Medicare is not only for people 65 and older, though that is the main route

Most people think of Medicare as a program for seniors, and it is true that anyone 65 or older can enroll. But Medicare also covers some younger people under specific circumstances. You can get Medicare before 65 if you have been receiving Social Security Disability Insurance (SSDI) for 24 months, if you have end-stage renal disease (ESRD), or if you have amyotrophic lateral sclerosis (ALS). Each path has different rules about when coverage starts and what you pay.

The confusion happens because age 65 is the automatic trigger — you do not have to do anything except be a U.S. citizen or permanent resident. But if you are younger and fall into one of the other categories, you have to take action to enroll, and the timing matters. Missing the window can cost you money in penalties or leave you without coverage when you thought you had it.

Key Takeaways

  • You can get Medicare at 65 automatically if you are a U.S. citizen or permanent resident, but you still have to enroll during your initial enrollment period or pay a late penalty.
  • If you receive SSDI, Medicare starts automatically after you have been on disability for 24 months, with no action required on your part.
  • People with end-stage renal disease or ALS can get Medicare regardless of age, but the rules about when coverage begins differ between the two conditions.
  • If you work past 65 and have employer health insurance, you may be able to delay Medicare without penalty, but you must tell Social Security.
  • Turning 65 does not automatically enroll you — you have a three-month window before and after your birthday to enroll without paying extra.

Medicare at 65: The standard path and the enrollment window

At 65, you become may be able to access for Medicare Part A (hospital insurance) and Part B (medical insurance) if you are a U.S. citizen or have been a permanent resident for at least five years. You do not have to wait for anything — may be able to access is automatic. But enrollment is not. You have to sign up during your initial enrollment period, which runs for three months before your 65th birthday, the month you turn 65, and three months after.

If you miss this window, you will pay a late enrollment penalty on Part B for as long as you have Medicare. The penalty is 10 percent of the Part B premium for each full year you were may be able to access but did not enroll. If you wait five years to sign up, you will pay 50 percent more than the standard premium, and that extra amount stays with you permanently. Part A has a similar penalty if you do not enroll when first may be able to access, though the rules are slightly different if you were covered by an employer plan.

The one exception is if you are still working at 65 and covered by your employer's health plan. You can delay Medicare Part B without penalty if your employer has 20 or more employees and you are actively employed. You must tell Social Security that you are delaying, and you have eight months after you leave the job or lose coverage to enroll without penalty. If you do not report the delay, Social Security will not know, and you will be charged the late penalty anyway.

Getting Medicare before 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. The 24-month clock starts from the month Social Security approves your disability claim, not from when you applied. Medicare Part A and Part B both start automatically on the first day of the 25th month — you do not have to enroll or do anything.

You will receive a Medicare card in the mail before your coverage begins. If you do not receive it within a few weeks of the start date, contact Social Security to confirm the card is on the way. Some people on SSDI also may have access to for Medicaid (the state program), which covers things Medicare does not. Whether you may have access to depends on your state and your income, so check with your state Medicaid office or call 211 to learn what is available where you live.

Medicare for people with end-stage renal disease (ESRD)

If you have end-stage renal disease and need dialysis or a kidney transplant, you can get Medicare regardless of age. The timing depends on which treatment you are receiving. If you start dialysis, Medicare begins the first day of the fourth month after you start treatment. If you receive a kidney transplant, Medicare begins the month of the transplant. If you are already on Medicare for another reason (like SSDI), your coverage continues without interruption.

You do not have to enroll — your dialysis center or transplant program will report your condition to Social Security, and Medicare will start automatically. You will receive a card in the mail. If you are under 65 and do not yet have Medicare, this is your path to coverage. After you have had a transplant for three years, you may lose Medicare coverage unless you are 65 or may have access to for another reason, so plan ahead if that applies to you.

Medicare for people with ALS

Amyotrophic lateral sclerosis (ALS) is one of the few conditions that makes you may be able to access for Medicare before 65 without waiting. Unlike SSDI, where you wait 24 months, ALS coverage can begin as soon as you are approved for SSDI. Some people with ALS are approved for disability quickly because the condition is progressive and clearly disabling, though the approval process still takes time.

Once Social Security approves your SSDI claim for ALS, Medicare Part A and Part B start the first day of the month after approval. You do not have to enroll. Your Medicare card will arrive by mail. If you are working or have other health insurance when you are approved, you can keep that coverage and use Medicare as a secondary payer, or switch to Medicare as your primary coverage.

What happens if you are not yet 65 and do not have SSDI, ESRD, or ALS

If you are under 65 and do not fall into one of the categories above, you cannot get traditional Medicare. Your options are the Affordable Care Act (ACA) marketplace, coverage through an employer or spouse's employer, Medicaid (if your state has expanded it and you meet income limits), or short-term health plans. Each has different costs and coverage rules.

The ACA marketplace lets you compare plans and see what you might pay based on your income. You can enroll during the open enrollment period (usually November through January) or if you have a may have access to life event like losing a job or moving. Medicaid is free or very low-cost in many states, but income limits vary widely. If you are self-employed or between jobs, the marketplace is often the most straightforward route. Call 211 or visit healthcare.gov to explore what is available in your area.

Delaying Medicare if you are still working at 65

If you are 65 and still working with employer health insurance, you can delay Medicare Part B without paying a late penalty. This is useful if your employer plan is good and you want to keep it. You must meet two conditions: your employer must have at least 20 employees, and you must be actively employed (not just on the payroll). Part-time work counts as long as you are actually working.

You have to tell Social Security that you are delaying Part B. You can do this by phone, in person at a Social Security office, or online at ssa.gov. Write down the date you reported the delay — Social Security uses this to calculate your penalty-free enrollment window. When you leave the job or lose coverage, you have eight months to enroll in Part B without penalty. If you wait longer than eight months, you will pay the late penalty for the rest of your life.

Frequently Asked Questions

Can I get Medicare if I am 62 and not on disability?

No. If you are under 65 and do not have SSDI, ESRD, or ALS, Medicare is not available to you. You would need to look at ACA marketplace plans, Medicaid (if your state qualifies you), or employer coverage. You can enroll in Social Security retirement benefits at 62, but that does not give you Medicare — you still have to wait until 65.

What if I turned 65 and did not enroll in Medicare because I did not know I had to?

You can still enroll, but you will owe a late penalty on Part B. The penalty is 10 percent of the current Part B premium for each full year you were may be able to access but did not enroll. You can enroll during the General Enrollment Period (January 1 through March 31 each year), and coverage starts July 1. Contact Social Security or visit Medicare.gov to enroll.

If I am on SSDI, do I have to do anything to get Medicare after 24 months?

No. Medicare starts automatically on the first day of the 25th month after your SSDI approval. You will receive a card in the mail. You do not have to call, explore, or take any action. If you do not receive the card by the start date, contact Social Security to confirm it is on the way.

Can I have both Medicare and Medicaid at the same time?

Yes. If you are on Medicare and your income is low enough, you may may have access to for Medicaid in your state. Medicaid can help pay your Medicare premiums and cover services Medicare does not, like long-term care. Rules vary by state, so contact your state Medicaid office or call 211 to learn whether you may have access to.

What if I am 65 but still working and my employer does not have 20 employees?

You cannot delay Medicare without penalty. You must enroll during your initial enrollment period (three months before and after your 65th birthday) or pay a late penalty on Part B. Even if you have employer coverage, you need to enroll in Medicare to avoid the penalty. You can have both Medicare and employer coverage at the same time.