Three ways to qualify before 65
| Reason | When Medicare starts | How you enroll |
|---|---|---|
| Social Security or Railroad Retirement disability benefits | After 24 months of benefits | Automatic |
| ALS (Lou Gehrig's disease) | The month disability benefits start | Automatic once benefits start |
| End-stage renal disease (ESRD) | Usually the 4th month of dialysis; earlier with home dialysis training or a transplant | Apply through Social Security |
You (or, for ESRD, your spouse or parent) need enough Medicare-covered work. See Medicare eligibility.
Medigap under 65 in North Carolina
North Carolina is one of the states that requires Medigap access before 65, with limits. Under G.S. 58-54-45, if you're eligible for Medicare because of a disability:
- Companies must offer at least Plan A, plus Plan D or Plan G if they sell those plans to people 65 and older.
- You must apply during the 6 months starting with the first month you enroll in Part B. Companies can't turn you down or price you on your health in that window.
- If your Medicare Advantage plan ends, you have 63 days to buy Plan A, D or G from any company.
- Companies may set separate rates for people under 65.
The statute speaks of Medicare "by reason of disability"; if you have Medicare only because of kidney failure, ask the company how it applies to you. At 65 you get a full 6-month open enrollment period. See Medigap in North Carolina.
State Health Plan members on disability Medicare
If you have State Health Plan coverage and become eligible for Medicare because of a disability, the Plan says it becomes secondary as of your Medicare eligibility date, and if you don't take Part B, you're responsible for what Part B would have paid. See State Health Plan retirees and Medicare.
Help with costs
If your income is limited, North Carolina's Medicare Savings Programs (MQB) can pay your Part B premium, and people with Medicare and full NC Medicaid get their Medicaid through NC Medicaid Direct. Apply through ePASS or your county Department of Social Services; see Medicare Savings Programs in North Carolina and NC Medicaid and Medicare. To review plans from the companies they work with, you can request a call from a licensed insurance agent.
Related questions
How do I sign up for Medicare in North Carolina?
Online, by phone or in person.
What if I miss my enrollment period?
Penalties and your next chance.
Can I get Medigap under 65 in North Carolina?
What state law requires.
Sources
- Social Security — Sign up for Medicare
- Medicare.gov — End-stage renal disease (ESRD)
- eCFR — 42 CFR Part 406, hospital insurance eligibility and entitlement
- North Carolina General Assembly — G.S. 58-54-45, Medigap by reason of disability
- State Health Plan — Retiree presentation (Medicare due to disability)
- NC Medicaid — North Carolina expands Medicaid
More questions in this guide
- Do I need Medicare Part B if I'm still working at 65 in North Carolina?
- How do I sign up for Medicare in North Carolina?
- What are the Medicare deadlines in North Carolina for 2027?
- What happens if I miss my Medicare enrollment period in North Carolina?
- When should I sign up for Medicare if I'm turning 65 in North Carolina?
Part of the guide: Medicare enrollment periods in North Carolina · All questions
Frequently asked questions
Do I have to sign up for Medicare if I get SSDI?
No. Social Security enrolls you in Part A and Part B automatically after 24 months of disability benefits and mails your card about 3 months ahead. You can turn down Part B, but if you have no job-based coverage from current work, you may owe a late penalty later.
Which Medigap plans can I buy under 65 in North Carolina?
If you have Medicare because of a disability, G.S. 58-54-45 requires companies to offer at least Plan A, and Plan D or G if they sell those to people 65 and older, without health questions during the 6 months after you first enroll in Part B. Companies may charge people under 65 different rates.
Does NC Medicaid expansion cover me if I'm on Medicare?
No. The expansion that began December 1, 2023 covers adults 19 to 64 who don't have Medicare. With Medicare, you may still qualify for full NC Medicaid or a Medicare Savings Program (MQB) through other eligibility groups.
What happens when I turn 65?
You get a new chance to choose Medicare plans and a new, full 6-month Medigap open enrollment period, when companies must sell you any policy they offer regardless of your health.
Medicare in your North Carolina county
Plans, local agents and help, county by county: Wake · Mecklenburg · Guilford · Forsyth · Durham · Cumberland · Buncombe · Union · Johnston · Cabarrus · New Hanover · Gaston · Onslow · Iredell · Alamance · Pitt · Davidson · Brunswick · Catawba · Rowan · All 100 counties →
