Who Qualifies for Medicare and Who Doesn't

Not everyone gets Medicare — it depends on age, work history, and citizenship

Medicare is available to most people 65 and older, but age alone is not enough. You also need to have worked and paid Medicare taxes for a certain number of years, or be a spouse or dependent of someone who did. Some younger people with disabilities or end-stage renal disease can get Medicare too, but the rules are stricter. If you do not meet these conditions, Medicare will not cover you, even if you are a U.S. citizen.

Understanding who qualifies matters because it shapes what insurance you need to look for instead. If you fall outside Medicare's rules, you may need to explore the Health Insurance Marketplace, Medicaid, or employer coverage. Knowing where you stand now — before you turn 65 — helps you plan ahead and avoid gaps in coverage.

Key Takeaways

You must be 65 or older and have worked and paid Medicare taxes for at least 10 years (40 quarters) to get Medicare based on age.
If you are younger than 65, you may still get Medicare if you have been receiving Social Security disability benefits for 24 months, or if you have end-stage renal disease or ALS.
Spouses and ex-spouses of workers who paid Medicare taxes can get Medicare at 65 even if they did not work enough years themselves.
Non-citizens must be lawful permanent residents (green card holders) or have another may have access to immigration status to get Medicare.
If you do not meet Medicare rules, you can look for coverage through Medicaid, the Health Insurance Marketplace, or your employer.

The age and work history requirement

The most common path to Medicare is turning 65 and having worked in a job where you paid Medicare taxes. You need to have earned at least 40 quarters of coverage — that is roughly 10 years of work, though the years do not have to be recent or consecutive. Each quarter you earn a certain amount (the threshold changes yearly), you earn one quarter of coverage, up to a maximum of four per year.

If you worked for an employer, Medicare taxes came out of your paycheck automatically. If you were self-employed, you paid them as part of your self-employment tax. Either way, the Social Security Administration keeps a record. When you turn 65, you can check your work history by creating an account at ssa.gov and viewing your Social Security statement. This shows how many quarters you have earned and whether you are on track.

If you fall short of 40 quarters, you do not get Medicare based on your own work record. You may still be able to get it as a spouse or dependent, or you may need to look at other insurance options.

Medicare for spouses and dependents

You do not have to have worked yourself to get Medicare at 65. If your spouse worked and paid Medicare taxes for 40 quarters, you can get Medicare as a spouse at 65, even if you never worked or worked only a few years. The same applies if you are a divorced ex-spouse — you can claim on your ex's record if you were married for at least 10 years, are at least 65, and are not remarried.

Your spouse or ex-spouse does not have to be on Medicare themselves for you to use their record. They just need to be 62 or older and have the required work history. If your spouse is still working and has not yet signed up for Social Security, you can still claim on their record once you turn 65.

Adult children (age 19 and older) can also get Medicare if they became disabled before age 22 and their parent worked and paid Medicare taxes for 40 quarters. The parent must be at least 62, retired, or deceased.

Medicare for people under 65 with disabilities

If you are younger than 65 and have a disability, you may get Medicare after you have been receiving Social Security Disability Insurance (SSDI) for 24 months. SSDI is a separate program from Medicare, but it is the gateway to Medicare for younger people. You do not have to be on SSDI for a full two years before you can start the process — you can contact Medicare about three months before you hit the 24-month mark.

The disability must be one that Social Security recognizes as severe enough to prevent you from working. Social Security has a list of conditions that automatically may have access to, but you can also be approved for other conditions if you can show you cannot work because of them. The process of getting SSDI itself can take months or even years, so many people do not reach Medicare until their early 30s or later.

If you are denied SSDI, you do not get Medicare through this route. You would need to look at Medicaid or marketplace coverage instead.

Medicare for people with end-stage renal disease or ALS

Two conditions bypass the usual age and disability rules: end-stage renal disease (ESRD) and amyotrophic lateral sclerosis (ALS). If you have ESRD and need dialysis or a kidney transplant, you can get Medicare regardless of age or work history. The same is true if you have been diagnosed with ALS — you become may be able to access for Medicare when ready, without waiting for SSDI approval or any other condition.

For ESRD, Medicare coverage usually starts the month you begin dialysis or the month you have a kidney transplant, whichever comes first. If you are on a transplant waiting list but not yet on dialysis, you may be able to start Medicare earlier — contact your nephrologist or dialysis center to find out. For ALS, coverage starts the month after you are diagnosed and your doctor submits the diagnosis to Social Security.

Citizenship and immigration status requirements

You must be a U.S. citizen or a lawful permanent resident (green card holder) to get Medicare. Some other immigration statuses may also may have access to, but citizenship or a green card is the clearest path. If you are a citizen or green card holder and meet the age or disability requirements, your immigration status does not disqualify you.

If you are not a citizen or green card holder, you cannot get Medicare, even if you have worked and paid Medicare taxes for many years. You would need to look at other coverage options, which vary by state and immigration status. Some states offer Medicaid to certain non-citizens, and the Health Insurance Marketplace may have plans available to you depending on your situation.

What to do if you do not meet Medicare rules

If you are 65 or older but do not have 40 quarters of work history, and you are not a spouse or dependent of someone who does, you do not get Medicare. The same applies if you are younger than 65 and do not have SSDI, ESRD, or ALS. In these cases, you have other options.

Medicaid is a state-run program that covers low-income people of any age. Income limits and coverage vary by state, but many states cover people 65 and older regardless of work history if their income is low enough. You can contact your state Medicaid office or visit medicaid.gov to learn what your state offers.

The Health Insurance Marketplace (healthcare.gov) lets you shop for private insurance plans if you are not on Medicare or Medicaid. You may be able to lower your costs through tax credits if your income is between 100 and 400 percent of the federal poverty level. Open enrollment usually runs from November through January, though you may be able to sign up outside that window if you have a may have access to life event.

If you have access to employer coverage — either your own or through a spouse — that is often the most affordable option. Some employers offer retiree health plans to people over 65 who did not get Medicare, though these are becoming less common.

Frequently Asked Questions

Can I get Medicare if I worked but did not pay Medicare taxes?

It depends on what kind of work you did. If you worked for a railroad, certain government agencies, or as a minister, you may have paid into a different system. Contact the Social Security Administration at 1-800-772-1213 to find out whether your work counts toward Medicare. Some people have a mix of covered and non-covered work, and the covered quarters still count.

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

Work you did outside the United States does not count toward the 40 quarters needed for Medicare, even if you paid taxes on it. Only work in the U.S. where you paid Medicare taxes counts. If you worked in multiple countries, only your U.S. work history matters for Medicare purposes.

Can I get Medicare before 65 if I am retired?

No. Retirement alone does not lower the Medicare age to below 65. You can only get Medicare before 65 if you have been on SSDI for 24 months, have ESRD, or have ALS. If you retire before 65, you will need to find other coverage until you turn 65 and meet the age requirement.

If I am denied Medicare, can I appeal?

If Social Security denies your claim for Medicare, you can ask for reconsideration. The process is the same as appealing a Social Security decision. You have 60 days from the date of the denial letter to request reconsideration. Contact your local Social Security office or call 1-800-772-1213 for help with the appeal.

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

No, but you must be a lawful permanent resident (green card holder) or have another may have access to immigration status. Undocumented immigrants cannot get Medicare, even if they have worked and paid Medicare taxes. Some states offer Medicaid to undocumented seniors, so check with your state Medicaid office about what coverage may be available to you.

This guide is for general information only and is not medical, financial, legal, or other professional advice. For decisions specific to your situation, consult a qualified professional. See our Editorial Policy.