Not everyone over 65 automatically gets Medicare, and age alone does not may provide coverage

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. You also need to have worked and paid Medicare taxes for at least 10 years (40 quarters). If you meet these conditions, you can enroll in Medicare Part A (hospital insurance) and Part B (medical insurance) when you turn 65.

Some people under 65 can also get Medicare. You may be covered if you have received Social Security Disability Insurance (SSDI) for 24 months, have end-stage renal disease (ESRD), or have been diagnosed with amyotrophic lateral sclerosis (ALS). These are the only three conditions that allow Medicare coverage before age 65.

If you do not meet these requirements, you cannot get Medicare, even if you are retired or have low income. In that case, you would need to look at other insurance options, such as coverage through a spouse's employer, the Affordable Care Act marketplace, or Medicaid (which is a separate program run by states).

Key Takeaways

  • You must be 65 or older, a U.S. citizen or permanent resident of five years, and have paid Medicare taxes for at least 10 years to get Medicare based on age.
  • People under 65 can get Medicare only if they have been on SSDI for 24 months, have end-stage renal disease, or have ALS.
  • Permanent residents must have lived in the United States for at least five consecutive years before they turn 65 to be covered.
  • If you do not meet Medicare requirements, you may be able to get health insurance through your employer, a spouse's plan, Medicaid, or the ACA marketplace.

The citizenship and residency requirement

To get Medicare at 65, you must be either a U.S. citizen or a lawful permanent resident (green card holder). If you are a permanent resident, you must have lived in the United States for at least five consecutive years before you turn 65. Those five years do not have to be when ready before 65—they just need to be five years total that you spent as a permanent resident in the country.

If you are a citizen of another country and do not have a green card, you cannot get Medicare no matter how long you have lived or worked in the United States. If you are a permanent resident but have not yet completed five years in the country, you will have to wait until that five-year mark to enroll, even if you are already 65.

The work history requirement

Medicare Part A is funded by payroll taxes that you and your employers pay while you work. To get Part A without paying a monthly premium, you need to have paid these taxes for at least 10 years. The Social Security Administration counts this as 40 quarters of coverage—roughly 10 years of work, though the exact timeline depends on when you worked and how much you earned each year.

If you have not worked 10 years but are married to someone who has, you may be able to get Medicare based on your spouse's work record. The same applies if you are divorced from someone you were married to for at least 10 years—you can use their work history even if you did not work that long yourself.

If you have fewer than 10 years of work history and do not have a spouse or ex-spouse whose record you can use, you can still enroll in Medicare Part B and Part D (prescription drug coverage) at 65, but you will pay a higher monthly premium for Part B. You will not be covered for hospital care under Part A unless you pay a monthly premium for that as well.

Medicare coverage for people under 65

Three specific conditions allow people younger than 65 to get Medicare. The first is SSDI—if you have been receiving Social Security Disability Insurance for 24 months, you become covered by Medicare automatically. The 24 months starts from the month you first became may have access to to SSDI benefits, not from when you applied.

The second condition is end-stage renal disease (ESRD), which means your kidneys no longer work well enough to sustain life without dialysis or a transplant. You can get Medicare as soon as you need dialysis or receive a transplant, even if you have never worked or paid Medicare taxes. This coverage is permanent, even if you later receive a successful kidney transplant.

The third condition is ALS (amyotrophic lateral sclerosis), also called Lou Gehrig's disease. Unlike SSDI, you do not have to wait 24 months—you can get Medicare as soon as you are diagnosed with ALS and are may have access to to SSDI benefits. This is the only condition where the 24-month waiting period is waived.

What happens if you do not meet Medicare requirements

If you are 65 or older but do not meet the citizenship, residency, or work history requirements, you cannot get Medicare. You will need to find health insurance another way. If you are still working, you may be covered through your employer's health plan. If your spouse is still working, you might be able to stay on their employer plan or enroll in it when you turn 65.

If you do not have employer coverage, you can look for a plan through the Affordable Care Act (ACA) marketplace at Healthcare.gov. You can enroll during the annual open enrollment period (usually November through January) or if you have had a may have access to life event, such as losing employer coverage. Costs vary based on your income, and you may be able to get financial help paying premiums.

You may also be covered by Medicaid, which is a joint federal and state program for people with low income. Medicaid rules vary by state, and some states cover more people than others. You can check whether you may be covered by contacting your state's Medicaid office or using the Healthcare.gov tool to see what programs you might be able to use.

Enrolling in Medicare when you meet the requirements

If you do meet the requirements for Medicare, you should enroll during your Initial Enrollment Period (IEP), which is the seven-month window that begins three months before the month you turn 65 and ends three months after. If you enroll during this window, your coverage can start as early as the first day of the month you turn 65.

If you miss your Initial Enrollment Period and do not have other health coverage, you may have to pay a penalty when you do enroll. For Part B, the penalty is 10 percent of the standard premium for each full year you were not covered. For Part D (prescription drugs), the penalty is 1 percent of the national average premium for each month you were not covered. These penalties stay with you for as long as you have Medicare.

You can enroll online at Medicare.gov, by phone at 1-800-MEDICARE, or in person at your local Social Security office. You will need to provide proof of citizenship or permanent residency and your work history (Social Security will have this on file).

Questions to ask your doctor or Social Security

Before you turn 65, contact Social Security to confirm that your work record is correct and that you have enough quarters of coverage for Medicare Part A. You can create an account at ssa.gov to view your earnings record online, or call Social Security at 1-800-772-1213 to ask about your specific situation.

If you are not sure whether you meet the residency requirement as a permanent resident, bring your green card and documents showing when you first arrived in the United States to your local Social Security office. They can tell you whether your five years will be complete by the time you turn 65.

If you have SSDI, ESRD, or ALS, ask Social Security when you will become covered by Medicare and what documents you need to have ready. If you are on SSDI, they will contact you automatically when your 24-month waiting period is over, but it is worth confirming the date so you are not surprised by a bill.

Frequently Asked Questions

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

No. You must have lived in the United States for at least five consecutive years as a permanent resident before you turn 65. If you will reach that five-year mark after you turn 65, you will have to wait until you have completed five years to enroll in Medicare, even though you are already 65.

What if I worked for 10 years but not all of it was in the United States?

Work you did outside the United States generally does not count toward Medicare coverage, with some exceptions for people who worked in certain countries that have agreements with the U.S. Social Security Administration. Contact Social Security to review your specific work history and find out whether any of your foreign work can be credited.

If I am on SSDI, do I automatically get Medicare when I turn 65?

No. You get Medicare after you have been on SSDI for 24 months. Once those 24 months are up, Medicare starts automatically—you do not have to enroll. When you turn 65, you will transition from SSDI to regular Social Security retirement benefits, but your Medicare coverage continues without interruption.

Can I get Medicare if I am married to a U.S. citizen but I am not a citizen myself?

No. Being married to a citizen does not make you covered by Medicare. You must be a U.S. citizen or a permanent resident yourself. If you are a permanent resident, you still need to have lived in the country for five years before you turn 65.

What should I do if I do not meet Medicare requirements and cannot find other insurance?

Contact your state's Medicaid office to see whether you may be covered based on income. You can also call 211 (a free helpline) to find local health centers that offer care on a sliding fee scale based on what you can afford. Some community health centers provide primary care, prescriptions, and preventive services regardless of insurance status.