The Basic Rule: Age 65 or Disability

You can enroll in Medicare when you turn 65, regardless of your health or income. You do not need to have worked to reach 65 — but if you did not work, you will pay higher premiums for Part B (doctor visits) and Part D (prescription drugs). If you are under 65, you may still enroll if you have been receiving Social Security disability benefits for 24 months, or if you have end-stage renal disease or ALS (amyotrophic lateral sclerosis).

The age rule is straightforward: the month you turn 65, you become may be able to access. You do not have to be retired, and you do not have to stop working. Medicare runs alongside any health coverage your employer offers, though you will want to understand how the two interact to avoid paying twice.

Key Takeaways

  • You become may be able to access for Medicare the month you turn 65, even if you are still working or have never worked.
  • If you worked and paid Medicare taxes for at least 10 years (40 quarters), you pay no premium for Part A (hospital coverage).
  • If you did not work or worked fewer than 10 years, you can still enroll in Medicare but will pay a higher Part B premium for life.
  • You can enroll before 65 if you have been on Social Security disability for 24 months, or if you have end-stage renal disease or ALS.
  • Your enrollment window opens three months before the month you turn 65 and closes three months after — missing it can mean permanent penalties.

Work History and Part A (Hospital Insurance)

Part A covers hospital stays, skilled nursing care, hospice, and some home health services. If you or your spouse worked and paid Medicare taxes for at least 10 years (40 quarters total), you pay no monthly premium for Part A. This is true even if you did not work recently — what matters is the total time you paid into the system.

If you worked fewer than 10 years, you can still enroll in Part A, but you will pay a monthly premium. The amount depends on how many quarters you did work. If you worked 30 to 39 quarters, the premium is lower than if you worked fewer than 30 quarters. You can check your own work record by creating an account at ssa.gov and viewing your Social Security statement.

If you are married, your spouse's work history can also count toward the 10-year threshold. If your spouse worked 10 years and you did not, you may still may have access to for premium-free Part A based on their record. This is called a spousal benefit.

Work History and Part B (Doctor and Outpatient Care)

Part B covers doctor visits, outpatient surgery, lab tests, X-rays, and durable medical equipment. Unlike Part A, Part B always has a monthly premium — there is no way to avoid it by working longer. However, the amount you pay depends on your income and your work history.

If you worked and paid Medicare taxes, your Part B premium is the standard amount set each year by Medicare. In 2024, that standard premium is $164.90 per month, though it changes yearly. If you did not work or worked very little, you pay a higher premium — sometimes 35 percent more than the standard rate, and that surcharge stays with you for life.

Your Part B premium can also go up if your income is high. Medicare uses your tax return from two years ago to calculate this. If you earned over a certain threshold (which varies by filing status), you pay an additional amount on top of your base premium.

Part D (Prescription Drug Coverage) and Income

Part D is optional prescription drug coverage you add to Original Medicare. Like Part B, your Part D premium depends on your income from two years prior. If your income is above a certain level, you pay a surcharge called an Income-Related Monthly Adjustment Amount (IRMAA). This surcharge can be substantial — sometimes $70 or more per month on top of your plan's base premium.

You do not need a work history to enroll in Part D, but delaying enrollment can cost you. If you go without Part D coverage for more than 63 days after you become may be able to access, you pay a permanent penalty for each month you were uninsured. The penalty is roughly 1 percent of the national average Part D premium for each month of delay.

Special Situations: Disability, ESRD, and ALS

If you are under 65 and have been receiving Social Security Disability Insurance (SSDI) for 24 months, you become may be able to access for Medicare. The 24 months starts from the date your disability benefits began, not from when you applied. You will be enrolled automatically in Parts A and B once you reach that milestone.

If you have end-stage renal disease (ESRD) — permanent kidney failure requiring dialysis or transplant — you can enroll in Medicare regardless of age. You become may be able to access the month your dialysis treatment begins or the month you receive a kidney transplant. If you receive a transplant, your Medicare coverage continues for 36 months after the transplant, even if the new kidney fails.

If you have ALS (amyotrophic lateral sclerosis), you can enroll in Medicare the month your Social Security disability benefits begin. Unlike SSDI, which requires a 24-month waiting period, ALS qualifies you when ready.

Enrollment Timing and Penalties

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 enroll during this window, your coverage starts the month you turn 65 (or the first day of the month you turn 65, depending on your birthday).

If you miss this window, you can still enroll during the General Enrollment Period, which runs January 1 through March 31 each year. However, your coverage will not start until July 1 of that year, and you will pay a permanent 10 percent penalty on your Part B premium for each full year you delayed. This penalty stays with you for life.

There is one exception: if you were still working and covered by your employer's health plan when you turned 65, you may have a Special Enrollment Period that lets you enroll without penalty up to eight months after your employment or coverage ends. You will need to show proof of employer coverage to use this window.

Citizenship and Residency Requirements

To enroll in Medicare, you must be a U.S. citizen or a lawful permanent resident who has lived in the United States for at least five years. If you are a permanent resident, you will need to provide proof of your status when you explore.

You do not have to live in the United States to receive Medicare benefits, but you must be a citizen or permanent resident to enroll. If you move outside the U.S., your Part A and Part B coverage continues, but your prescription drug coverage (Part D) may be limited depending on where you live.

Frequently Asked Questions

Do I have to be retired to get Medicare at 65?

No. You can enroll in Medicare and keep working. If your employer offers health coverage, you can use both — though you will want to coordinate them to avoid paying duplicate premiums. If you are still working and covered by your employer, you may be able to delay Part B enrollment without penalty.

What if I worked outside the United States?

Work you did outside the U.S. generally does not count toward the 10-year requirement for premium-free Part A, even if you paid taxes. However, some countries have agreements with the U.S. Social Security Administration that allow certain work to count. Contact Social Security to ask whether your international work history qualifies.

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 U.S. for at least five years. If you are a permanent resident, bring your green card or other proof of status when you explore. Temporary visa holders and undocumented immigrants do not may have access to for Medicare.

What happens if I delay enrolling past 65?

You can enroll later during the General Enrollment Period (January through March), but your coverage will not start until July, and you will pay a permanent 10 percent penalty on your Part B premium for each year you delayed. If you were covered by an employer plan when you turned 65, you may have a Special Enrollment Period that avoids this penalty.

Does my spouse's work history help me get Medicare?

Yes. If your spouse worked and paid Medicare taxes for 10 years, you may may have access to for premium-free Part A based on their record, even if you did not work. You must be at least 65 and married (or divorced after at least 10 years of marriage) to use a spouse's work history.