The Basic Rules for Medicare may be able to access

You can enroll in Medicare when you turn 65, regardless of your health or income. You do not need to be retired, and you do not need to have worked a certain number of years — though most people do need a work history to receive benefits. The main requirement is age: if you are 65 or older and a U.S. citizen or permanent resident who has lived in the country for at least five years, you meet the age and residency test.

There are two exceptions to the age 65 rule. If you have been receiving Social Security Disability Insurance (SSDI) for 24 months, you become may be able to access for Medicare at any age. If you have end-stage renal disease (ESRD) or ALS (amyotrophic lateral sclerosis), you may be may be able to access regardless of age. These are narrow categories, but they exist because these conditions create medical needs that Medicare is designed to cover.

Key Takeaways

  • You are may be able to access for Medicare at age 65 if you are a U.S. citizen or permanent resident who has lived in the country for at least five years.
  • You do not need to be retired or have a specific income level to enroll in Medicare at 65.
  • If you have received SSDI for 24 months or have ESRD or ALS, you may be may be able to access before age 65.
  • You must enroll during your initial enrollment period, which begins three months before the month you turn 65 and ends three months after.
  • If you miss your initial enrollment period, you may face a permanent penalty on your premiums unless you have a may have access to reason for the delay.

Work History and Social Security Credits

Most people who enroll in Medicare Part A (hospital insurance) need to have worked and paid Medicare taxes for a certain length of time. You typically need 40 credits, which is roughly 10 years of work. Each year you work and pay Medicare taxes, you earn up to four credits. If you have fewer than 40 credits, you may still be able to enroll in Part A, but you will pay a premium for it — this is not automatic.

Your spouse's work history can also count. If you are married and your spouse has 40 credits, you may be able to enroll in Part A based on their record, even if you do not have 40 credits yourself. The same applies if you are divorced and were married for at least 10 years. You do not need your ex-spouse's permission to use their record.

Part B (medical insurance) and Part D (prescription drug coverage) do not have a work history requirement. Anyone who is 65 or older and a U.S. citizen or permanent resident can enroll in these parts, regardless of how long they worked.

Enrollment Periods and important date

Your initial enrollment period is the window when you can enroll without penalty. It runs for seven months: three months before the month you turn 65, the month you turn 65, and three months after. If your birthday is in March, your initial enrollment period starts in December and ends in June.

If you enroll during this window, your coverage can start as early as the first day of the month you turn 65. If you enroll after your birthday month, your coverage typically starts the first day of the following month. Enrolling early — even just a few months before your 65th birthday — gives you time to understand your options and avoid gaps in coverage.

If you miss your initial enrollment period, you enter the general enrollment period, which runs from January 1 to March 31 each year. Coverage under this period starts July 1. Missing this window means waiting until the next calendar year to enroll. More importantly, you may face a permanent increase to your Part B and Part D premiums — a penalty that stays with you as long as you have Medicare.

When You Can Delay Enrollment Without Penalty

There are situations where you can delay enrollment past your initial enrollment period without facing a premium penalty. The most common is if you are still working and covered by your employer's health plan. If your employer has 20 or more employees, you can delay Part B enrollment without penalty as long as you are actively employed and covered. Once you leave that job or lose the coverage, you have eight months to enroll in Part B without penalty.

If you are receiving COBRA (continuation coverage from a former employer), you can also delay without penalty. The same eight-month window applies after COBRA ends. If you have coverage through a spouse's employer plan, the same rule holds — you can delay Part B as long as you are covered, and you have eight months after that coverage ends.

Part A does not usually carry a penalty for late enrollment if you have group health coverage through work. However, once you lose that coverage, you should enroll promptly. Document the date you lost coverage, because you will need to show this to Medicare if you enroll late.

Special Situations: Disability, ESRD, and ALS

If you have been receiving SSDI for 24 consecutive months, you become may be able to access for Medicare automatically. You do not need to wait until 65. Medicare begins the 25th month of your disability benefits. You will receive a notice from Social Security explaining your Medicare enrollment, and coverage typically starts without you needing to take action — though you should verify this by checking your Social Security account or calling Social Security directly.

If you have ESRD, you may be may be able to access for Medicare regardless of age. You must be a U.S. citizen or permanent resident, and you typically need to be on dialysis or have received a kidney transplant. may be able to access begins the first day of the month you start dialysis or the month of your transplant. If you are already receiving Social Security or Railroad Retirement Board benefits, Medicare begins automatically. If not, you will need to contact Social Security to enroll.

If you have ALS, you become may be able to access for Medicare when ready upon diagnosis — you do not have to wait for SSDI approval or any other condition. You will need to provide medical documentation of your diagnosis. Contact Social Security or Medicare directly to begin the enrollment process.

Income and Asset Limits

Medicare itself has no income or asset limits. You can be wealthy or have very little money and still enroll at 65. However, if your income is low, you may be able to receive help paying your Medicare premiums and cost-sharing through programs like the Low-Income Subsidy (LIS) or Medicaid. These programs do have income limits, and they vary by state.

LIS helps pay Part D premiums and reduces your out-of-pocket costs for prescriptions. Medicaid can help pay Part A and Part B premiums and cover services Medicare does not. To learn whether you may be able to receive help, contact your state Medicaid office or call 1-800-MEDICARE to ask about programs in your area. Income limits change each year, so even if you were told you did not may have access to in the past, it is worth checking again.

Citizenship and Residency Requirements

You must be a U.S. citizen or a permanent resident (green card holder) to enroll in Medicare. If you are a permanent resident, you must have lived in the United States for at least five years. The five years do not have to be continuous — time spent outside the country counts as long as you maintained your permanent resident status.

If you are a citizen or permanent resident but have spent significant time outside the United States, keep records of your residency. You may need to provide proof when you enroll. A passport, birth certificate, or green card is usually sufficient. If you are unsure about your status, contact Social Security or Medicare before your 65th birthday to confirm you are may be able to access.

Frequently Asked Questions

What happens if I turn 65 while still working?

You can enroll in Medicare at 65 even if you are still working. If your employer has 20 or more employees and you are covered by their health plan, you can delay Part B without penalty. Part A (hospital insurance) typically has no penalty for delay if you have employer coverage. Once you leave the job or lose coverage, you have eight months to enroll in Part B without penalty.

Can I enroll in Medicare before I turn 65?

No, unless you have been receiving SSDI for 24 months, have ESRD, or have ALS. For everyone else, enrollment begins three months before the month you turn 65. You cannot enroll earlier than that, even if you want to.

What if I was not born in the United States?

You can enroll in Medicare if you are a U.S. citizen or a permanent resident who has lived in the country for at least five years. Bring proof of citizenship (passport or birth certificate) or your green card when you enroll. If you became a permanent resident recently, count the years carefully — the five-year requirement is strict.

Do I lose Medicare if I move out of the country?

You can keep Medicare Part A and Part B if you move outside the United States, but coverage is limited. Medicare generally does not pay for care received outside the U.S., except in rare cases (like emergency care in Canada or Mexico near the U.S. border). Part D (prescription drug coverage) does not work outside the country. If you plan to live abroad, contact Medicare to understand what coverage will and will not explore.

What if I have never worked?

If you have never worked or have fewer than 40 credits, you can still enroll in Part A at 65, but you will pay a premium for it. The premium amount depends on how many credits you do have. You can enroll in Part B and Part D regardless of work history. Contact Social Security to find out how many credits you have and what your Part A premium would be.