There’s an official list of conditions, plus a process to qualify if your condition isn’t on the list.
Alex Rosenberg
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Alex Rosenberg is a NerdWallet writer focusing on Medicare and information technology. He has more than 10 years of experience researching and writing about health care, insurance, technology, data privacy and public policy. His research has supported lawmakers in the Wisconsin State Legislature as well as health systems and national health authorities in the U.S. and more than 10 other countries. He is based in Eau Claire, Wisconsin.
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To qualify for Medicare under age 65, you generally need to have a disability that makes you unable to work for at least a year. Examples include certain cancers, respiratory illnesses and musculoskeletal disorders.
The disability requirements come from the Social Security Disability Insurance program, or SSDI. You first need to qualify for SSDI to become eligible for Medicare based on disability .
The Social Security Administration, or SSA, calls its definition of disability “strict.” But there still are some options if your condition doesn’t appear on the official list to qualify for SSDI.
The Social Security Administration administers two income assistance programs for people with disabilities: Social Security Disability Insurance, or SSDI, and Supplemental Security Income, or SSI.
While they have similar names and purposes, the two programs don’t work the same when it comes to Medicare. SSDI can qualify you for Medicare under age 65. In most states, SSI can qualify you for Medicaid , instead.
There’s no exhaustive list of conditions that do or don’t qualify for SSDI. For adults, the SSA has a list of impairments in 14 categories that might qualify for SSDI if they’re sufficiently severe.
Examples of individual impairments on the list include limb amputations, post-traumatic stress disorder, chronic heart failure, loss of speech and chronic liver disease. Meeting certain clinical and functional criteria on the list is one way to qualify for SSDI.
Not having a condition on the list doesn’t mean you can’t qualify. There’s also a process to determine whether other conditions are severe enough to meet the SSA’s requirements.
There’s a five-step process to determine whether your condition meets the required definition to qualify for the SSDI program. If you qualify for SSDI, you can later become eligible for Medicare based on disability.
Here are the five questions the SSA uses to evaluate the disability status for SSDI applicants [0]
If you’re working, there’s an income cap to qualify for SSDI. In 2023, you generally can’t make more than $1,470 per month. If you’re blind, it’s $2,460 per month [0]
Social Security Administration . Disability Benefits: Are You Working?. Accessed May 12, 2023.Your condition must significantly limit your ability to do “basic work activities” for at least 12 months because of changes to things like strength, mobility or memory.
The SSA has lists of medical conditions for adults and children that it considers potentially severe enough to prevent you from working, organized by body system.
If your condition is on the list and you satisfy the first two questions, you have a qualifying disability. The next questions don’t apply.
If your condition isn’t on the list, you’re not necessarily disqualified. The SSA has to determine whether your condition is as severe as those that are on the list. If so, you will continue through the process.
If your condition isn’t on the list, the SSA considers whether it prevents you from performing any of the work you’ve done in the past. If so, you continue through the process.
If your condition prevents you from doing work you’ve done before, the SSA also considers whether there are other kinds of work you could still do.
Your medical condition isn’t the only factor here. The SSA also considers age, education, work experience and skills.
If there’s no other work you could do, then you have a qualifying disability.
You must have a qualifying disability to receive SSDI benefits, which can make you eligible for Medicare based on disability. But having a qualifying disability isn’t enough on its own. SSDI also has requirements for your work history.
The SSA measures work history with the same Social Security work credits needed for Social Security retirement benefits.
Most people applying for SSDI need 40 work credits, or 10 years of work, to qualify. A work credit is a metric used by the federal government to measure time in the workforce; one credit is equal to a quarter of work, subject to certain income minimums. Half of that qualifying work — 20 credits’ worth, or five years — needs to have been within the 10 years before the year your disability began [0]
Social Security Administration . Disability Benefits: How Much Work Do You Need?. Accessed May 12, 2023.
You can earn a maximum of four credits per year. In 2023, you earn one credit for every $1,640 in wages or self-employment income. You would need to make $6,560 to earn all four credits in 2023.
The number of work credits you need depends on your age. If you’re under 60, you can qualify for SSDI with fewer than 40 work credits.
After you become entitled to SSDI benefits, there’s generally a 24-month waiting period before you qualify for Medicare based on disability [0]
Social Security Administration . Medicare Information. Accessed May 12, 2023.There are special exceptions for people who receive SSDI benefits and have certain conditions.
If you have amyotrophic lateral sclerosis, or ALS, you become eligible for Medicare the first month you receive SSDI benefits.
If you have end-stage renal disease, or ESRD, you generally become eligible for Medicare on the first day of the fourth month of your dialysis treatments. It could be sooner if you undergo training for home dialysis.
If you have ESRD and you’re getting a kidney transplant, you become eligible for Medicare the month you’re admitted to a Medicare-certified hospital for the transplant. You’re covered for a maximum of two months before the transplant takes place, so your eligibility might change if the transplant is delayed or rescheduled.
Medicare Advantage is an alternative to traditional Medicare offered by private health insurers. It covers the same benefits as Medicare Part A and Part B.
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Average Medicare star rating, weighted by enrollment. Star ratings are determined by the Centers for Medicare & Medicaid Services (CMS).
Get a quote on NerdWalletWe will connect you with Medicare companies based on the information you provide. They will help you find a plan that suits your needs. If you prefer to speak to a licensed insurance agent right away, please call the number listed.
States available 49 states, Washington, D.C., and Puerto Rico Members in high-rated plans High (90% or more) Member satisfaction Above average (855) 432-0512 M-F 9am-9pm ET, Sa 10am-9pm ET Speak to a licensed insurance agent on askchapter.org See more plans About the authorYou’re following Alex Rosenberg
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Alex is a NerdWallet writer focusing on Medicare and information technology. He has written about health, tech, and public policy for over 10 years. See full bio.
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