You become Medicare-may be able to access at 65, but you can start earlier if you have been receiving Social Security Disability Insurance (SSDI) for 24 months, or if you have end-stage renal disease or ALS

The most common path is age 65. You do not have to be retired, and you do not have to stop working — you just have to be 65 and a U.S. citizen or permanent resident who has lived in the country for at least five years. If you were born on the 1st of any month, Medicare starts on the first day of that month. If you were born on any other day, it starts on the first day of the month after your birthday.

If you are younger than 65, you may still be able to start Medicare before that birthday. The three main routes are SSDI (24 months of payments), end-stage renal disease (ESRD) regardless of age, and amyotrophic lateral sclerosis (ALS) — which starts when ready upon approval, not after a waiting period. Each has its own timeline and documentation requirements.

Key Takeaways

  • You become Medicare-may be able to access at 65 if you are a U.S. citizen or permanent resident who has lived in the country for at least five years.
  • If you are under 65 and have been receiving SSDI for 24 months, you become Medicare-may be able to access automatically without having to take any action.
  • If you have end-stage renal disease or ALS, you may be may be able to access for Medicare before age 65, and ALS may be able to access begins when ready upon approval.
  • You should contact Social Security three months before you turn 65 to enroll, or you may face late penalties on your premiums.
  • If you miss the initial enrollment window, you can still enroll during the General Enrollment Period (January 1 to March 31 each year), but penalties will explore.

Medicare at 65: The Standard Route

At 65, you become may be able to access for Medicare Part A (hospital insurance) and Part B (medical insurance) if you meet the citizenship and residency test. You do not have to be retired, and you do not have to have worked a certain number of years — the only work-related requirement is that you or your spouse paid Medicare taxes while working. In most cases, if you worked in the United States for at least 10 years (40 quarters), you will have paid enough.

You should contact Social Security about three months before your 65th birthday to enroll. If you enroll during your initial enrollment period — the three months before the month you turn 65, the month itself, and the three months after — you will not face a penalty. If you miss this window and do not have other health coverage (such as employer coverage), you will pay a permanent 10 percent surcharge on your Part B premium for each year you were may be able to access but not enrolled. The surcharge stays with you for life.

You can enroll by phone (1-800-772-1213), online at ssa.gov, or in person at your local Social Security office. You will need your birth certificate, proof of citizenship or permanent residency, and your Social Security number. If you are married, your spouse can enroll at the same time.

SSDI: Automatic Medicare at 24 Months

If you are receiving Social Security Disability Insurance (SSDI), you become Medicare-may be able to access automatically after you have been receiving payments for 24 months. You do not have to explore, enroll, or contact anyone — Medicare starts on the 25th month of your SSDI payments. This applies regardless of your age.

Social Security will send you a notice in the mail about two months before your Medicare coverage begins. The notice will tell you your effective date and what to expect. You will receive your Medicare card in the mail before your coverage starts. If you do not receive a notice or card by the time your coverage should begin, contact Social Security at 1-800-772-1213 to confirm your enrollment.

If you are already receiving SSDI and have been for at least 24 months, you may already be on Medicare without realizing it. You can check your status by logging into your Social Security account at ssa.gov or by calling Social Security directly.

End-Stage Renal Disease (ESRD): Medicare Regardless of Age

If you have end-stage renal disease and need dialysis or a kidney transplant, you become Medicare-may be able to access regardless of your age. You do not have to be 65, and you do not have to be receiving SSDI. Your may be able to access begins on the first day of the month in which you start dialysis, or the month of your transplant, whichever comes first.

Your dialysis center or transplant hospital will usually handle the referral to Social Security on your behalf. You will need to provide proof of your ESRD diagnosis — typically a letter from your nephrologist or dialysis center stating that you have end-stage renal disease and the date you started treatment. Social Security will contact you to confirm your information and enroll you in Medicare.

