Medicare is primarily for people 65 and older, but not only for them

Medicare covers most people who reach 65, regardless of income or health history. But the program also covers some younger people in specific situations: those with end-stage renal disease (permanent kidney failure requiring dialysis or transplant), those with amyotrophic lateral sclerosis (ALS), and those who have received Social Security disability benefits for 24 months. Age is the main gateway, but it is not the only one.

The reason Medicare exists at all is that older adults face higher medical costs and have more difficulty getting private insurance. When the program started in 1965, it was designed around the reality that people over 65 use hospital and doctor services far more often than younger people do. That pattern has not changed. But the program's rules have expanded over time to include people younger than 65 who face similar barriers.

Key Takeaways

  • 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.
  • Some people under 65 can get Medicare if they have end-stage renal disease, ALS, or have been on Social Security disability for 24 months.
  • You do not have to stop working to get Medicare, and having Medicare does not affect your job or your employer's insurance.
  • You must sign up during your enrollment window or face a permanent penalty on your premiums, even if you have other insurance.

What happens at 65 and why the age matters

At 65, you become may be able to access to sign up for Medicare Part A (hospital insurance) and Part B (doctor and outpatient services). You do not have to retire, and you do not have to stop working. If you are still employed and your employer offers health insurance, you can keep that coverage and delay Medicare Part B without penalty — but you still need to sign up for Part A on time.

The age 65 threshold exists because that is when medical costs typically rise sharply. People over 65 visit doctors more often, spend more nights in hospitals, and take more medications than younger adults. Private insurance companies price their plans based on risk, which means older people pay much more for the same coverage. Medicare was created to spread that cost across the whole group of older adults and the general tax base, rather than pricing individuals out of coverage.

If you delay signing up after you turn 65 without a valid reason (such as employer coverage), you will pay a permanent 10 percent increase on your Part B premium for each year you were late. This penalty stays with you for life, even if you sign up later. The same applies to Part D (prescription drug coverage): late enrollment means a permanent penalty.

Who under 65 can get Medicare

Three groups of people younger than 65 can get Medicare. The first is anyone with end-stage renal disease — permanent kidney failure that requires dialysis or a transplant. You become may be able to access as soon as your doctor determines you have this condition, regardless of age.

The second group is people with ALS (Lou Gehrig's disease). You become may be able to access for Medicare the month your ALS diagnosis is confirmed, with no waiting period.

The third group is people who have been receiving Social Security Disability Insurance (SSDI) for 24 months. After two years on SSDI, you automatically move to Medicare. This covers people with any disability that Social Security has determined will last at least 12 months or result in death.

How Medicare differs from other insurance for older adults

Medicare is federal insurance run by the Centers for Medicare & Medicaid Services (CMS), a division of the U.S. Department of Health and Human Services. It is not means-tested — your income and savings do not determine whether you can get it. You pay premiums based on your income only for Part B and Part D; Part A is free if you or your spouse paid Medicare taxes for at least 10 years while working.

Some older adults also have Medicaid, which is state-run insurance for people with low income. You can have both Medicare and Medicaid at the same time. When you do, Medicare is your primary insurance and Medicaid fills in some of the gaps — copayments, deductibles, and services Medicare does not cover. This combination is sometimes called "dual coverage."

Others buy private Medigap (supplemental) insurance to cover what Medicare does not pay. Medigap is sold by private insurance companies but is regulated by federal law, so the same plan letter (Plan A, Plan B, Plan G, and so on) covers the same benefits no matter which company sells it.

What you pay and what Medicare covers

Part A (hospital insurance) is free for most people 65 and older. Part B (doctor visits, lab work, imaging, outpatient surgery) costs a monthly premium that varies based on your income. In 2024, the standard Part B premium was $164.90 per month for people with income below a certain threshold, but higher-income retirees pay more.

You also pay a deductible before Medicare starts paying: $1,676 per year for Part B in 2024, though this amount changes yearly. After you meet the deductible, you typically pay 20 percent of the cost of most services, and Medicare pays 80 percent.

Part D (prescription drug coverage) requires a separate monthly premium that varies by plan and pharmacy. Part A covers hospital stays, skilled nursing facility care, hospice, and some home health services. Part B covers doctor visits, preventive care, lab work, imaging, and outpatient procedures.

When to sign up and what happens if you miss the window

Your initial enrollment period begins three months before the month you turn 65 and ends three months after. During this seven-month window, you can sign up for Part A and Part B without penalty. If you have employer coverage through a current job, you can delay Part B without penalty, but you must still sign up for Part A on time.

If you miss this window and do not have a may have access to reason (such as employer coverage or certain life events), you pay a permanent penalty. For Part B, the penalty is 10 percent of the standard premium for each year you were late. For Part D, the penalty is 1 percent of the national average plan premium for each month you were late. These penalties are permanent and follow you for life.

You can sign up during the General Enrollment Period from January 1 to March 31 each year, but the penalty still applies. The only way to avoid the penalty is to have had creditable coverage (employer insurance or other may have access to coverage) during the time you were not enrolled in Medicare.

How to sign up and where to get help

You can sign up for Medicare online at Medicare.gov, by phone at 1-800-MEDICARE (1-800-633-4227), or in person at your local Social Security office. You will need your Social Security number, proof of citizenship or permanent residency, and proof of age (usually your birth certificate).

If you are already receiving Social Security benefits, you will be contacted automatically about Medicare three months before you turn 65. If you are not yet receiving Social Security, you will need to contact Social Security to start the process.

State Health Insurance information Programs (SHIPs) offer free counseling about Medicare enrollment, coverage options, and costs. You can find your state's SHIP by calling 1-800-MEDICARE or visiting Medicare.gov. Many Area Agencies on Aging also offer free help with Medicare questions.

Frequently Asked Questions

Can I get Medicare before 65 if I am retired?

No. Retirement alone does not make you may be able to access. You must be 65, or have end-stage renal disease, ALS, or have been on Social Security disability for 24 months. If you retire before 65, you will need to find other coverage until you reach 65 or may have access to through one of the other pathways.

What if I am still working at 65 and have employer insurance?

You can keep your employer coverage and delay Medicare Part B without penalty. You must still sign up for Part A on time. When you do leave your job, you have a special enrollment period to sign up for Part B without penalty. Tell your employer's benefits office that you are on Medicare so they coordinate payments correctly.

Do I lose Medicare if I move out of the United States?

Medicare generally does not cover care outside the U.S., with rare exceptions. If you move abroad permanently, you should contact Medicare to understand how your coverage changes. Some people keep Medicare and buy supplemental coverage that works internationally, while others switch to local insurance in their new country.

Can my adult child get Medicare if I am on it?

No. Medicare is individual insurance tied to your own work history or disability status. Your family members must meet their own may be able to access requirements. Adult children do not may have access to based on a parent's Medicare enrollment.

What happens to my Medicare if I go back to work after 65?

Your Medicare coverage continues regardless of whether you work. Working does not affect your may be able to access or your benefits. If your employer offers health insurance, you can have both employer coverage and Medicare, and they will coordinate to pay your bills.