Not everyone in the United States has Medicare

Medicare is available to people who meet specific requirements, but many seniors and working-age adults do not. You become covered at 65 if you or your spouse paid Medicare taxes while working, or you may be covered earlier if you have end-stage renal disease, ALS, or have been receiving Social Security disability benefits for 24 months. If you do not meet these conditions, you will need to find coverage through another source — Medicaid, the Affordable Care Act marketplace, your employer, or out-of-pocket.

The gap between who has Medicare and who does not matters because uninsured people often delay care, face larger medical bills, and have fewer options when they become seriously ill. Understanding whether you may have access to now, and what to do if you do not, helps you plan ahead instead of facing a crisis.

Key Takeaways

  • You become may be able to access for Medicare at 65 if you or your spouse paid Medicare taxes for at least 10 years while working in the United States.
  • Some people under 65 may have access to if they have been receiving Social Security disability for 24 months, have end-stage renal disease, or have ALS.
  • If you do not meet Medicare requirements, Medicaid, the Affordable Care Act marketplace, or employer coverage may be available depending on your state and income.
  • You must sign up for Medicare during your initial enrollment window or face permanent late penalties on your premiums.
  • Non-citizens may have limited or no access to Medicare and Medicaid depending on immigration status and length of residence.

Who qualifies for Medicare at 65

The main path to Medicare is turning 65 and having a work history in the United States. Specifically, you or your spouse must have paid Medicare taxes (the 2.9% deduction from paychecks labeled "Medicare") for at least 10 years — not necessarily consecutive. If you worked and paid taxes for that long, you are covered automatically when you turn 65, even if you have not yet retired.

Your spouse can also may have access to you for Medicare at 65 if they have the 10-year work history, even if you never worked outside the home. If you are divorced, you may may have access to on your ex-spouse's record if the marriage lasted at least 10 years and you are at least 62 years old. You do not need to be in contact with your ex-spouse to use their record.

If you worked for a railroad, you may have paid into the Railroad Retirement Tax Act instead of Medicare. You still become may be able to access for Medicare at 65, but you will need to contact the Railroad Retirement Board to confirm your coverage and enroll.

Who qualifies for Medicare before 65

Three groups of people under 65 can receive Medicare. The first is people who have been receiving Social Security disability benefits for 24 months — the clock starts from the month you were approved for disability, not the month you applied. The second is people with end-stage renal disease (permanent kidney failure requiring dialysis or transplant), who become may be able to access when ready upon diagnosis. The third is people with ALS (amyotrophic lateral sclerosis), who become may be able to access when ready as well.

If you are under 65 and believe you may fall into one of these groups, contact Social Security at 1-800-772-1213 to confirm your status. Do not assume you are automatically enrolled — you still need to sign up for Medicare parts during your enrollment window, or you may face gaps in coverage.

Who does not may have access to for Medicare

People who did not work long enough in the United States, or who never worked, do not may have access to for Medicare based on age alone. This includes people who worked fewer than 10 years, people who worked only outside the United States, and people who never entered the workforce. If you are 65 or older and do not meet the work requirement, Medicare is not available to you.

Non-citizens have additional restrictions. Permanent residents (green card holders) must have lived in the United States for at least 5 years to be may be able to access for Medicare at 65, even if they have the required work history. Undocumented immigrants are not may be able to access for Medicare under any circumstance. Refugees and asylees may be may be able to access after 5 years of permanent resident status.

People under 65 who do not have disability, end-stage renal disease, or ALS are not may be able to access for Medicare, regardless of income or health status. This is true even if you are very ill or unable to work.

What to do if you do not may have access to for Medicare

If you are 65 or older and do not may have access to for Medicare, your options depend on your state and income. Medicaid is a state-run program that covers low-income people of any age; may be able to access and coverage vary by state, and some states have expanded Medicaid while others have not. You can learn whether your state offers Medicaid and what the income limits are by visiting your state health department website or calling 211.

The Affordable Care Act (ACA) marketplace allows you to buy private insurance directly, with subsidies available if your income is between 100% and 400% of the federal poverty level. You can compare plans and see what you may pay at healthcare.gov. Open enrollment typically runs from November 1 to January 15 each year, though you may be able to enroll outside this window if you have had a major life change (such as loss of other coverage).

If you are still working, your employer may offer health insurance. Some employers continue coverage for retirees, though this is becoming less common. Ask your human resources department what options exist for you after you retire.

If none of these options are available, some communities have free or low-cost clinics that serve uninsured people. Call 211 or your local health department to find clinics near you.

When to sign up for Medicare if you may have access to

If you may have access to for Medicare, timing matters. Your initial enrollment period is the 7-month window that begins 3 months before the month you turn 65 and ends 3 months after. For example, if you turn 65 in June, your enrollment period runs from March through September. During this window, you can sign up for Medicare parts A and B without penalty.

If you miss this window and do not have other may have access to coverage (such as an active employer plan), you will pay a permanent penalty on your Part B and Part D premiums for as long as you have Medicare. The penalty is 10% of the standard premium for each 12-month period you were not enrolled. This penalty does not go away, even if you sign up years later.

You can sign up for Medicare online at Medicare.gov, by phone at 1-800-MEDICARE, or in person at your local Social Security office. If you are already receiving Social Security benefits, you may be enrolled automatically, but you should confirm this by checking your Medicare.gov account.

Special situations and exceptions

If you are still working at 65 and your employer has 20 or more employees, you may be able to delay Medicare Part B without penalty. This is called creditable coverage. You must have actual health insurance through your employer — not just access to it. When you retire or lose that coverage, you have 8 months to sign up for Part B without penalty. Ask your employer's benefits department whether your plan qualifies.

If you are a federal employee, railroad employee, or member of certain other groups, your coverage rules may differ. Contact your benefits administrator directly to learn your specific enrollment requirements.

If you are in the U.S. military or a veteran, you may have coverage through TRICARE or the VA instead of Medicare. You can have both, but you do not have to enroll in Medicare Part B if you have VA coverage. However, you still must enroll in Part A at 65 to avoid penalties.

Frequently Asked Questions

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

Work outside the United States generally does not count toward the 10-year requirement for Medicare. However, some countries have agreements with the United States that allow work credits to be combined. Contact Social Security at 1-800-772-1213 to discuss your specific situation and whether any of your foreign work history counts.

Can I get Medicare if I am a permanent resident but have not lived in the US for 5 years?

No. Permanent residents must have lived in the United States for at least 5 years to be may be able to access for Medicare at 65, even if they have the required work history. After 5 years, you become may be able to access if you also meet the 10-year work requirement. You can check your permanent resident status and timeline with U.S. Citizenship and Immigration Services.

What happens if I turn 65 but do not sign up for Medicare?

If you do not sign up during your initial enrollment period and you do not have other may have access to coverage, you will owe a permanent penalty on your Part B and Part D premiums. The penalty is 10% per year you were not enrolled. This penalty stays with you for life, so signing up as soon as you realize the mistake is important.

Can I have both Medicare and Medicaid?

Yes. If you may have access to for both, you are called "dual may be able to access." Medicare is your primary insurance, and Medicaid covers some costs Medicare does not, such as copayments and long-term care. You can have both at the same time, and many people do.

Do I need to do anything to keep my Medicare if I move to another state?

No. Medicare is federal and works the same in every state. Your coverage does not change when you move. However, your doctors and hospitals may change, so you should check whether your current providers accept Medicare in your new state.