The Main Rule: Age 65 and U.S. Citizenship or Permanent 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. That is the baseline. You do not need to be retired — you can still be working — but you must reach 65 and meet the residency requirement.

The citizenship or permanent residency rule is strict. If you are in the country on a visa or temporary status, you cannot get Medicare at 65 no matter how long you have lived here. If you are a permanent resident, you need to show your green card or other proof of that status when you first sign up.

You can sign up for Medicare starting three months before the month you turn 65. If you miss that window, you can still sign up later, but you may face a permanent penalty on your premiums — so timing matters even though there is no hard important date.

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 sign up three months before you turn 65, and signing up on time avoids a permanent increase to your Part B and Part D premiums.
  • If you are still working at 65 and have health coverage through your job, you may be able to delay Medicare without penalty, but you must tell Social Security about your work status.
  • You may become may be able to access for Medicare before 65 if you have been on Social Security disability for 24 months, or if you have end-stage renal disease or ALS.
  • Permanent residents must provide proof of residency status when they sign up, and the five-year clock starts from the date they received their green card.

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

You can get Medicare before 65 in three situations. The first is if you have been receiving Social Security Disability Insurance (SSDI) for 24 months. The 24-month clock starts from the month you first became may be able to access for SSDI, not from the month you applied. Once those 24 months pass, Medicare begins automatically — you do not need to sign up again.

The second path is if you have end-stage renal disease (ESRD), meaning your kidneys no longer work and you need dialysis or a transplant. You become may be able to access for Medicare as soon as you start dialysis or get a transplant, even if you are younger than 65 and have never worked. You have 12 months from the start of dialysis to sign up without penalty.

The third path is if you have amyotrophic lateral sclerosis (ALS). You become may be able to access for Medicare the same month you become may be able to access for SSDI, with no 24-month wait. This is the only condition with that when ready pathway.

Work History: The 40-Quarter Rule

To get Medicare Part A (hospital coverage) at 65, you or your spouse must have worked and paid Medicare taxes for at least 40 quarters — that is 10 years of work, though not necessarily consecutive. Each quarter is three months, so 40 quarters equals roughly 10 years of full-time work. If you worked part-time, you may still have earned enough in a single year to count as four quarters.

If you do not have 40 quarters yourself, you may be able to use your spouse's work record if you are married and at least 62 years old. If your spouse is deceased, you may be able to use their record if you were married for at least nine months. If you do not meet the 40-quarter rule and cannot use a spouse's record, you can still buy Part A at 65, but the monthly premium will be higher than for someone who earned it.

You can check your own work record and quarter count by creating an account on ssa.gov and viewing your Social Security statement. That statement shows exactly how many quarters you have earned and is the fastest way to know where you stand before you turn 65.

Permanent Residents and Citizenship Requirements

If you are a lawful permanent resident (green card holder), the five-year clock for Medicare may be able to access starts from the date you received your green card, not from the date you entered the country. You must have held permanent resident status for those five consecutive years by the time you turn 65.

When you sign up for Medicare, you will need to provide proof of your permanent resident status. A green card itself is the clearest proof, but you can also use a passport with an I-551 stamp, a Permanent Resident Card, or a Notice of Approval of process to Register Permanent Residence or Adjust Status (Form I-797). If your green card is expired, it still counts as proof — the expiration date does not affect your Medicare may be able to access.

If you are a permanent resident and have not yet reached five years, you cannot get Medicare at 65. You will need to wait until you have held permanent resident status for the full five years, even if you are older than 65 by then.

Delayed Enrollment and Working Past 65

If you are still working at 65 and your employer offers health coverage, you may be able to delay Medicare without penalty. This is called the working exception. To use it, you must have health coverage through your current employer (or your spouse's current employer) based on current employment, and you must tell Social Security that you are still working.

If you delay Medicare because you are working, you can sign up later without the usual penalty on Part B and Part D premiums. However, you must sign up within eight months of leaving your job or losing your employer coverage, whichever comes first. If you miss that window, the penalty becomes permanent.

Part A (hospital coverage) does not have a penalty for late enrollment, so some people delay only Part B and Part D while keeping Part A. Talk to Social Security or Medicare before you turn 65 if you plan to work past that age — they can tell you exactly what to do to protect yourself from penalties.

How to Verify Your may be able to access Before You Sign Up

The fastest way to check your own may be able to access is to create a my Social Security account at ssa.gov. You can see your work record, your quarter count, and your estimated benefits all in one place. This takes about 10 minutes and gives you a clear picture before you contact Medicare.

If you are a permanent resident, gather your green card or other proof of status before you sign up. If you are using a spouse's work record, you will need their Social Security number and proof of marriage (or death certificate if they have passed away).

You can also call Social Security at 1-800-772-1213 to ask about your may be able to access. They can tell you your quarter count over the phone and answer questions about the working exception or permanent residency rules. Have your Social Security number ready when you call.

Frequently Asked Questions

What happens if I turn 65 but do not have 40 quarters of work?

You can still get Medicare Part A at 65 by paying a monthly premium, which is higher than for someone who earned it through work. Part B and Part D are available to anyone at 65 regardless of work history. You can also check whether a spouse's work record qualifies you, which may lower or eliminate your Part A premium.

Can I get Medicare if I am a permanent resident but have not lived here five years?

No. You must have held permanent resident status for five consecutive years by the time you turn 65. If you have not reached five years, you will need to wait until you do, even if you are already 65 or older. The clock starts from the date on your green card.

Do I have to retire to get Medicare at 65?

No. You can be working full-time and still get Medicare at 65. If your employer offers health coverage, you may be able to delay Medicare without penalty, but you are not required to retire to become may be able to access.

If I have been on disability for two years, when does Medicare start?

Medicare begins automatically in the 25th month of your SSDI may be able to access. You do not need to sign up — it starts on its own. The 24-month wait is measured from the month you first became may be able to access for SSDI, not from the month you applied or the month you received your first check.

What if I was born outside the United States but am now a citizen?

U.S. citizenship is all that matters for Medicare may be able to access at 65. How you became a citizen — through naturalization, marriage, or any other path — does not affect your may be able to access. You will need to show proof of citizenship when you sign up, such as a passport or naturalization certificate.