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 main pathway, and it applies regardless of your income or health status. You do not have to be retired to sign up at 65 — you can still be working.

If you were born on the first of the month, Medicare considers you that age starting the month before. If you were born on any other day, your coverage starts the month you turn 65. You should sign up during your Initial Enrollment Period, which runs for seven months: the three months before the month you turn 65, the month itself, and the three months after.

Signing up late can cost you. If you do not sign up when you first become may be able to access and you do not have other health coverage that counts as "creditable coverage," you will pay a permanent penalty on your Part B and Part D premiums for as long as you have Medicare.

Key Takeaways

  • You are may be able to access for Medicare at 65 if you are a U.S. citizen or have been a lawful permanent resident for at least five consecutive years.
  • You can sign up during a seven-month window: three months before you turn 65, the month you turn 65, and three months after.
  • Some people under 65 become may be able to access if they have received Social Security Disability Insurance (SSDI) for 24 months or have end-stage renal disease or ALS.
  • If you delay signing up past your Initial Enrollment Period and do not have other may have access to coverage, you will pay a higher premium for Part B and Part D for life.
  • You sign up through Social Security, either online, by phone, or in person at a local office.

may be able to access Before Age 65: Disability, Kidney Disease, and ALS

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 months. The 24 months do not have to be consecutive — they count from the date your disability began, even if you appealed and were denied at first. Once you have received SSDI for 24 months, you automatically move to Medicare.

The second pathway is if you have end-stage renal disease (ESRD) — permanent kidney failure requiring dialysis or a transplant. You become may be able to access when ready once your doctor determines you have ESRD, even if you have not started treatment yet. You do not have to wait for Social Security to make a information.

The third is if you have been diagnosed with amyotrophic lateral sclerosis (ALS), also called Lou Gehrig's disease. You become may be able to access for Medicare when ready upon diagnosis, without waiting for any other approval. Your doctor will need to report the diagnosis to Social Security.

Work History and Medicare Part A

To receive Medicare Part A (hospital insurance) without paying a premium, you or your spouse must have worked and paid Medicare taxes for at least 40 quarters — roughly 10 years. These quarters do not have to be recent or consecutive. If you worked part-time or had gaps in employment, the quarters still count as long as you paid the Medicare tax.

If you do not have 40 quarters of work history, you can still get Part A by paying a monthly premium. The premium amount depends on how many quarters you do have. If you have 30 to 39 quarters, you pay a reduced premium. If you have fewer than 30 quarters, you pay the full premium. Your spouse's work history can count toward your may be able to access if you are married, even if you did not work yourself.

If you are not a U.S. citizen but are a lawful permanent resident, your work history counts the same way. Undocumented immigrants are not may be able to access for Medicare, regardless of age or work history.

Signing Up: When and How to Do It

You sign up for Medicare through Social Security, not through Medicare directly. You have three options: online at ssa.gov, by phone at 1-800-772-1213 (TTY 1-800-325-0778), or in person at your local Social Security office. If you are deaf or hard of hearing, you can use the relay service or video relay service.

You will need your Social Security number, proof of citizenship or lawful permanent residency, and proof of age (a birth certificate or passport). If you are signing up based on disability or kidney disease, bring medical records showing your diagnosis and the date it began.

If you are still working at 65 and have health insurance through your employer, you may be able to delay Part B without penalty. This is called the Special Enrollment Period. You must have coverage that counts as "creditable coverage" — your employer's plan qualifies, but many individual plans do not. Ask your employer's benefits office whether your plan qualifies before you decide to delay.

What Happens If You Miss Your Enrollment Period

If you do not sign up during your Initial Enrollment Period and you do not have creditable coverage, you will pay a late enrollment penalty. For Part B, the penalty is 10 percent of the standard premium for each 12-month period you were may be able to access but not signed up. This penalty stays on your premium for life, even after you do sign up.

For Part D (prescription drug coverage), the penalty is 1 percent of the national base beneficiary premium for each month you were may be able to access but not signed up. Like Part B, this penalty is permanent. The only way to avoid these penalties is to sign up as soon as you realize you missed the important date — the sooner you enroll, the sooner the penalty stops growing.

If you have creditable coverage through an employer plan or retiree health plan, you are protected from these penalties. When you lose that coverage, you have a two-month Special Enrollment Period to sign up for Medicare without penalty. Keep records showing when your coverage ended.

Medicare and Social Security: Timing Your Claims

Signing up for Medicare is separate from claiming Social Security retirement benefits, but the two are connected at age 65. If you have not yet claimed Social Security, you still need to sign up for Medicare during your Initial Enrollment Period. You can claim Social Security later without losing Medicare coverage.

If you claim Social Security before 65, you will be automatically enrolled in Medicare Part A and Part B when you turn 65. You will receive a notice in the mail about two months before your 65th birthday. If you do not want Part B, you must decline it in writing — otherwise you are enrolled and will pay the premium.

If you are still working and earning above a certain amount, claiming Social Security early can reduce your benefit. The earnings limit changes each year. Talk to Social Security about how working will affect your benefit before you claim.

Medicaid and Medicare: How They Work Together

Being may be able to access for Medicare does not automatically make you may be able to access for Medicaid, which is a separate program run by your state. Some people may have access to for both — these people are called "dual may be able to access." Medicaid can help pay your Medicare premiums and cover costs that Medicare does not, like long-term care.

Each state sets its own Medicaid income and asset limits. To find out whether you might be may be able to access, contact your state Medicaid office or call 211 to be connected to your local health department. You can also explore through your state's online portal or in person at your county social services office.

If you are may be able to access for both Medicare and Medicaid, you should sign up for both. Medicaid will not pay your Medicare premiums unless you are enrolled in Medicare first.

Frequently Asked Questions

What if I am still working at 65 — do I have to sign up for Medicare?

Yes, you should sign up during your Initial Enrollment Period even if you are working and have employer coverage. If you do not sign up and you lose your employer coverage later, you will face late enrollment penalties. The only exception is if your employer has 20 or more employees — in that case, your employer's plan is primary and you can delay Part B without penalty as long as you are actively employed.

Can my spouse sign up for Medicare based on my work history?

Yes, if you have 40 quarters of work history, your spouse can get Part A without paying a premium even if they do not have 40 quarters themselves. Your spouse must be at least 65 (or may be able to access due to disability, kidney disease, or ALS) and a U.S. citizen or lawful permanent resident. Your spouse will still need to sign up separately through Social Security.

What if I worked outside the United States?

Work you did outside the U.S. generally does not count toward the 40 quarters needed for Part A, unless you worked for the U.S. government or a U.S. employer. If you are not sure whether your work counts, contact Social Security with details about your employer and the dates you worked. They can review your record.

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 you must remain a U.S. citizen. Part D (prescription drug coverage) does not work outside the U.S., so you will need to arrange coverage for medications in your new country. Before you move, contact Medicare at 1-800-MEDICARE to let them know your new address.

What if I was denied Social Security Disability and then approved on appeal?

Your 24 months of SSDI may be able to access count from the date your disability began, not from the date you were approved. So if you were denied, appealed, and were approved two years later, you would already have your 24 months and would become may be able to access for Medicare right away. Social Security will calculate this for you.