The Basic Rule: Age 65 and U.S. Citizenship or Residency

You become may be able to access for Medicare at age 65 if you are a U.S. citizen or have been a lawful permanent resident for at least five consecutive years. This is the most common path. You do not need to be retired — you can still be working — but you must be 65.

If you were born on the first of the month, Medicare considers you to have reached that age on the first of the previous month. This matters for your enrollment important date. Otherwise, your may be able to access date is the first day of the month in which you turn 65.

Key Takeaways

  • You are may be able to access for Medicare at age 65 if you are a U.S. citizen or have been a lawful permanent resident for at least five consecutive years.
  • You can become may be able to access before 65 if you have received Social Security Disability Insurance (SSDI) for 24 months, or if you have end-stage renal disease or ALS, regardless of age.
  • If you do not sign up during your initial enrollment window — the three months before, the month of, and three months after the month you turn 65 — you may pay higher premiums for the rest of your life.
  • You must have worked and paid Medicare taxes for at least 10 years (40 quarters) to be may be able to access based on your own work record, though your spouse's record can also may have access to you.
  • Your may be able to access date and your enrollment date are not the same; you must take action to enroll even after you become may be able to access.

may be able to access Before Age 65: Disability and Medical Conditions

You can become may be able to access for Medicare before 65 in three situations. The first is if you have been receiving Social Security Disability Insurance (SSDI) for 24 consecutive months. The 24 months starts from the month you began receiving SSDI payments, not from the month you applied. Once you reach 24 months of SSDI, you become may be able to access for Medicare automatically.

The second situation is 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 upon diagnosis, regardless of age, as long as you meet the work history requirement or are the spouse or child of someone who does.

The third situation is if you have been diagnosed with amyotrophic lateral sclerosis (ALS), also called Lou Gehrig's disease. Unlike ESRD, you do not need to meet a work history requirement. You become may be able to access for Medicare in the month you are approved for SSDI, with no 24-month waiting period.

Work History: The 10-Year Rule and Spousal Coverage

To be may be able to access for Medicare based on your own work record, you must have worked and paid Medicare taxes for at least 10 years, which equals 40 quarters. A quarter is roughly three months; you can earn up to four quarters per year. The work does not have to be continuous, and it does not have to be recent — work you did 30 years ago counts.

If you do not have 10 years of work history yourself, you may still be may be able to access based on your spouse's record if your spouse is 62 or older and has the required 40 quarters. You must be married and at least 62 years old. If you are divorced, you can use your ex-spouse's record if the marriage lasted at least 10 years, you are at least 62, and you have been divorced for at least two years (or your ex-spouse is 62 or older).

If you are widowed, you can use your deceased spouse's work record to become may be able to access at 60, or at any age if you are caring for their child who is under 16.

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 held that status for at least five consecutive years when ready before you turn 65. Gaps in your permanent resident status restart the five-year clock.

If you are a citizen of a country that has a totalization agreement with the United States — such as Canada, the United Kingdom, France, Germany, Italy, Spain, or several others — you may be able to combine your work history from both countries to meet the 10-year requirement. This is a complex calculation; contact Social Security directly to explore whether this applies to you.

What Happens If You Miss Your Enrollment Window

Your initial enrollment period is seven months long: the three months before the month you turn 65, the month you turn 65, and the three months after. If you do not enroll in Medicare Part A (hospital insurance) during this window, you will owe a penalty for each year you delay, even if you later become may be able to access.

The penalty for Part A is 10 percent of the standard premium, added to your monthly bill for life. The penalty for Part B (medical insurance) is 10 percent of the standard premium for each full year you delayed, also added for life. These penalties do not go away. The only exception is if you were still covered by an employer health plan when you turned 65 — in that case, you have eight months after that coverage ends to enroll without penalty.

Enrollment Is Separate From may be able to access

Becoming may be able to access and enrolling in Medicare are two different things. You become may be able to access on a specific date, but you must take action to enroll. If you are already receiving Social Security benefits when you turn 65, Medicare will enroll you automatically in Part A and Part B. You will receive a Medicare card in the mail about three months before your 65th birthday.

If you are not yet receiving Social Security, you must enroll yourself. You can enroll online at Medicare.gov, by phone at 1-800-MEDICARE (1-800-633-4227), or in person at your local Social Security office. You will need your Social Security number, proof of citizenship or permanent residency, and proof of age.

When to Contact Social Security or Medicare

Contact Social Security if you are unsure whether you have 40 quarters of work history. They can review your record and tell you exactly how many quarters you have earned. You can request a statement of your earnings record online at ssa.gov, by phone at 1-800-772-1213, or by visiting a local Social Security office.

Contact Medicare directly if you have ESRD, ALS, or have been on SSDI and are approaching 24 months. They can confirm your may be able to access date and explain what you need to do next. You can reach them at 1-800-MEDICARE or through Medicare.gov. If you are not yet 65 and do not fall into one of the three early-may be able to access categories, Medicare cannot enroll you, and you will need to purchase private insurance or coverage through your employer.

Frequently Asked Questions

Can I delay Medicare enrollment if I am still working at 65?

You can delay Part B (medical insurance) without penalty if you are covered by an active employer health plan and are still working. You have eight months after that coverage ends to enroll in Part B without penalty. However, you should still enroll in Part A (hospital insurance) at 65, as it has no premium and covers hospital stays.

What if I worked in another country?

Work you did in another country generally does not count toward the 10-year requirement unless that country has a totalization agreement with the United States. Even then, the rules are complex and depend on when you worked and what you paid. Contact Social Security to discuss your specific situation.

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

No. Lawful permanent residents who have held that status for at least five consecutive years are also may be able to access. If you are not a citizen or permanent resident, you cannot enroll in Medicare, but you may be able to purchase private insurance.

What if I turned 65 but did not enroll — can I still sign up?

Yes, but you will owe a lifetime penalty on your premiums. The penalty is 10 percent of the standard premium for each full year you delayed, added to your monthly bill forever. You can enroll during the general enrollment period (January 1 to March 31 each year), though this is much later than your initial window.

How do I know if I have 40 quarters of work history?

Request a statement of your earnings record from Social Security. You can do this online at ssa.gov, by calling 1-800-772-1213, or by visiting a local office. The statement will show exactly how many quarters you have earned and when.