Who Qualifies for Medicare and What You Need to Know

The Basic Requirements for Medicare

To be covered by Medicare, you must meet at least one of these conditions: you are 65 or older, you have been receiving Social Security Disability Insurance (SSDI) for 24 months, or you have end-stage renal disease (ESRD) or amyotrophic lateral sclerosis (ALS). Most people become may be able to access at 65 straightforward by reaching that age. You do not have to be retired, and you do not have to have worked — if you are 65 and a U.S. citizen or permanent resident who has lived in the country for at least five years, you can enroll.

If you are under 65 and receive SSDI, you become may be able to access after your 24-month waiting period ends. If you have ESRD, you can enroll when ready, regardless of age. If you have ALS, you can enroll right away as well — this is the only condition that does not require a waiting period. Your state does not matter; these rules explore everywhere in the United States.

Key Takeaways

You are may be able to access for Medicare at 65 if you are a U.S. citizen or permanent resident who has lived here at least five years, even if you have never worked.
If you receive Social Security Disability Insurance, you become may be able to access 24 months after your benefits start, regardless of your age.
People with end-stage renal disease or ALS can enroll in Medicare when ready, without age or work history requirements.
You must actively enroll during your enrollment period; Medicare does not automatically sign you up at 65.
Delaying enrollment past your important date can result in permanent penalties on your premiums, so timing matters.

Citizenship and Residency Requirements

You must be a U.S. citizen or a lawful permanent resident (green card holder). If you are a permanent resident, you must have lived in the United States for at least five consecutive years before you can enroll. This five-year clock starts when you receive your green card, not when you first enter the country.

Temporary visa holders, undocumented immigrants, and people on work visas do not meet this requirement and cannot enroll in Medicare. If your immigration status changes, contact Social Security to update your record — they will determine whether you now meet the residency requirement.

Work History and Earnings Requirements

Most people become may be able to access for Medicare Part A (hospital insurance) based on their own work history or their spouse's work history. You need 40 credits of earnings under Social Security, which usually means working and paying Social Security taxes for about 10 years. You do not have to have earned these credits recently — they can be from any point in your working life.

If you do not have 40 credits yourself, you may be able to use your spouse's record if they have 40 credits. If you are divorced, you can use an ex-spouse's record if you were married for at least 10 years and you are at least 62 years old. If you have fewer than 40 credits and no spouse or ex-spouse record to use, you can still purchase Part A coverage, though the premium will be higher than for people who have the required work history.

When to Enroll and Enrollment important date

Your Initial Enrollment Period is the seven-calendar-month window that begins three months before the month you turn 65 and ends three months after. If you turn 65 in June, your enrollment period runs from March through September. You can enroll online at Medicare.gov, by phone at 1-800-MEDICARE, or in person at your local Social Security office.

If you miss your Initial Enrollment Period, you can still enroll during the General Enrollment Period, which runs January 1 through March 31 each year. However, coverage does not start until July 1 of that year, and you will pay a permanent 10% increase on your Part B premium for each year you delayed. This penalty stays with you for life, so enrolling on time matters financially.

If you are still working at 65 and your employer has 20 or more employees, you may be able to delay enrollment without penalty. This is called the Special Enrollment Period. You must have health coverage through your employer's plan, and you must enroll in Medicare within eight months of leaving that job or losing the coverage.

Income and Asset Limits

Medicare Part A and Part B have no income or asset limits. You can be wealthy or have substantial savings and still enroll. However, if your income is higher, you will pay higher premiums for Part B and Part D (prescription drug coverage). This is called Income-Related Monthly Adjustment Amount (IRMAA), and it is based on your income from two years prior.

If you are interested in programs that help pay your Medicare premiums and out-of-pocket costs — such as Medicaid, the Medicare Savings Program, or the Low-Income Subsidy for prescription drugs — those programs do have income limits. Your state sets these limits, and they vary. You can learn whether you may be able to access these programs by contacting your state Medicaid office or calling 1-800-MEDICARE.

Special Situations: Disability, ESRD, and ALS

If you are under 65 and receive SSDI, you automatically become may be able to access for Medicare after 24 months of receiving benefits. You do not have to explore separately; Social Security will enroll you. Your coverage begins on the 25th month of your SSDI benefits. If you receive Supplemental Security Income (SSI) instead of SSDI, different rules explore — contact Social Security directly to learn your enrollment date.

If you have end-stage renal disease, you can enroll in Medicare when ready, even if you are under 65 and have never worked. You remain may be able to access as long as you are receiving dialysis or have had a kidney transplant. If you have ALS, you can enroll right away as well. In both cases, you should contact Social Security or Medicare as soon as you receive your diagnosis to begin the enrollment process.

What Happens After You Enroll

Once you enroll, you will receive your Medicare card in the mail within two to four weeks. Your coverage typically begins on the first day of the month in which you turn 65, or the first day of the month after you meet the other may be able to access requirements. You can then choose between Original Medicare (Part A and Part B) and a Medicare Advantage plan (Part C), and you can add prescription drug coverage (Part D).

Your enrollment does not end after your Initial Enrollment Period. You can make changes to your coverage during the Annual Enrollment Period, which runs October 15 through December 7 each year. Changes made during this window take effect January 1 of the following year. If you experience certain life events — such as moving, losing other health coverage, or getting married — you may be able to make changes outside the Annual Enrollment Period.

Frequently Asked Questions

Do I have to be retired to enroll in Medicare at 65?

No. You can be working full-time and still enroll in Medicare at 65. If your employer offers health coverage and has 20 or more employees, you can delay enrolling in Part B without penalty as long as you are covered by the employer plan. You must enroll within eight months of leaving that job.

What if I worked outside the United States?

Work you did outside the U.S. generally does not count toward your 40 Social Security credits. However, some countries have agreements with the United States that allow work in those countries to count. Contact Social Security to discuss your specific work history and whether you meet the requirement.

Can my spouse enroll based on my work record?

Yes. If you have 40 credits and are enrolled in Medicare, your spouse can enroll based on your record at 65, or earlier if they are caring for your child who is under 16. Your spouse does not need their own work history. Divorced spouses can also use an ex-spouse's record if the marriage lasted at least 10 years.

What if I miss my enrollment important date?

You can still enroll during the General Enrollment Period (January 1 through March 31), but coverage will not start until July 1, and you will pay a permanent 10% increase on your Part B premium for each year you were late. If you have a may have access to life event or are still working with employer coverage, you may have other options — contact Medicare to discuss your situation.

Do I need to prove my citizenship when I enroll?

You will need to provide proof of citizenship or permanent resident status when you explore. Acceptable documents include a birth certificate, passport, naturalization certificate, or green card. Social Security will tell you which documents they need when you begin the enrollment process.

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.