Although many agents and insurers market Medicare toward senior citizens, they aren’t the only people covered by this government program. If fact, more than 7 million Medicare recipients at the end of 2025 were under 65.
There are distinctions in how people become eligible for Medicare under the age of 65, based on eligibility requirements imposed by the Social Security Administration.
We’ll analyze this group of enrollees together and discuss how you can best utilize this knowledge for your insurance sales.
Who’s Eligible for Medicare Under Age 65?
The simplest answer for how individuals under 65 can qualify for Medicare is that they’ve been receiving Social Security Disability Income (SSDI) or Railroad Retirement Board (RRB) disability benefits for a minimum of 24 months.
To qualify for SSDI or RRB disability benefits under the age of 65, medical professionals must determine that the beneficiary is unable to work or provide for themselves due to a physical or mental health impairment that will last at least 12 months, or until the person’s death.
Usually, someone must work a required number of work credits to qualify for SSDI or RRB benefits; however, there are extenuating circumstances when someone’s work credits may be transferable to their disabled child, spouse, widow, or widower.
What Disabilities Qualify Someone for Medicare?
Should someone be diagnosed with end-stage renal disease (ESRD) or amyotrophic lateral sclerosis (ALS), they’ll automatically qualify for Medicare coverage that begins immediately with their first SSDI or RRB disability check.
While these may currently be the only illnesses that automatically qualify someone for coverage, there are other common diseases that can qualify someone for SSDI and Medicare. More specific diseases/disabilities include, but are not limited to:
- Multiple Sclerosis
- Cerebral Palsy
- Neurodevelopmental Disorders
- Cystic Fibrosis
- Heart Disease
- Chronic Liver Failure
- And more! (no disease can be an automatic disqualification)
Qualifying for Medicare Under 65 with Medicaid
A large portion of Medicare beneficiaries under 65 also qualify for Medicaid assistance. Those who qualify for the Part D assistance program, or Medicaid Extra Help, are able to receive additional benefits to reduce their out-of-pocket drug spending.
To qualify for Extra Help Under 65:
- Single with an annual income less than $23,940
- Married couple with an annual income less than $32,460
- Qualify for Medicare based on disability
This especially vulnerable population could use the added assistance to make getting health care a little easier. Approximately 25 percent more beneficiaries under 65 qualify for Medicaid assistance. This group qualifies for benefits that have an estimated value of $5,700 per person.
Beneficiaries can apply for Extra Help by:
- Going to the Social Security Administration’s website
- Calling 800-772-1213 (TTY: 800-325-0778), Monday through Friday, 8AM to 7PM, local time
- Visiting their local Social Security office
To assist this demographic, establish a presence in your community. Community centers, resource offices, food banks, and local small businesses are great places to meet clients who could fit into this demographic and could benefit from your services.
Transitioning to Medicare from Marketplace Coverage
Once eligible for Medicare Part A due to disability, verify that your client’s marketplace coverage is cancelled. Benefits are not coordinated, and it’s best to cancel their marketplace plan before their Medicare coverage is active to avoid coverage gaps or overpayments.
After being deemed eligible for premium-free Part A, or if they already have Part A, clients will no longer qualify for help from the marketplace to pay premium costs or other medical expenses through tax credits or subsidies. Clients receiving subsidies may have to pay them back when they file their federal income taxes.
This period is crucial for individuals looking to keep their health care costs low. Medicare Advantage plans can be a good option for these clients!
Medicare Advantage Sales Potential
Due to these clients’ special circumstances allowing them to qualify for Medicare coverage under the age of 65, they are more likely to have specific plan needs that Medicare Advantage plans can accommodate.
These clients could be more likely to update or switch plans due to the additional Special Enrollment Periods (SEPs) they may qualify for outside of their Initial Enrollment Period (IEP) or the Annual Enrollment Period (AEP)!
Medicare Advantage has grown 3.2 percent from 2025. Selling Medicare Advantage plans to under-65 clients is an opportunity no insurance agent should miss out on!
Special Needs Plans (SNPs)
Many of the under-65 Medicare beneficiaries may qualify for a Special Needs Plan, one of the most beneficial types of Medicare Advantage plans. For clients that just qualify based on a disability, a Chronic Condition Special Needs Plan (C-SNP) might do.
However, many in this group are eligible for both Medicare and Medicaid, due to their disabilities and lower incomes, and are therefore able to enroll in Dual Eligible Special Needs Plans (D-SNPs).
According to AHIP, the under-65 dually eligible group comprises 35.7 percent of Medicare Advantage enrollments! D-SNPs are low-cost Medicare Advantage plans that are not only extremely beneficial for clients, since they enable more coordinated care, but equally so for the agents who sell them.
Being contracted to sell D-SNPs allows agents to continue selling to more clients outside of the Annual Enrollment Period, during lock-in! This is an invaluable opportunity for insurance agents to increase their sales and commissions and serve the underserved and less privileged who need the best possible Medicare plans they can afford.
Part D Opportunities
A stark contrast between these groups, and where more sales opportunities outside of AEP arise, the under-65 group’s eligibility for prescription drug plans (PDP).
Although guaranteed issue rights are different for the under-65 population than they are for seniors, this population could still benefit from these plans if they qualify. Although federal law does not require carriers to issue PDP plans to those under-65, there are several states that require at least one policy be available for younger clients.
Insurance agents can offer a variety of different MAPD or PDP plans to their clients who may be overpaying for, or are unhappy with, the current coverage they carry for their prescriptions.
By educating clients on their options, apart from Original Medicare, you could make an invaluable impact on your community and improve the lives and health of these individuals!
The Takeaway
While it may not be on the top of your list as a Medicare insurance agent to market and sell to those under the age of 65, you could be missing out on commissions from a market in your area that would benefit greatly from the products you sell.
Moreover, you could be helping improve your community by providing more Medicare coverage options for your disabled, underserved, and disenfranchised neighbors.
There’s no greater impact one can have than helping those less fortunate than themselves, and as an insurance agent you are in the perfect position to do so!
If you’re ready to learn more about how you can sell to the under-65 market in your area, contact our Sales team today or register with Ritter to learn more.
Not affiliated with or endorsed by Medicare or any government agency.
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