What you'll learn
- After 24 months of Social Security disability benefits, you get Parts A and B automatically.
- People with ALS get Medicare the month disability benefits start. Kidney failure (ESRD) has its own timeline.
- In Texas, people under 65 on Medicare because of a disability have a 6-month window after enrolling in Part B to buy Medigap Plan A. Texans with ESRD or ALS have broader rights under a 2025 state law.
- Turning 65 opens a new Medigap Open Enrollment Period.
Most people think of Medicare as a 65th-birthday milestone. But many Texans qualify earlier because of a disability, ALS, or kidney failure. If that's you, or someone you care for, the rules work a little differently, and Texas has its own twist on Medigap.
Three paths to Medicare before 65
| Situation | When Medicare starts |
|---|---|
| Social Security Disability Insurance (SSDI) | After you've received disability benefits for 24 months |
| ALS (Lou Gehrig's disease) | The same month your disability benefits begin |
| End-stage renal disease (ESRD) | Usually the first day of the fourth month of dialysis. It can start sooner with home dialysis training or a kidney transplant |
If kidney failure is your path to Medicare, our guide to Medicare and dialysis in Texas explains coverage, costs, and the state's Kidney Health Care program.
Enrollment is usually automatic
If you qualify through SSDI, you don't have to file a separate Medicare application. Medicare mails a welcome package with your card 3 months before your Part A and Part B coverage begins.
Part A is premium-free for most people in this situation. Part B has a monthly premium, $202.90 in 2026, plus a $283 yearly deductible. The 2027 amounts are announced each fall. Part B is optional, but turning it down without other qualifying coverage can lead to a late enrollment penalty later, so talk it through with Social Security (1-800-772-1213) before you decide. You can learn more in our guide to the Part B late enrollment penalty.
ESRD works differently. If you have kidney failure, you generally apply through Social Security rather than being enrolled automatically.
Filling the gaps in Original Medicare
Original Medicare pays most of the bill, but you're responsible for the Part B 20% coinsurance, and there's no yearly cap on what that can add up to. Texans under 65 generally look at these options:
- Medicare Advantage. If you have Parts A and B and live in a plan's service area, you can join regardless of age. These plans have a yearly out-of-pocket maximum, and many include drug coverage. Compare them in Medicare Advantage vs. Original Medicare in Texas.
- Medigap, if you can buy it (see the Texas rules below).
- Medicare Savings Programs through Texas Health and Human Services, if your income and resources qualify. These can pay your Part B premium and sometimes more. See how Texans can get help with the Part B premium.
- QDWI, a Texas Medicare Savings Program that can pay the Part A premium for some working people under 65 with disabilities who have to pay for Part A.
The Texas Medigap rules
Federal law doesn't guarantee people under 65 the right to buy a Medigap policy. Texas adds some protection, regulated by the Texas Department of Insurance (TDI):
- Disability: People under 65 with disability-based Medicare get a 6-month open enrollment period beginning when they enroll in Part B. TDI says this right applies only to Medigap Plan A.
- ESRD or ALS: Under Texas House Bill 2516, which took effect September 1, 2025, companies that sell Medigap to people 65 and older must offer the same coverage to people under 65 on Medicare because of ESRD or ALS. Plans A, B, and D must be priced at the 65-and-older rate, and other plans can't cost more than 200% of it. The enrollment window is six months starting with the first month of Part B.
Turning 65 gives you a fresh start
When you reach 65, your Medicare continues without interruption. TDI notes that people who got Medicare because of a disability get another Medigap open enrollment period during the first six months after turning 65. During that window you may be able to choose from more Medigap plans. Our turning 65 in Texas guide covers what to expect.
Free, unbiased help
The Texas Health Information, Counseling and Advocacy Program (HICAP) offers free Medicare counseling, including for people under 65. Call 1-800-252-9240. If you're far from a city, HICAP can help by phone, which can save a long drive. If you prefer to talk in Spanish, ask whether a Spanish-speaking counselor is available.
Common questions
Do I have to sign up for Medicare if I'm on SSDI?
Usually not. Medicare says you get Parts A and B automatically after receiving disability benefits for 24 months, and your welcome package with your Medicare card is mailed about 3 months before coverage starts. Part B is optional, so you can contact Social Security if you have other coverage and want to talk through whether to keep it.
Can I buy a Medigap policy in Texas if I'm under 65?
The Texas Department of Insurance says people under 65 with disability-based Medicare get a 6-month open enrollment period starting when they enroll in Part B, and that right applies to Medigap Plan A. Under a 2025 Texas law, people under 65 with ESRD or ALS must be offered the same Medigap coverage sold to people 65 and older.
What happens to my Medicare when I turn 65?
Your coverage continues. The Texas Department of Insurance notes that people who got Medicare because of a disability have another Medigap open enrollment period during the first six months after turning 65.
Sources
- Medicare.gov: I'm getting Social Security benefits before 65
- Medicare.gov: End-Stage Renal Disease (ESRD)
- Social Security: Medicare (publication 05-10043)
- Medicare.gov: Medicare costs
- Texas Department of Insurance: Medicare supplement insurance guide
- Texas Legislature: HB 2516 (89th Legislature), enrolled bill text
- Medicare.gov: Medicare Savings Programs
- Texas HHS: Medicare (HICAP and Medicare Savings Programs)
- Social Security: Sign up for Medicare