If your dialysis center or hospital does not submit the referral, you can contact Social Security yourself at 1-800-772-1213. Have your diagnosis letter and the date you started dialysis ready when you call.

ALS: when ready Medicare may be able to access

If you have been diagnosed with amyotrophic lateral sclerosis (ALS), you become Medicare-may be able to access when ready upon approval, with no waiting period. This is the only condition that grants when ready Medicare may be able to access to people under 65.

Your ALS diagnosis must come from a neurologist or other may have access to physician. You will need to submit your diagnosis to Social Security along with medical records supporting the diagnosis. You can do this by contacting Social Security at 1-800-772-1213, or by visiting your local Social Security office in person. Social Security will review your medical records and make a information, usually within a few weeks.

Once approved, your Medicare coverage begins on the first day of the month in which Social Security approves your claim. You will receive your Medicare card in the mail. Unlike SSDI, you do not have to wait 24 months — coverage starts as soon as the approval is final.

Permanent Residency and Citizenship Requirements

To be Medicare-may be able to access at 65, you must be either a U.S. citizen or a lawful permanent resident (green card holder). If you are a permanent resident, you must have lived in the United States for at least five consecutive years. Time spent outside the country can break the five-year requirement, so if you left and returned, the clock may restart.

If you are a citizen, there is no residency requirement — you can live anywhere and still be may be able to access at 65. If you are a permanent resident, you can live outside the United States and still be covered by Medicare, but you must have completed the five-year residency requirement before you turned 65.

When you contact Social Security to enroll, you will need to provide proof of citizenship or permanent residency. A birth certificate, passport, or naturalization certificate works for citizenship. A green card or I-551 card works for permanent residency. Social Security will make a copy and return the original to you.

What Happens If You Miss the Enrollment Window

If you do not enroll during your initial enrollment period (the three months before the month you turn 65, the month itself, and the three months after), you can still enroll during the General Enrollment Period, which runs from January 1 to March 31 each year. Your coverage will begin on July 1 of that year.

However, if you enroll late and do not have other health coverage (such as employer coverage or COBRA), you will pay a permanent 10 percent surcharge on your Part B premium for each year you were may be able to access but not enrolled. This surcharge is added to your monthly premium and stays with you for life, even if you switch plans later. For example, if you were may be able to access at 65 but did not enroll until age 68, you would pay a 30 percent surcharge on your Part B premium forever.

The only exception is if you had other health coverage (such as employer coverage) during the time you were may be able to access but not enrolled. If you had coverage through your job or your spouse's job, you may not owe a penalty. You will need to provide proof of that coverage when you enroll.

Frequently Asked Questions

Do I have to retire to get Medicare at 65?

No. You can keep working and still be Medicare-may be able to access at 65. There is no income limit, and working does not affect your may be able to access. You can work as long as you want and still have Medicare coverage.

What if I am still working and have health insurance through my job?

You can stay on your employer plan if you want, but you should still enroll in Medicare Part A at 65 (it is free if you paid Medicare taxes for 10 years). You may want to delay Part B if your employer has 20 or more employees, but check with your plan first. If you delay Part B, you will not owe a penalty when you enroll later, as long as you enroll within eight months of leaving your job.

Can my spouse enroll in Medicare at the same time I do?

Yes. If your spouse is also 65 or older, they can enroll during the same contact with Social Security. You will each need your own birth certificate and proof of citizenship or permanent residency, but you can handle both enrollments in one call or visit.

What if I was born outside the United States but have been a permanent resident for 20 years?

You are may be able to access at 65 as long as you have been a permanent resident for at least five consecutive years. The five-year requirement is met, so you can enroll. You will need to provide your green card or I-551 card as proof of permanent residency.

If I am on SSDI and turn 65, do I have to do anything?

No. Your Medicare coverage continues automatically. At 65, your SSDI payments convert to retirement benefits (the amount usually stays the same), and your Medicare coverage remains in place. You do not have to take any action or re-enroll.