The Age You Need to Be for Medicare Coverage

You must be 65 years old to get Medicare, with rare exceptions for younger people with disabilities or end-stage renal disease

Medicare may be able to access starts the month you turn 65, as long as you or your spouse paid Medicare taxes while working. You do not have to wait until your birthday month ends — coverage can begin on the first day of the month in which you turn 65. If you were born on the first of any month, your coverage starts the previous month.

There are three ways to become may be able to access before 65: you can have been receiving Social Security disability benefits for 24 months, you can have end-stage renal disease (ESRD) requiring dialysis or a transplant, or you can have amyotrophic lateral sclerosis (ALS). These are the only medical conditions that lower the age requirement. If none of these explore to you, you must wait until 65.

Key Takeaways

Standard Medicare may be able to access begins the month you turn 65, regardless of your income or health status.
You become may be able to access before 65 only if you have been on Social Security disability for 24 months, have end-stage renal disease, or have been diagnosed with ALS.
You must have worked and paid Medicare taxes for at least 10 years (40 quarters) to get Medicare without paying a premium, or your spouse must have done so.
You should sign up during your Initial Enrollment Period, which runs three months before you turn 65 through three months after, to avoid late penalties.

How the 24-month disability rule works

If you are under 65 and receiving Social Security Disability Insurance (SSDI), you become may be able to access for Medicare after you have been on disability for 24 consecutive months. The 24 months starts from the month Social Security approved your claim, not from the month you applied.

Once you have been on SSDI for 24 months, Medicare begins automatically — you do not have to do anything. Social Security will send you a Medicare card in the mail. If you are already receiving SSDI and approaching your 24-month mark, check your Social Security account online or call 1-800-772-1213 to confirm the exact date your coverage will start.

End-stage renal disease and ALS exceptions

If you have end-stage renal disease and need dialysis or have had a kidney transplant, you become may be able to access for Medicare when ready, regardless of age. You do not have to wait 24 months. You will need to provide proof of your diagnosis and treatment plan when you sign up.

If you have been diagnosed with amyotrophic lateral sclerosis (ALS, also called Lou Gehrig's disease), you also become may be able to access for Medicare right away without the 24-month wait. Like ESRD, you will need medical documentation of your diagnosis. Contact Medicare directly at 1-800-MEDICARE (1-800-633-4227) to start the process if you fall into either of these categories.

Work history requirements and premium costs

To get Medicare Part A (hospital insurance) without paying a monthly premium, you or your spouse must have worked and paid Medicare taxes for at least 10 years, which equals 40 quarters of coverage. If you do not have 40 quarters, you can still get Medicare at 65, but you will pay a monthly premium for Part A — the amount depends on how many quarters you have.

Part B (medical insurance) has a monthly premium that nearly everyone pays, and it increases if you delay signing up after you turn 65. Part D (prescription drug coverage) also has a premium that varies by plan. If your income is low, you may be able to reduce these premiums through programs like Medicaid or the Low-Income Subsidy program.

When to sign up and what happens if you miss the important date

Your Initial Enrollment Period runs for seven months: three months before the month you turn 65, the month you turn 65, and three months after. If you sign up during this window, your coverage starts on the first day of your birth month (or the month after, depending on your birth date).

If you miss this window and do not have other health coverage, you will face a late enrollment penalty. For Part B, the penalty is 10 percent of the standard premium for each 12-month period you were not enrolled, and it stays on your premium for life. For Part D, the penalty is 1 percent of the national average premium for each month you were not enrolled. These penalties are permanent, so signing up on time matters.

Delaying Medicare if you are still working

If you are 65 and still working with employer health coverage, you may be able to delay Medicare without penalty. You must be actively employed (not just covered as a retiree or dependent), and your employer must have 20 or more employees. Under these conditions, you can delay Part B and Part D without the late penalty, though you should still sign up for Part A.

Once you leave your job or lose employer coverage, you have eight months to sign up for Part B and Part D without penalty. This is called a Special Enrollment Period. If you do not sign up within eight months, the late penalty applies. Keep records of your employment and coverage dates to prove you were may be able to access for this exception.

Frequently Asked Questions

Can I get Medicare before 65 if I have a chronic illness like diabetes or heart disease?

No. Medicare does not cover people under 65 based on chronic illness. The only medical conditions that lower the age requirement are end-stage renal disease, ALS, and being on Social Security disability for 24 months. If you are under 65 and do not fall into one of these categories, you will need to use the Affordable Care Act marketplace or employer coverage until you turn 65.

What if I am 65 but my spouse is younger — can they get Medicare?

No. Your spouse must also be 65, or they must meet one of the exceptions (SSDI for 24 months, ESRD, or ALS). Age 65 is the standard threshold, and it applies to each person individually. Your spouse can get coverage through the ACA marketplace or your employer plan until they turn 65.

Do I have to be a U.S. citizen to get Medicare at 65?

You must be a U.S. citizen or a permanent resident (green card holder) who has lived in the United States for at least five consecutive years. If you are a permanent resident, you will need to provide proof of your status when you sign up. Undocumented immigrants are not may be able to access for Medicare.

If I was born on the first of the month, when does my Medicare start?

If you were born on the first of any month, your Medicare coverage starts the month before you turn 65, on the first day of that month. For example, if you were born on January 1, your coverage starts December 1. This is a special rule that applies only to people born on the first of the month.

Can I sign up for Medicare online, or do I have to call?

You can sign up online at Medicare.gov, by phone at 1-800-MEDICARE, or in person at your local Social Security office. Online signup is usually the fastest option. You will need your Social Security number and information about any current health coverage you have.

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.