You can draw Medicare at 65, or earlier if you have been on disability or dialysis for 24 months

Most people become may be able to access for Medicare on the first day of the month they turn 65. You do not have to be retired — you can still be working. You do not have to have paid into Social Security for a certain number of years to get Medicare Part A (hospital insurance), though you do need 40 quarters of work history to avoid a premium. If you are younger than 65, you may still draw Medicare if you have been receiving Social Security Disability Insurance (SSDI) for 24 months, or if you have end-stage renal disease (ESRD) and need dialysis or a transplant.

The month you turn 65 is the month your coverage begins — you do not need to wait until your birthday itself. If you were born on January 15, your coverage starts January 1. If you were born on January 1, your coverage still starts January 1. This matters because you have a window to sign up without penalty, and that window closes at the end of the month you turn 65.

Key Takeaways

  • Medicare Part A (hospital insurance) starts the month you turn 65, regardless of whether you are still working.
  • You need 40 quarters of work history (roughly 10 years) to get Part A without paying a premium; if you have fewer quarters, you can still enroll but will pay a monthly cost.
  • If you miss the sign-up window at 65, you will pay a permanent penalty on Part B (medical insurance) unless you have employer coverage or other may have access to circumstances.
  • You can draw Medicare before 65 if you have been on SSDI for 24 months, or if you have end-stage renal disease and need dialysis or a transplant.
  • Your spouse may draw Medicare on your work record at 62, even if you have not yet turned 65.

The standard age: 65 and the enrollment window

The month you turn 65 is when Medicare Part A coverage begins. You do not have to do anything if you are already receiving Social Security — Medicare will enroll you automatically about three months before your 65th birthday. If you are not yet on Social Security, you will need to sign up for Medicare yourself through Social Security's website, by phone, or in person at a local office.

Your enrollment window runs from three months before your 65th birthday through three months after. If you sign up during this window, there is no penalty. If you miss it and do not have may have access to coverage (such as health insurance through an employer), you will pay a permanent 10 percent surcharge on Part B premiums for as long as you have Medicare. This penalty does not go away, so signing up on time matters.

You can work past 65 and still draw Medicare. Your coverage does not depend on retirement. If you are still employed and your employer offers health insurance, you can delay enrolling in Part B (the medical insurance part) without penalty, as long as you enroll within eight months of leaving that job or losing the coverage.

Work history and Part A premiums

Part A (hospital insurance) is usually free at 65 if you or your spouse paid into Medicare taxes for at least 40 quarters — roughly 10 years of work. If you have fewer than 40 quarters, you can still enroll in Part A, but you will pay a monthly premium. The premium amount depends on how many quarters you have: those with 30 to 39 quarters pay a reduced premium, and those with fewer than 30 quarters pay the full premium.

Quarters of coverage are based on your earnings record, not on how long you worked. You can earn up to four quarters per year, so 10 years of steady work will get you to 40 quarters. If you worked part-time or had gaps, you may have fewer quarters. You can check your earnings record and quarter count on the Social Security website or by calling Social Security directly.

If you are not a U.S. citizen, you may still draw Medicare at 65 if you have been a permanent resident for at least five years and meet the work history requirement. Non-citizens without the required work history may still enroll in Part B and Part D (prescription drug coverage), but not Part A.

Drawing Medicare before 65: disability and kidney disease

If you have been receiving SSDI for 24 months, you become may be able to access for Medicare automatically. The 24 months starts from the date Social Security approved your disability claim, not from when you applied. Once you reach 24 months on SSDI, Medicare begins the following month — you do not have to sign up separately.

If you have end-stage renal disease (ESRD) and need dialysis or a kidney transplant, you can draw Medicare regardless of age. You must have worked long enough to have 40 quarters of coverage, or be the spouse or dependent child of someone who has. Once you start dialysis or have a transplant, Medicare begins in the month you start treatment (for dialysis) or the month of the transplant. If you are already on SSDI or Social Security retirement benefits when you develop ESRD, Medicare begins when ready.

If you have amyotrophic lateral sclerosis (ALS), you can draw Medicare after two months on SSDI instead of the usual 24 months. This is the only condition with a shorter waiting period.

Spousal and survivor benefits at younger ages

Your spouse can draw Social Security retirement benefits on your work record at age 62, even if you have not yet turned 65 or claimed your own benefits. However, your spouse cannot draw Medicare until they turn 65 themselves, unless they meet one of the other conditions (SSDI for 24 months, ESRD, or ALS). The fact that they are receiving spousal benefits does not lower the Medicare age.

If you die, your widow or widower can draw survivor benefits at 60, but again, Medicare does not begin until 65 unless they are disabled. A disabled widow or widower can draw Medicare at any age if they have been on SSDI for 24 months.

What happens if you delay past 65

You can delay enrolling in Medicare Part A past 65 without penalty — Part A has no late-enrollment penalty. However, Part B does. If you do not sign up for Part B during your enrollment window and do not have may have access to employer coverage, you will pay a 10 percent surcharge on your Part B premium for each 12-month period you were may be able to access but not enrolled. This penalty is permanent.

The exception is if you are still working and covered by your employer's health plan. In that case, you can delay Part B without penalty as long as you enroll within eight months of leaving the job or losing the coverage. You will need to provide proof of the employer coverage when you enroll.

Part D (prescription drug coverage) also has a late-enrollment penalty if you go 63 or more days without coverage and do not have other may have access to drug coverage. This penalty is 1 percent of the national base beneficiary premium for each month you were without coverage, and it is permanent.

How to sign up and what documents you need

If you are already receiving Social Security retirement or disability benefits, Social Security will enroll you in Medicare Parts A and B automatically. You will receive a Medicare card in the mail about two weeks before your coverage starts. You do not need to do anything.

If you are not yet on Social Security, you can sign up for Medicare through the Social Security website (ssa.gov), by calling 1-800-772-1213, or in person at your local Social Security office. You will need your Social Security number, proof of citizenship or legal residency (passport, birth certificate, or naturalization papers), and proof of age (birth certificate or passport). If you are signing up for Part B and have employer coverage, bring documentation of that coverage.

You can also sign up during the general enrollment period (January 1 through March 31 each year) if you miss your initial window, but you will pay a penalty unless you have a may have access to reason for the delay. Some life events — such as losing employer coverage or moving out of your plan's service area — create a special enrollment period that lets you sign up without penalty.

Frequently Asked Questions

Can I draw Medicare if I am still working at 65?

Yes. Medicare may be able to access at 65 is not tied to retirement. You can work full-time and draw Medicare at the same time. If your employer offers health insurance, you can delay Part B without penalty as long as you enroll within eight months of leaving the job.

What if I was born outside the United States?

You can draw Medicare at 65 if you are a permanent resident and have been for at least five years, and if you have 40 quarters of work history. Non-citizens without the work history can still enroll in Part B and Part D but not Part A. Bring your green card or naturalization papers when you sign up.

Do I lose Medicare if I go back to work after 65?

No. Medicare continues regardless of how much you earn or whether you work. Your coverage does not change based on income or employment status once you turn 65.

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

Yes, but you will pay a permanent penalty on Part B unless you have a may have access to reason for the delay, such as employer coverage or a special life event. The penalty is 10 percent of the Part B premium for each 12-month period you were may be able to access but not enrolled. Sign up as soon as possible to stop the penalty from growing.

Can my spouse draw Medicare on my work record?

Your spouse can draw Social Security retirement benefits on your record at 62, but they cannot draw Medicare until they turn 65 themselves. Medicare may be able to access is based on age or disability status, not on spousal benefits.