Not everyone gets Medicare, and age alone does not may provide it

Medicare is available to people 65 and older, but you must also meet one of three additional conditions: you must have worked and paid Medicare taxes for at least 10 years (or be married to someone who did), you must be receiving Social Security Disability Insurance (SSDI), or you must have end-stage renal disease or ALS. If you turn 65 and do not meet any of these conditions, you will not be enrolled in Medicare automatically, and you cannot purchase it on your own. Some people in this situation may be covered by Medicaid instead, depending on their state and income.

The work requirement is the most common barrier. You need 40 credits of work history under Social Security — roughly 10 years of paid employment. If you worked but did not pay into Social Security (for example, as a federal employee hired before 1984, or in certain religious communities), you may not have the credits you need. If you are a non-citizen, you must also be a lawful permanent resident or have been admitted for humanitarian purposes to be covered.

Key Takeaways

  • You must be 65 or older and have 40 Social Security work credits (about 10 years of paid work), or be on SSDI, or have end-stage renal disease or ALS.
  • If you do not meet these conditions at 65, you cannot buy Medicare later — you are permanently ineligible unless your circumstances change.
  • Some people who do not meet Medicare requirements may be covered by Medicaid, which varies by state and income.
  • Non-citizens must be lawful permanent residents or have been admitted for humanitarian purposes to be covered by Medicare.
  • If you worked but not under Social Security (such as some federal employees or clergy), you may not have the credits you need even if you are 65.

The work credit requirement: what counts and what does not

One credit is earned for each quarter of the year in which you earned at least a minimum amount of income (the threshold changes yearly). Most people earn four credits per year. You need 40 credits total, which typically takes 10 years of work, but the work does not have to be recent — credits earned 30 years ago count just as much as credits earned last year.

Work that counts toward credits includes any job where you paid Social Security and Medicare taxes — W-2 employment, self-employment income reported on a Schedule C, and some agricultural work. Work that does not count includes informal cash work with no tax reporting, work as a federal employee before 1984, work for some state or local governments that did not participate in Social Security, and work for certain religious organizations that have exemptions.

You can check your own work record by creating an account on ssa.gov and viewing your Social Security Statement. This statement shows the credits you have earned and estimates your future benefits. If you see errors, you can request a correction, though you must do so within a set time frame.

Who is covered before age 65

You can receive Medicare before 65 if you have been receiving SSDI for 24 consecutive months. SSDI is a program for people who cannot work due to a disability that is expected to last at least 12 months or result in death. You do not need to be 65 to be covered — you can be any age — but you must have been approved for SSDI first, and then you must wait 24 months from the month your benefits began.

People with end-stage renal disease (ESRD) — permanent kidney failure requiring dialysis or a transplant — are covered by Medicare regardless of age or work history. Similarly, people diagnosed with amyotrophic lateral sclerosis (ALS) are covered when ready, without the usual waiting period. These are the only two conditions that override the age and work requirements.

Non-citizens and immigration status

Non-citizens can receive Medicare, but only if they are lawful permanent residents (green card holders) or have been admitted to the United States for humanitarian purposes (such as refugees or asylees). Undocumented immigrants are not covered by Medicare. Temporary visa holders — such as people on H-1B, L-1, or student visas — are not covered, even if they have worked and paid taxes.

If you are a non-citizen and believe you meet the requirements, you will need to provide proof of your immigration status when you first contact Social Security. Acceptable documents include a green card, a refugee travel document, or an asylee travel document. If you are unsure of your status or how it affects your coverage, you can contact Social Security directly at 1-800-772-1213.

What happens if you do not meet the requirements

If you reach 65 and do not have 40 work credits, you cannot purchase Medicare coverage. There is no way to buy in later, and there is no appeal process that can override the requirement. Your only options are to continue working to earn more credits (if you are still employed), to rely on coverage through a current or former employer, or to look into Medicaid.

Medicaid is a joint federal-state program that covers low-income people of any age. The income limits and coverage rules vary significantly by state. Some states have expanded Medicaid to cover more people; others have not. If you do not meet Medicare requirements, contact your state Medicaid office or call 211 to find out whether you might be covered under your state's Medicaid program.

If you are still working, you may also have health coverage through your employer. Some employers continue to cover retirees, though this is becoming less common. Check your employee handbook or contact your HR department to see what coverage is available to you after you leave work.

Immigrants who worked under an ITIN

Some non-citizens worked in the United States using an Individual Taxpayer Identification Number (ITIN) rather than a Social Security number. If you paid taxes this way, those years of work do not count toward the 40 credits needed for Medicare. The Social Security Administration does not recognize ITIN work history for Medicare purposes, even though you paid into the system.

If you later became a lawful permanent resident and obtained a Social Security number, you can earn new credits going forward, but your earlier ITIN work years will not be credited retroactively. This is a significant barrier for some immigrants who worked for many years before obtaining legal status.

Government employees and special cases

Federal employees hired before 1984 were not required to pay into Social Security and Medicare. If you are in this group, you are not covered by Medicare based on your federal work history. You may instead be covered by the Federal Employees Health Benefits Program (FEHB) or the Federal Employees Retirement System (FERS). When you retire, you should contact your federal HR office to understand what health coverage you are may have access to to.

Some state and local government employees also did not pay into Social Security. If you worked for a state or local government and were not covered by Social Security, your work does not count toward the 40 credits. You should contact your state or local retirement system to find out what health coverage you are may have access to to as a retiree.

Frequently Asked Questions

Can I get Medicare if I am 65 but have only 30 work credits?

No. You must have exactly 40 credits. If you have 30 credits and are no longer working, you cannot receive Medicare. If you are still employed, you can continue working to earn the additional 10 credits you need, which typically takes about 2.5 more years.

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

Work outside the United States does not count toward your 40 credits, even if you paid taxes in that country. Only work performed in the United States while paying into Social Security counts. Some countries have agreements with the U.S. Social Security Administration that allow credits to be combined, but this is rare and applies only to specific countries.

If I am denied Medicare, can I appeal the decision?

You can request that Social Security review your work record and the credits they have on file for you. However, if your work history genuinely does not meet the 40-credit requirement, there is no appeal that will overturn the decision. You can only appeal if you believe Social Security made an error in counting your credits.

Am I covered by Medicare if my spouse has 40 credits but I do not?

Yes, if you are 62 or older and married to someone who is covered by Medicare. You can receive Medicare as a spouse even if you have no work credits of your own. You must have been married for at least one year, or be the parent of your spouse's child.

What if I worked but my employer did not report my income to Social Security?

You can request that Social Security add those earnings to your record if you have proof — such as old W-2 forms, pay stubs, or tax returns. You must request this correction within a specific time frame. Contact Social Security at 1-800-772-1213 to start the process.