Medigap and Part D plans from the companies they work with, or you can see plans in your ZIP code

Sources

Frequently asked questions

How do I qualify for Medicare under 65 in Washington?

There are three paths: after you've received Social Security disability benefits (SSDI) or certain Railroad Retirement disability benefits for 24 months; with ALS (Lou Gehrig's disease), starting the month your disability benefits begin; or with end-stage renal disease (ESRD) needing regular dialysis or a kidney transplant, usually starting the fourth month of dialysis.

What do I do during the 24-month SSDI waiting period?

Options in Washington include Apple Health (Medicaid) if you qualify, Apple Health for Workers with Disabilities if you work, COBRA from a former employer (which can be extended to 29 months for a disability), a spouse's employer plan, or a Washington Healthplanfinder plan. Apply for Apple Health through Washington Healthplanfinder or Washington Connection.

Can I get Medigap if I'm disabled and under 65 in Washington?

Maybe not. Washington law doesn't require insurance companies to sell Medigap to people under 65, and the Office of the Insurance Commissioner warns that you might not be able to buy the plan you want, or any plan, until 65. Once you have a policy, Washington's switching right applies. At 65 you get a 6-month Medigap open enrollment period. See our Medigap in Washington page.

Can I have both Medicare and Apple Health in Washington if I'm disabled?

Yes, if you qualify for both. This is called dual eligibility. Medicare pays first; Apple Health or a Medicare Savings Program can help with Medicare premiums and cost sharing, and Apple Health covers some services Medicare doesn't, such as long-term services and supports. People with Medicaid also get Extra Help with drug costs. You may be able to join a D-SNP, a plan for people with both.

What happens to my Medicare if I return to work?

During your 9-month SSDI trial work period, your benefits and Medicare continue. If your cash benefits later stop because of work, Social Security says most people keep Medicare for at least 93 months after the trial work period, as long as the disability continues. After that, you may be able to buy Medicare. Apple Health for Workers with Disabilities is another option in Washington.

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Licensed insurance agents for Washington

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