The Basic Rules for Medicare

You can get Medicare if you are 65 or older, or if you are under 65 and have received Social Security Disability Insurance (SSDI) for 24 months, or if you have end-stage renal disease or ALS. Most people also need to be a U.S. citizen or a lawful permanent resident who has lived in the country for at least five years. If you worked and paid Medicare taxes, you may not need to pay a monthly premium for Part A (hospital insurance). If you did not work long enough, you can still get Medicare but will pay a premium.

The key is that Medicare is tied to either your age, your disability status, or a specific serious illness — not to your income or health condition. You do not have to be poor to get it, and you do not have to be sick (though being sick does not disqualify you). If you turn 65 next month, you are on track to get Medicare. If you have been on disability for two years, you are already may be able to access. The rules are the same whether you are retired, still working, or have never worked.

Key Takeaways

  • You are may be able to access for Medicare at 65 if you are a U.S. citizen or lawful permanent resident who has lived here for five years.
  • If you worked and paid Medicare taxes for at least 10 years (40 quarters), you will not pay a monthly premium for Part A hospital coverage.
  • You can get Medicare before 65 if you have received SSDI for 24 months, have end-stage renal disease, or have ALS.
  • You should sign up for Medicare in the three months before you turn 65, even if you are still working, to avoid paying a penalty later.
  • If you are not sure whether you have worked long enough, you can check your Social Security earnings record online or call Social Security to ask.

Age 65 and Citizenship Requirements

The simplest path to Medicare is turning 65. 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 consecutive years. The five-year clock starts from the date your green card was issued, not from the date you entered the country. If you became a citizen, the five-year requirement does not explore — citizenship alone is enough.

If you are not yet a citizen or permanent resident, you cannot get Medicare based on age alone, even if you have lived and worked here for decades. You would need to meet one of the other pathways: disability, end-stage renal disease, or ALS. Some people in this situation may have other coverage through their employer or through a state program, so it is worth asking your doctor's office or a local health department what options exist where you live.

Work History and Medicare Part A Premiums

Medicare Part A covers hospital stays, skilled nursing care, and hospice. If you or your spouse worked and paid Medicare taxes for at least 10 years (40 quarters), you will not pay a monthly premium for Part A. A quarter is roughly three months, so 40 quarters is about 10 years of work. You do not have to have worked those 10 years in a row — the quarters can be spread across your whole working life.

If you did not work 10 years, or if your spouse did not and you are relying on their work record, you can still get Medicare Part A at 65, but you will pay a monthly premium. The amount depends on how many quarters you did work. If you worked between 30 and 39 quarters, your premium will be lower than if you worked fewer than 30 quarters. You can check your own work record by creating an account on ssa.gov and viewing your Social Security statement, or by calling Social Security at 1-800-772-1213.

Self-employed people and people who worked "under the table" may have gaps in their record. If you paid self-employment tax, those quarters should be recorded. If you did not, those years will not count toward the 10-year requirement. It is worth checking your record before you turn 65 so you know what to expect.

Disability and Medicare Before 65

If you are under 65 and have been receiving SSDI for 24 months, you become may be able to access for Medicare automatically. You do not have to do anything — Social Security will enroll you. The 24 months starts from the date your disability benefits began, not from the date you applied. If you were approved for benefits in January, your Medicare coverage will start in March of the following year (24 months later).

You must have been approved for SSDI itself, not Supplemental Security Income (SSI). These are different programs. SSDI is based on your own work record or your parent's work record if you became disabled before 22. SSI is a needs-based program for people with low income and resources. If you receive SSI, you do not automatically get Medicare, though you may be able to purchase it. Ask your Social Security representative which program you are on if you are not sure.

End-Stage Renal Disease and ALS

If you have end-stage renal disease (ESRD) — kidney failure that requires dialysis or a transplant — you can get Medicare regardless of your age or work history. Your coverage can start as soon as the month you begin dialysis treatment, or the month you have a kidney transplant, or the month your doctor determines you need dialysis (whichever comes first). You do not have to wait for a specific age.

