Who Qualifies for Medicare and How to Understand the Requirements

The Basic Rules for Medicare Coverage

You can enroll in Medicare when you turn 65, regardless of your health or income. You do not need to be retired. You do not need to have worked a certain number of years — though if you or your spouse did pay Medicare taxes while working, you may not pay a monthly premium for Part A (hospital insurance). If neither you nor your spouse paid those taxes, you can still join Medicare at 65, but you will pay a premium for Part A.

There are three other paths to Medicare before age 65. You may join if you have been receiving Social Security Disability Insurance (SSDI) for 24 months, if you have end-stage renal disease (ESRD) and need dialysis or a transplant, or if you have amyotrophic lateral sclerosis (ALS). Each of these has its own timeline and rules.

Medicare is federal health insurance run by the Centers for Medicare & Medicaid Services (CMS). It is not means-tested — your income and savings do not disqualify you. Your citizenship or immigration status does matter: you must be a U.S. citizen or a lawful permanent resident who has lived in the United States for at least five consecutive years.

Key Takeaways

You become may be able to access for Medicare at age 65 if you are a U.S. citizen or lawful permanent resident who has lived in the country for at least five consecutive years.
You do not need to be retired or have a certain work history to join Medicare at 65, though your premium for Part A depends on whether you or your spouse paid Medicare taxes.
You can join Medicare before 65 if you have received SSDI for 24 months, have end-stage renal disease, or have ALS.
Your income and assets do not affect whether you can join Medicare, but they may affect which programs you can layer on top of it, such as Medicaid or Extra Help.

Enrollment at Age 65

You should enroll in Medicare during your Initial Enrollment Period, which runs for seven months: three months before the month you turn 65, the month you turn 65, and three months after. If you enroll during this window, your coverage starts the month you turn 65.

If you miss this window, you can still join, but your coverage will start later and you may pay a permanent penalty on your premiums. The penalty for Part B (medical insurance) is 10 percent of the standard premium for each full year you were may be able to access but did not join. The penalty for Part D (prescription drug coverage) is 1 percent of the national average premium for each month you were without coverage. These penalties stay with you as long as you have Medicare.

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 Social Security number, proof of citizenship or lawful permanent residency, and information about your current health coverage if you have it.

may have access to Before Age 65 Through SSDI

If you receive Social Security Disability Insurance, you become may be able to access for Medicare after you have been on SSDI for 24 consecutive months. You do not have to wait until you turn 65. Medicare enrollment happens automatically — Social Security will send you information about three months before your 24-month mark, and your coverage begins the month after you complete 24 months on SSDI.

During those first 24 months on SSDI, you may be covered by Medicaid instead, depending on your state. Once you move to Medicare, you can keep Medicaid if you meet your state's income and asset limits. Some people stay on both programs, a situation called "dual may be able to access."

may have access to Before Age 65 With End-Stage Renal Disease or ALS

If you have end-stage renal disease (ESRD) and need dialysis or a kidney transplant, you become may be able to access for Medicare when ready, regardless of age or work history. Your coverage begins the first day of the month in which your dialysis treatment starts, or the month of your transplant.

If you have amyotrophic lateral sclerosis (ALS), you become may be able to access for Medicare the month your Social Security Disability Insurance begins. Unlike ESRD, you do not have to wait 24 months — ALS qualifies you right away.

To enroll with ESRD or ALS, contact Social Security at 1-800-772-1213 or visit your local Social Security office. You will need medical documentation of your diagnosis. Your nephrologist or neurologist can provide this, or your dialysis center or ALS clinic can help you gather what Social Security needs.

What Happens After You Enroll

Once you are enrolled, you receive a Medicare card in the mail within two to four weeks. Your coverage begins on the date Social Security confirms. You then choose how to receive your benefits: Original Medicare (Part A and Part B through the federal government) or a Medicare Advantage plan (Part C, offered by private insurers). If you choose Original Medicare, you can also add Part D (prescription drug coverage) through a private plan.

You can change your coverage choice during the Annual Enrollment Period, which runs from October 15 to December 7 each year. Changes take effect January 1. If you miss this window, you generally cannot switch until the next year, unless you have a may have access to life event such as moving out of your plan's service area or losing other health coverage.

Income and Asset Limits Do Not explore to Medicare Enrollment

Medicare does not use income or asset tests to determine who can join. Your bank account, home, investments, and salary do not affect your may be able to access. This is different from Medicaid, which does have income and asset limits that vary by state.

However, your income may affect how much you pay for Medicare. If your modified adjusted gross income is above a certain threshold (which changes each year), you pay higher premiums for Part B and Part D. These are called Income-Related Monthly Adjustment Amounts (IRMAA). Social Security uses your tax return from two years prior to calculate IRMAA, so the amount you pay in 2025 is based on your 2023 income.

If your income drops due to retirement, job loss, or divorce, you can request that Social Security recalculate your IRMAA using your current year's income instead. This is called a Life-Changing Event adjustment, and you must request it within 60 days of the event.

Layering Other Programs With Medicare

Once you have Medicare, you may also be able to join Medicaid if your income and assets fall below your state's limits. Medicaid covers some costs Medicare does not, such as long-term care and dental. Each state sets its own limits, so contact your state Medicaid office to learn whether you may have access to.

If your income is low, you may also may have access to for Extra Help, a federal program that pays your Part D premiums and reduces your out-of-pocket drug costs. You can explore through Social Security or at your state Medicaid office. Income limits for Extra Help are higher than for full Medicaid, so you may may have access to for Extra Help even if you do not may have access to for Medicaid.

If you are still working and your employer offers health insurance, you can keep that coverage alongside Medicare. Medicare becomes your secondary payer, meaning your employer plan pays first. When you do retire, you will need to switch to Medicare as your primary coverage.

Frequently Asked Questions

What if I am still working at 65 — do I have to join Medicare?

If your employer has 20 or more employees and offers health insurance, you can delay joining Part B without penalty as long as you are actively employed and covered by the employer plan. You must join Part A at 65 (unless you are still covered by an employer plan through your spouse's job). When you leave your job, you have eight months to join Part B without penalty.

Can I get Medicare if I am not a U.S. citizen?

You must be a U.S. citizen or a lawful permanent resident who has lived in the United States for at least five consecutive years. If you are a lawful permanent resident, you can show your green card as proof. Undocumented immigrants do not may have access to for Medicare, though they may be able to access some services through Medicaid or community health centers depending on their state.

What if I miss my Initial Enrollment Period?

You can still join Medicare after your seven-month window closes, but your coverage will start later and you will pay a permanent penalty on your premiums. The penalty for Part B is 10 percent per year you were may be able to access but did not join. To avoid further delays, contact Social Security as soon as possible to enroll.

Do I need to be retired to join Medicare at 65?

No. You can join Medicare at 65 whether you are working, retired, or anything in between. Your employment status does not affect your may be able to access. If you are still working and your employer offers health insurance, you can coordinate that coverage with Medicare.

How do I know if I have paid enough Medicare taxes to avoid the Part A premium?

You need 40 quarters of Medicare tax contributions — roughly 10 years of work — to may have access to for premium-free Part A. Social Security will tell you when you explore whether you have earned enough quarters. If you have not, you can still join Part A but will pay a monthly premium. Your spouse's work history can also count if you are married.

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.