The Basic Rule: Age, Disability, or Kidney Disease

You can enroll in Medicare if you are 65 or older, or if you are under 65 and have been receiving Social Security Disability Insurance (SSDI) for 24 months, or if you have end-stage renal disease (ESRD) or ALS. Those are the three paths. You do not need to be retired, and you do not need to have worked a certain number of years — though most people do need a work history to may have access to for the age-based version.

The work history requirement is straightforward: you or your spouse must have paid Medicare taxes for at least 10 years (40 quarters). If you have not, you can still enroll at 65, but you will pay a higher monthly premium for Part A (hospital coverage). If your spouse worked long enough, you may be able to use their record instead.

Citizenship or legal residency is also required. You must be a U.S. citizen or a lawful permanent resident who has lived in the United States for at least five consecutive years.

Key Takeaways

  • You become may be able to access for Medicare at 65 if you or your spouse paid Medicare taxes for at least 10 years, regardless of whether you are retired.
  • You can enroll before 65 if you have been on SSDI for 24 months, or when ready if you have end-stage renal disease or ALS.
  • Enrollment windows matter: you can enroll during the three months before your 65th birthday, the month you turn 65, and the three months after — missing this window costs you more in premiums later.
  • If you are still working at 65 and have health coverage through your employer, you may be able to delay enrollment without penalty, but you must tell Medicare about your coverage.

Enrollment at 65: The Initial Enrollment Period

Your Initial Enrollment Period is a seven-month window: the three months before the month you turn 65, the month itself, and the three months after. During this window, you can enroll in Medicare Part A (hospital insurance) and Part B (medical insurance) without waiting or paying a penalty.

If you miss this window, you will pay a permanent penalty on your Part B premium — an extra 10 percent for each year you were may be able to access but not enrolled. The penalty stays with you for life. Part A has a similar penalty if you do not have 30 quarters of work history, though the rules are more complex.

You do not have to enroll at 65 if you are still working and covered by your employer's health plan. However, you must tell Medicare that you have group health coverage. When you do eventually enroll, you will not face a penalty, as long as you enroll within eight months of leaving your job or losing that coverage.

Disability: The 24-Month SSDI Rule

If you are under 65 and receiving SSDI, you become may be able to access for Medicare automatically after you have been on SSDI for 24 months. You do not need to do anything — Medicare will enroll you. Your coverage begins on the 25th month of your SSDI award.

The 24-month clock starts from the month Social Security says your disability began, not from the month you first received a check. If you are unsure when your clock started, you can call Social Security at 1-800-772-1213 to ask.

If you are receiving Supplemental Security Income (SSI) instead of SSDI, the rules are different. SSI recipients can enroll in Medicare at 65 like anyone else, but they do not have the 24-month automatic pathway.

End-Stage Renal Disease and ALS

If you have end-stage renal disease (ESRD) — permanent kidney failure requiring dialysis or a transplant — you become may be able to access for Medicare when ready, regardless of age or work history. You do not have to wait for any period of time. The same is true if you have ALS (amyotrophic lateral sclerosis, also called Lou Gehrig's disease).

For ESRD, your coverage begins the first day of the month in which your dialysis treatment begins, or the month of your transplant, whichever comes first. For ALS, coverage begins the first day of the month you are approved for SSDI, even if you have not yet received a payment.

If you have ESRD and are already on Medicare through age or disability, your coverage continues without interruption. You will not lose it if your kidney function improves or if you receive a transplant.

Work History and Non-Covered Spouses

Most people may have access to for Medicare through their own work record or their spouse's. If you have not worked 10 years yourself, you can use your spouse's record if they have worked 10 years and are at least 62 years old (or any age if they are already on Social Security). You do not have to be married anymore — a divorced spouse record counts if the marriage lasted at least 10 years.

If neither you nor your spouse has a 10-year work history, you can still enroll in Medicare at 65, but you will pay the full Part A premium (about $278 to $557 per month, depending on the year). Part B premiums are based on income and explore to everyone.

If you worked in a job where you did not pay Medicare taxes — some government employees fall into this category — you may have a different situation. Contact Social Security to find out whether your work counts toward the 10-year requirement.

Citizenship and Residency Requirements

You must be a U.S. citizen or a lawful permanent resident. If you are a lawful permanent resident, you must have lived in the United States for at least five consecutive years before you can enroll.

Temporary visas, work permits, and other non-permanent immigration statuses do not count. If you are unsure about your status, contact U.S. Citizenship and Immigration Services (USCIS) or speak with an immigration attorney before you turn 65.

What Happens If You Do Not Meet the Requirements

If you are 65 or older but do not have a 10-year work history and cannot use a spouse's record, you cannot enroll in Part A (hospital insurance) without paying the full premium. You can still enroll in Part B (medical insurance) at the standard rate.

If you are under 65 and do not have SSDI, ESRD, or ALS, you cannot enroll in Medicare. You will need to find coverage through the Affordable Care Act marketplace, your employer, or another source. Some people in this situation are may be able to access for Medicaid instead, depending on their state and income.

Frequently Asked Questions

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

No. You can be working full-time and still enroll in Medicare at 65 if you meet the work history requirement. If you are covered by your employer's health plan, you can delay enrollment without penalty, but you must tell Medicare about your coverage.

What if I was born outside the United States?

You can enroll in Medicare if you are a U.S. citizen or a lawful permanent resident who has lived in the United States for at least five consecutive years. Bring your citizenship or permanent resident card when you explore.

Can my ex-spouse's work record count toward my Medicare?

Yes, if you were married for at least 10 years and your ex-spouse is at least 62 years old (or any age if already on Social Security). You do not have to be in contact with them — Social Security can verify the record on its own.

What if I am on disability but not SSDI?

If you are receiving disability benefits from your employer, a union, or a private insurance policy, those do not count toward Medicare. You must wait until 65 to enroll, unless you also may have access to through ESRD or ALS.

Do I lose Medicare if I go back to work?

No. Once you are enrolled in Medicare, you keep it even if you return to work or earn income. Your coverage does not change based on how much you earn.