Not everyone over 65 is covered by Medicare automatically

You become may be able to access for Medicare at 65 if you are a U.S. citizen or permanent resident who has lived in the country for at least five years. But may be able to access also depends on your work history or your spouse's work history. If you or your spouse paid Medicare taxes for at least 10 years (40 quarters) while working, you may have access to. If neither of you has that work history, you may still get coverage, but you will pay a monthly premium with no government subsidy.

The key point: turning 65 does not automatically enroll you. You must sign up during your enrollment window, or you may face a permanent penalty on your premiums. Even if you work past 65 and have employer coverage, you still need to understand when to enroll to avoid that penalty.

Key Takeaways

  • You must be 65, a U.S. citizen or permanent resident of five years, and have either your own or a spouse's work history of at least 10 years of Medicare tax payments to get Medicare without a premium surcharge.
  • If you do not have the required work history, you can still get Medicare at 65, but you will pay the full monthly premium with no government help.
  • Turning 65 does not automatically sign you up — you must enroll yourself during your Initial Enrollment Period, which runs three months before, during, and three months after the month you turn 65.
  • If you miss your enrollment window and do not have may have access to employer coverage, you will pay a permanent 10 percent penalty on your Part B premium for as long as you have Medicare.
  • Non-citizens and people who have not lived in the U.S. for five consecutive years may not may have access to, even at 65.

The work history requirement: what counts and what does not

Medicare is funded by payroll taxes, so the program ties coverage to your work record. You need 40 quarters of Medicare tax contributions — that is roughly 10 years of work, though the exact timeline depends on when you worked. Each quarter you earned at least a certain amount (the threshold changes yearly) counts as one quarter toward your 40.

If you did not work that long yourself, your spouse's work history can count. If your spouse paid Medicare taxes for 40 quarters, you can get Medicare Part A (hospital coverage) at no monthly cost when you turn 65, even if you never worked. The same rule applies if you are divorced and were married for at least 10 years — your ex-spouse's record can may have access to you.

Work done before you became a permanent resident usually does not count. Work done without a valid Social Security number does not count. Self-employment income counts only if you paid self-employment tax on it.

What happens if you do not have 40 quarters

You can still get Medicare at 65, but you will pay a monthly premium for Part A (hospital insurance). As of 2024, that premium ranges from roughly $275 to $505 per month, depending on how many quarters you do have. The fewer quarters you have, the higher your premium. You will also pay the standard Part B premium for doctor visits and outpatient care.

If you have between 30 and 39 quarters, you pay a reduced premium. If you have fewer than 30 quarters, you pay the full premium. There is no way to lower this premium through income or other factors — it is based solely on your work history.

Some people in this situation choose not to enroll in Medicare at 65 if they have employer coverage through a job or a spouse's job. That is a valid choice, but you must enroll within eight months of losing that coverage to avoid the permanent premium penalty.

Non-citizens and residency requirements

You must be a U.S. citizen or a lawful permanent resident (green card holder) to get Medicare. If you are a citizen, there is no residency requirement. If you are a permanent resident, you must have lived in the United States for at least five consecutive years before you turn 65.

Temporary visa holders, undocumented immigrants, and people on humanitarian visas do not may have access to for Medicare, even at 65. Some states offer separate health programs for non-citizens, but those are not Medicare and operate under different rules.

If you are a permanent resident and have not yet lived in the U.S. for five years, you can still work and pay Medicare taxes. Those quarters count toward your may be able to access, and you will become may be able to access for Medicare once you have been a permanent resident for five consecutive years and reach 65.

Enrollment windows and what missing them costs

Your Initial Enrollment Period is a seven-month window: three months before the month you turn 65, the month you turn 65, and three months after. You must enroll in Part A and Part B during this window. If you miss it and do not have may have access to employer coverage, you pay a permanent 10 percent penalty on your Part B premium for as long as you have Medicare.

If you have employer coverage through your job or your spouse's job, you can delay enrollment without penalty. But you must enroll within eight months of losing that coverage. If you wait longer, the same 10 percent penalty applies.

You enroll through Social Security — either online at ssa.gov, by phone at 1-800-772-1213, or in person at your local Social Security office. You will need your birth certificate, proof of citizenship or permanent residency, and proof of your work history (usually a Social Security statement).

Special situations: working past 65, disability, and end-stage renal disease

If you are still working at 65 and have employer coverage, you can delay Medicare enrollment without penalty. But tell your employer's benefits office that you are turning 65 so they know to coordinate with Medicare when you do enroll. Some employers require you to enroll in Medicare once you turn 65 even if you are still working.

If you became disabled before 65 and have been receiving Social Security Disability Insurance (SSDI) for 24 months, you automatically become may be able to access for Medicare at that point, regardless of your age. You do not have to wait until 65. The same applies if you have end-stage renal disease (ESRD) or ALS — you can get Medicare regardless of age.

If you are not yet 65 and do not fall into one of these categories, you cannot get Medicare. You would need to find coverage through the Affordable Care Act marketplace, your employer, or Medicaid (if your state offers it and you meet income limits).

How to check your work history and quarters

You can see your own work record and quarters at ssa.gov/myaccount. Create an account, log in, and look at your earnings record. It shows every year you worked and how much you earned. Social Security uses this to calculate your quarters.

If you see errors — missing years of work, incorrect earnings, or a name mismatch — contact Social Security to correct it before you turn 65. Errors can delay your Medicare enrollment or lower your benefits. You can call 1-800-772-1213 or visit a local Social Security office.

If you are checking your spouse's or ex-spouse's record to see if you may have access to through them, you will need their permission and their Social Security number. Social Security can tell you over the phone whether your spouse's record qualifies you, even if you cannot see the details yourself.

Frequently Asked Questions

Can I get Medicare before 65?

Yes, if you have been receiving SSDI for 24 months, have end-stage renal disease, or have ALS. Otherwise, you must wait until 65. If you are under 65 and do not may have access to for these programs, you can look for coverage through your employer, the Affordable Care Act marketplace, or Medicaid.

What if I am a permanent resident but have not lived in the U.S. for five years yet?

You cannot enroll in Medicare until you have been a permanent resident for five consecutive years and reached 65. However, your work history and quarters still count toward your may be able to access once you meet both requirements. Keep paying Medicare taxes if you are working.

Do I have to enroll in both Part A and Part B at 65?

If you have the required work history, Part A is free and you should enroll. Part B (doctor visits) has a monthly premium and you can delay it if you have employer coverage. If you do not have employer coverage, delaying Part B past your enrollment window triggers a permanent penalty.

What if I worked in another country before coming to the U.S.?

Work done outside the U.S. generally does not count toward Medicare quarters, even if you paid similar taxes. Only work done in the U.S. with a valid Social Security number counts. Some countries have agreements with the U.S. Social Security Administration that may allow credits to transfer, but this is rare and requires a separate process.

Can my adult child help me enroll if I am having trouble?

Yes. Your adult child can help you create a my Social Security account, gather documents, or call Social Security on your behalf if you give them permission. They can also go with you to a local Social Security office. However, only you can sign the enrollment forms.