Who Can Get Medicare: Age, Work History, and Citizenship Requirements

The Basic Requirements for Medicare Coverage

You can get Medicare if you are 65 or older, or if you are under 65 and have received Social Security Disability Insurance (SSDI) for 24 months, or if you have end-stage renal disease (ESRD) or amyotrophic lateral sclerosis (ALS). Most people become Medicare-may be able to access at 65 straightforward by reaching that age — you do not need to be retired, and you do not need to have worked recently. The key requirement is that you or your spouse paid Medicare taxes while working.

If you are a U.S. citizen or permanent resident who has lived in the country for at least five consecutive years, you meet the citizenship and residency test. Non-citizens may also be covered if they are permanent residents with the required residency period. The Social Security Administration (SSA) and Centers for Medicare & Medicaid Services (CMS) verify these facts when you contact them to enroll.

Key Takeaways

You become Medicare-may be able to access at 65 if you or your spouse paid Medicare taxes for at least 10 years (40 quarters) while working.
You can get Medicare before 65 if you have received SSDI for 24 months, have ESRD, or have been diagnosed with ALS.
U.S. citizens and permanent residents who have lived in the country for at least five consecutive years meet the residency requirement.
You must contact Social Security or Medicare directly to enroll; coverage does not start automatically at 65.
If you do not have 40 quarters of work history, you may still be covered as a spouse or widow or widower of someone who does.

Work History: The 40-Quarter Rule

The most common path to Medicare is through your own work record. You need at least 40 quarters of Medicare tax contributions — roughly 10 years of full-time work. A quarter is three months; you can earn up to four quarters per year, so the 40-quarter requirement typically takes 10 years to meet, but the work does not have to be consecutive. If you worked part-time or had gaps in employment, the quarters still count as long as you paid Medicare taxes during those periods.

You can check your own work record by creating an account on ssa.gov and viewing your Social Security Statement. This document shows the quarters you have earned and whether you have reached 40. If you are close but have not yet reached 40 quarters, you can see exactly how many more you need. Social Security keeps records going back decades, so even work from 30 or 40 years ago counts toward your total.

Coverage Through a Spouse or Former Spouse

If you do not have 40 quarters of your own work history, you may still get Medicare at 65 if your current spouse, former spouse, or deceased spouse has 40 quarters. You must be married to your current spouse for at least one year (or be the parent of their child) to use their record. For a former spouse, you must have been married for at least 10 years, be at least 62 years old, and not be remarried.

If your spouse is deceased, you can get Medicare on their record at 60 (or 50 if you are disabled), provided you were married for at least 10 years and have not remarried. When you contact Social Security to enroll, bring documentation of the marriage — a marriage certificate, divorce decree, or death certificate, depending on your situation. Social Security will verify the work record and determine your coverage.

Medicare Before 65: SSDI, ESRD, and ALS

You become Medicare-may be able to access at any age if you have received SSDI for 24 consecutive months. SSDI is a Social Security program for people with disabilities who have worked and paid into the system, or for adult children and spouses of disabled or deceased workers. Once you have been on SSDI for two years, Medicare coverage begins automatically — you do not need to explore separately. Your coverage starts on the first day of the 25th month of SSDI.

If you have end-stage renal disease (ESRD) — permanent kidney failure requiring dialysis or transplant — you become Medicare-may be able to access when ready, regardless of age or work history. Similarly, if you are diagnosed with amyotrophic lateral sclerosis (ALS), you become may be able to access right away. For both ESRD and ALS, you will need medical documentation from your doctor. Contact Medicare directly at 1-800-MEDICARE to begin the enrollment process, and bring your diagnosis paperwork and proof of citizenship or permanent residency.

Citizenship and Residency Requirements

You must be a U.S. citizen or a permanent resident (green card holder) to get Medicare. If you are a permanent resident, you must have lived in the United States for at least five consecutive years when ready before you turn 65 or become otherwise may be able to access. The five-year clock resets if you leave the country for more than six months in a row, so any extended time outside the U.S. interrupts the count.

Refugees and asylees are treated as permanent residents for Medicare purposes, even if they have not yet obtained a green card. If you are in any of these categories, bring your immigration documents (green card, refugee travel document, or asylum approval letter) when you contact Social Security or Medicare. If you are not yet a permanent resident but are working and paying Medicare taxes, those quarters still count toward the 40-quarter requirement if you later become may be able to access.

What Happens If You Do Not Meet the Requirements

If you reach 65 and do not have 40 quarters of work history, and you do not may have access to through a spouse or former spouse, you cannot get Medicare Part A (hospital insurance) based on age. You may still be able to purchase Part A by paying a monthly premium, though the cost is higher than for those who may have access to based on work history. Contact Social Security to learn the current premium and whether you are may be able to access to buy in.

If you are under 65 and do not have SSDI, ESRD, or ALS, you are not yet Medicare-may be able to access. You may be able to get coverage through your employer's health plan, the Affordable Care Act marketplace, or Medicaid, depending on your income and state. The Healthcare.gov website and your state Medicaid office can tell you what options are available to you. Once you turn 65 or meet one of the other may be able to access criteria, you can enroll in Medicare at that time.

How to Verify Your may be able to access

The fastest way to check your may be able to access is to create an account on ssa.gov, view your Social Security Statement, and confirm your work quarters. The statement shows your earnings history and the number of quarters you have earned. If the information is incorrect — for example, if an employer did not report your wages — you can request a correction by contacting Social Security with pay stubs or tax returns as proof.

If you are unsure whether you meet the requirements, call Social Security at 1-800-772-1213 (TTY 1-800-325-0778) and speak with a representative. They can review your work record, check your spouse's record if needed, and tell you exactly when you become may be able to access. Have your Social Security number and date of birth ready. If you are explore based on ESRD or ALS, have your medical documentation available as well.

Frequently Asked Questions

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

No. Medicare is based on age and work history, not on retirement status. You can continue working and still enroll in Medicare at 65 if you meet the requirements. If you are still working and have employer health coverage, you may want to delay enrolling in Medicare Part B, though you should still enroll in Part A to avoid penalties later.

What if I worked outside the United States?

Work done outside the U.S. generally does not count toward the 40-quarter requirement, even if you paid taxes in another country. However, some countries have agreements with the U.S. Social Security system that allow work to be credited. Contact Social Security to discuss your specific situation and any international work history you have.

Can I get Medicare if I am a permanent resident but have not lived in the U.S. for five years yet?

Not based on age at 65. However, if you have 40 quarters of work history in the U.S., you may be able to get Medicare before the five-year residency requirement is met. Contact Social Security to review your work record and determine your options.

What if my work record shows quarters I did not earn?

Contact Social Security when ready with documentation of your actual earnings — pay stubs, W-2 forms, or tax returns. Social Security can correct errors, but you must report them. The correction process can take several months, so report errors as soon as you notice them.

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

You can keep Medicare Part A and Part B if you move abroad, but coverage rules and payment methods change. Part D (prescription drug coverage) generally does not work outside the U.S. Contact Medicare at 1-800-MEDICARE before you move to understand how your coverage will work in your new location.

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.