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 may pay higher premiums. Medicare also covers some people under 65 who have been receiving Social Security Disability Insurance (SSDI) for at least 24 months, or who have End-Stage Renal Disease (ESRD) or Amyotrophic Lateral Sclerosis (ALS).

The program is run by the Centers for Medicare & Medicaid Services (CMS), a federal agency. You do not explore through a state office or a private company — you work with Social Security to enroll, even though Medicare itself is separate from Social Security benefits.

Key Takeaways

  • You become may be able to access for Medicare at age 65 if you are a U.S. citizen or permanent resident who has lived in the country for at least five consecutive years.
  • 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, you pay a monthly premium.
  • You can enroll before age 65 if you have been on SSDI for 24 months, have ESRD, or have ALS, regardless of age.
  • Missing your enrollment window can result in permanent premium penalties, so the timing of when you sign up matters even if you do not use Medicare right away.

Work History and Premium Costs

Your work history determines whether you pay a premium for Part A, which covers hospital stays, skilled nursing, hospice, and home health. If you or your spouse worked and paid Medicare taxes for at least 10 years (40 quarters), you pay no Part A premium. If you worked fewer than 10 years, you pay a monthly premium — the amount depends on how many quarters you did work.

Self-employed people and employees both pay Medicare taxes on their earnings. The tax rate is the same whether you worked full-time or part-time, so what matters is the total number of quarters you contributed, not how much you earned in each one. A quarter counts if you paid any Medicare tax during that three-month period.

Part B, which covers doctor visits and outpatient care, has a separate premium that nearly everyone pays. The standard premium in 2024 is $174.70 per month, but it rises if your income was above a certain level two years before. Higher earners pay an Income-Related Monthly Adjustment Amount (IRMAA) on top of the base premium.

Citizenship and Residency Requirements

You must be a U.S. citizen or a permanent resident (green card holder) to enroll in Medicare at 65. 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. Temporary visa holders, undocumented immigrants, and people on other non-permanent statuses do not meet this requirement.

Once you turn 65 and meet the residency rule, you stay may be able to access even if you leave the country for extended periods. You can live abroad and keep your Medicare coverage, though some services (like hospital stays) may not be covered outside the U.S. and its territories.

Enrollment Timing and Penalties

Your Initial Enrollment Period (IEP) 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 on the first day of your birth month or the first day of the month after you enroll, whichever is later.

If you miss your IEP and do not have other health coverage (such as employer coverage), you face a permanent penalty. For Part A, the penalty is 10 percent of the premium for twice the number of years you were late. For Part B, the penalty is 10 percent of the base premium for each full 12-month period you were late. These penalties stay with you for life, even if you enroll years later.

The exception is if you had creditable coverage — employer health insurance, TRICARE, or certain other plans — when you turned 65. If you had creditable coverage, you can enroll without penalty during an eight-month period after that coverage ends. You will need to show proof of the coverage you had.

Special Cases: Disability, ESRD, and ALS

If you are under 65 and have been receiving SSDI for 24 months, you become may be able to access for Medicare automatically. You do not need to do anything — Social Security will enroll you. The 24-month waiting period starts from the month you first became may be able to access for SSDI, not from the month you applied.

If you have ESRD (permanent kidney failure requiring dialysis or transplant), you can enroll in Medicare regardless of age. You must be a U.S. citizen or permanent resident, and you have a three-month window to enroll: the month you start dialysis, the month before, or the month after. If you have a transplant, you stay may be able to access for Medicare for three years after the transplant, even if your new kidney works well enough that you no longer need dialysis.

If you have ALS (Lou Gehrig's disease), you become may be able to access for Medicare when ready upon approval of your SSDI claim — you do not have to wait 24 months like other SSDI recipients. Social Security will enroll you automatically.

Income and Asset Limits

Medicare has no income or asset limits for enrollment. You can be wealthy or have no income at all and still enroll at 65. Your income does affect your Part B and Part D (prescription drug) premiums through IRMAA, but it does not prevent you from joining.

If your income was high two years ago, you will pay a higher premium now. CMS uses your tax return from two years prior to calculate IRMAA. If your income dropped significantly since then (due to retirement, job loss, or a major life event), you can request a Life-Changing Event (LCE) reduction, and CMS will use your current income instead. You must file the request within 60 days of the event.

Frequently Asked Questions

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

No. Permanent residents (green card holders) who have lived in the U.S. for at least five consecutive years before turning 65 are also may be able to access. Temporary visa holders and undocumented immigrants do not meet the requirement.

What happens if I keep working past 65 and do not enroll in Medicare?

If you have employer health coverage through your job, you can delay Medicare without penalty as long as the employer has 20 or more employees. Once you leave that job or lose the coverage, you have eight months to enroll without penalty. If you do not have employer coverage and miss your IEP, you will owe a permanent penalty.

Can I get Medicare if I never worked?

Yes, but you will pay a premium for Part A. If you are married and your spouse worked 10 years or more, you may be able to get Part A based on their work record and pay a lower premium. Contact Social Security to find out what you may have access to for.

Does my income affect whether I can enroll?

No. Medicare has no income limits for enrollment at 65. Your income does affect how much you pay for Part B and Part D premiums, but it does not prevent you from joining.

What if I am on disability but under 24 months of SSDI?

You are not yet may be able to access for Medicare. Once you reach 24 months on SSDI, Social Security will enroll you automatically. If you have ESRD or ALS, you become may be able to access when ready regardless of how long you have been on SSDI.