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Selling Medicare for People Under 65: Qualifying Disabilities

By  Senior Market Advisors  on March 26, 2019

AEP is likely your busiest season, but there are several ways to sell Medicare outside of AEP. Those who are under 65 and receive Social Security Disability Insurance are often eligible for Medicare and have a SEP. If you are looking to make more sales and add to your book of business, you need to understand the role of qualifying disabilities with Medicare for people under 65.

What Disabilities Qualify for Medicare Under 65?

Most people are not eligible for Medicare until they turn 65, but that’s not the case for those with a long-term disability or disease. Did you know roughly 9.1 million people under 65 with disabilities are enrolled in Medicare due to ESRD, ALS, and other qualifying conditions?

ESRD and Medicare

Medicare for ESRD can provide coverage for permanent kidney failure and help with the costs of dialysis or kidney transplant. To be eligible, a beneficiary must be diagnosed with end-stage renal disease (ESRD) and qualify for SSDI (Social Security Disability Insurance) or Social Security retirement benefits/railroad retirement benefits based on their work history.

Original Medicare covers a kidney transplant, hospital inpatient dialysis, and outpatient dialysis from free-standing facilities and hospitals. However, Medicare does not cover surgeries or services leading up to dialysis. Fortunately, you can enroll beneficiaries in Chronic Special Needs Plans (CSNPs).

ALS and Medicare

If someone under 65 has been diagnosed with ALS, also known as Lou Gehrig’s Disease, they will be automatically enrolled in Medicare Part A and B the first month they receive Social Security Disability Insurance (SSDI) or a railroad disability annuity check.

Medicare coverage for ALS includes hospital, hospice, skilled nursing, and home health services through Part A. Preventative services, mental health, lab tests, x-rays, emergency transportation, and medical equipment are covered through Part B.

Once a beneficiary is automatically enrolled, they are eligible for a Medicare Advantage or Part D plan. Plus, some beneficiaries may be eligible to enroll in a Medicare Supplement plan, depending on their location.

Other Qualifying Disabilities

Beneficiaries are automatically enrolled in Original Medicare (Part A and B) after they have received Social Security disability benefits for 24 months or have certain disability benefits from the RRB for 24 months. They will get their red, white, and blue Medicare card in the mail 3 months before their 25th month of disability.

The following is a list of qualifying impairments with relevant examples.

  • Musculoskeletal disorders (back injuries and joint/bone dysfunction)
  • Cardiovascular conditions (heart failure and coronary artery disease)
  • Senses and speech issues (vision and hearing loss)
  • Respiratory illnesses (COPD, cystic fibrosis, or asthma)
  • Neurological disorders (cerebral palsy and epilepsy)
  • Immune system disorders (HIV/Aids, lupus, and rheumatoid arthritis)
  • Mental disorders (PTSD, Schizophrenia, autism, and anxiety)
  • Skin disorders (cellulitis and dermatitis)
  • Digestive tract problems (Crohn’s disease, hepatitis, and liver disease)
  • Kidney problems (ESRD and genitourinary problems)
  • Cancer (Breast cancer, prostate cancer, etc.)
  • Hematological disorders (sickle cell disease, hemophilia, and bone marrow failure)

Please note, each condition and qualifying situation is unique, and we can not guarantee qualification or coverage. If a beneficiary’s impairment is not on this list, they may still be eligible for disability benefits under other SSA guidelines.

How to Sell Medicare for People Under 65

At Senior Market Advisors, we make sure our agents are equipped with the necessary tools to succeed and make the most sales. We offer a custom-built CRM system, Medicare Supplement quote engine, in-house marketing team, and so much more. Plus, we offer online sales training, a sales support team, and top-tier commissions. Ready to contract? Visit to start digitally contracting!