If you have amyotrophic lateral sclerosis (ALS, also called Lou Gehrig's disease), you can get Medicare when ready upon diagnosis, with no age requirement and no work history requirement. You do not have to wait 24 months as you would with other disabilities. Your coverage begins the first month you are may be able to access, and Social Security will handle the enrollment.

For both ESRD and ALS, you will still need to be a U.S. citizen or lawful permanent resident. If you have one of these conditions and are not yet a citizen, contact your local Social Security office to discuss your options.

What to Do If You Are Not Sure About Your Work History

The easiest way to check your work record is to go to ssa.gov, create a "my Social Security" account, and view your Social Security statement. This shows all the quarters you have been credited with, year by year. You can see exactly how many quarters you have and whether you are close to 10 years. If you see an error — a year you worked but it is not listed — you can request a correction by mail with proof of earnings (a W-2 or tax return).

If you do not want to create an online account, you can call Social Security at 1-800-772-1213 and ask a representative to tell you how many quarters you have. They can also tell you whether you are may be able to access for Medicare based on your work record, and what your Part A premium would be if you did not work the full 10 years. This call is free and takes about 15 minutes.

If you worked for a railroad, your work record may be handled by the Railroad Retirement Board instead of Social Security. If you think this applies to you, call the Railroad Retirement Board at 1-877-772-5772.

When to Sign Up for Medicare

You should sign up for Medicare in the three months before you turn 65. This is called your Initial Enrollment Period, and it runs from three months before your birthday month through three months after. For example, if you turn 65 in June, your enrollment period is March through September. If you sign up during this window, your coverage will start on the first day of your birthday month.

If you miss this window, you can still sign up later, but you may pay a penalty. For every year you delay signing up for Part B (doctor and outpatient care) or Part D (prescription drugs) after you turn 65, your monthly premium goes up by 10 percent for as long as you have Medicare. This penalty does not go away. The only exception is if you had health insurance through an employer while you were still working — in that case, you have a grace period to sign up without penalty.

You can sign up online at Medicare.gov, by phone at 1-800-MEDICARE (1-800-633-4227), or in person at your local Social Security office. If you are already receiving Social Security benefits, you may be enrolled automatically at 65, but you should check your mail to confirm.

Frequently Asked Questions

Can I get Medicare if I am not a U.S. citizen?

You can get Medicare if you are a lawful permanent resident (green card holder) and have lived in the United States for at least five consecutive years. If you have ESRD or ALS, the same citizenship rule applies. If you are not a permanent resident, you cannot get Medicare based on age or most disabilities, though some states offer coverage to immigrants through their own programs.

What if I worked in another country before I moved to the United States?

Work you did in another country does not count toward the 10-year requirement for Medicare Part A. Only work you did in the United States, where you paid Medicare taxes, counts. If you worked in Canada or another country with a social security agreement with the U.S., you may be able to combine your work records — ask Social Security about this.

If my spouse worked long enough, can I get Medicare without paying a premium?

Yes. If your spouse worked and paid Medicare taxes for at least 10 years, you can get Medicare Part A without a premium at 65, even if you did not work that long yourself. You must be married and at least 65 years old. If you are divorced, you can use your ex-spouse's record if you were married for at least 10 years and are at least 62.

Do I have to be retired to get Medicare at 65?

No. You can still be working and get Medicare at 65. In fact, you should sign up even if you are still working and have employer coverage, because waiting can result in a penalty later. If you have employer coverage, you may be able to delay Part B without penalty, but you should check with your employer's benefits office first.

What happens if I turn 65 while I am on disability?

When you turn 65, your SSDI automatically converts to Social Security retirement benefits. Your Medicare coverage continues without interruption. The amount of your monthly check may change slightly, but your health coverage stays the same.