Not everyone receives Medicare — you must meet specific age or disability requirements set by the federal government

Medicare is available to people who are 65 or older, people under 65 with certain disabilities, and people of any age with end-stage renal disease (ESRD) or ALS. If you don't fall into one of these categories, you won't be covered by Medicare, even if you've paid taxes your whole life. The program is federal and the rules are the same everywhere in the United States.

Many people assume that because they've worked and paid Medicare taxes, they're automatically may have access to to Medicare. That's not quite how it works. You do need a work history to may have access to — generally 40 quarters of coverage, which is about 10 years of work — but the age or disability requirement is separate. Meeting one doesn't automatically mean you meet the other.

Key Takeaways

  • You must be 65 or older, under 65 with a may have access to disability, have end-stage renal disease, or have ALS to receive Medicare.
  • Having paid Medicare taxes through your job does not may provide Medicare coverage if you don't meet the age or medical condition requirements.
  • If you're under 65 and disabled, you typically must have been receiving Social Security Disability Insurance (SSDI) for 24 months before Medicare begins.
  • People who don't may have access to for Medicare may have other coverage options through their employer, the Affordable Care Act marketplace, or Medicaid.

Age 65 and older: the main path to Medicare

The largest group of Medicare recipients are people who turn 65. You become may be able to access for Medicare the month you turn 65, regardless of whether you're still working. You don't have to retire or stop earning income.

To may have access to at 65, you need at least 40 quarters of Medicare-covered work history. A quarter is roughly three months, so 40 quarters equals about 10 years. If you don't have 40 quarters yourself, you may still may have access to based on your spouse's work history, even if you're divorced (as long as the marriage lasted at least 10 years).

You can sign up for Medicare starting three months before you turn 65. If you miss that window, you can still sign up, but you may face a permanent penalty on your Part B premium if you delay without a valid reason.

Under 65 with a disability: the 24-month waiting period

If you're under 65 and have a disability that prevents you from working, you may may have access to for Medicare through the Social Security Disability Insurance (SSDI) program. However, there's a waiting period: you must have been receiving SSDI for 24 months before Medicare coverage begins.

This means if you're approved for SSDI today, you won't be may be able to access for Medicare until two years from now. During that gap, you'll need other coverage — through a former employer, a spouse's plan, the Affordable Care Act marketplace, or Medicaid, depending on your state and income.

The Social Security Administration determines whether your condition qualifies as a disability under their rules. This is different from other definitions of disability — for example, you might may have access to for disability benefits through your employer's insurance but not for SSDI, or vice versa.

End-stage renal disease and ALS: when ready Medicare access

Two medical conditions bypass the age and work-history requirements: end-stage renal disease (ESRD) and amyotrophic lateral sclerosis (ALS, also called Lou Gehrig's disease). If you have either condition, you become may be able to access for Medicare when ready, regardless of your age or how long you've worked.

For ESRD, may be able to access begins the month you start dialysis or the month you have a kidney transplant, whichever comes first. For ALS, may be able to access begins the month you're approved for SSDI, with no 24-month waiting period — this is the only disability category with when ready Medicare access.

What happens if you don't may have access to for Medicare

If you're under 65 and don't have a may have access to disability, ESRD, or ALS, Medicare is not an option for you. You'll need to find coverage elsewhere. Your options depend on your age, income, and employment status.

If you're still working, your employer may offer health insurance. If not, you can shop for coverage through the Affordable Care Act (ACA) marketplace during the open enrollment period (usually November through January). Depending on your income, you may receive a tax credit to lower your monthly premium.

If your income is very low, you may may have access to for Medicaid, which is run by your state. Medicaid rules vary widely by state — some states cover more people than others, and income limits differ. You can check whether you might may have access to through your state's Medicaid office or through Healthcare.gov.

Immigrants and Medicare may be able to access

To may have access to for Medicare, you must be a U.S. citizen or a lawful permanent resident (green card holder) who has lived in the United States for at least five years. If you're in the U.S. on a temporary visa or are undocumented, you don't may have access to for Medicare.

If you're a lawful permanent resident and meet the age or disability requirements, you can enroll in Medicare. You'll need to provide proof of your immigration status when you sign up.

Government workers and railroad employees

Most government employees and railroad workers are covered by Medicare under the same rules as everyone else. However, some federal employees hired before 1984 may be covered by the Federal Employees Health Benefits Program (FEHB) instead of Medicare, or in addition to it.

Railroad employees are covered by a separate system called the Railroad Retirement Board (RRB), which provides benefits similar to Social Security and Medicare. If you worked for the railroad, contact the RRB directly to understand your coverage.

Frequently Asked Questions

Can I get Medicare if I've never worked?

No, you need at least 40 quarters of Medicare-covered work history to may have access to at 65. However, if you're married or were married for at least 10 years, you may may have access to based on your spouse's work record, even if you never worked yourself.

If I'm 64 and disabled, can I get Medicare now?

Only if you've been receiving SSDI for 24 months already. If you're newly approved for SSDI at 64, you'll have to wait until you're 66 (24 months later) for Medicare to begin. Until then, you'll need other coverage.

What if I worked in another country — does that count toward Medicare?

Work outside the United States generally does not count toward the 40 quarters needed for Medicare. However, some countries have agreements with the U.S. Social Security Administration that allow certain work to be credited. Contact Social Security to ask about your specific situation.

Can I be denied Medicare if I have a pre-existing condition?

No. Once you meet the age or medical requirements for Medicare, you cannot be denied coverage based on your health status or medical history. Pre-existing conditions are fully covered from day one.

Do I have to be a U.S. citizen to get Medicare?

You must be a U.S. citizen or a lawful permanent resident who has lived in the U.S. for at least five years. Temporary visa holders and undocumented immigrants do not may have access to for Medicare.