The main routes to Medicare coverage

You can get Medicare in three main ways: by reaching age 65, by receiving Social Security Disability Insurance (SSDI) for 24 months, or by having end-stage renal disease (ESRD) or ALS. Most people enter through age 65. If you are disabled or have one of those two conditions, you may may have access to earlier. The rules are straightforward, but the timing and the paperwork differ depending on which path applies to you.

Medicare is federal health insurance run by the Centers for Medicare & Medicaid Services (CMS). You do not have to be retired to get it, and you do not have to be poor. The program is based on age, disability status, or specific medical conditions — not on income or employment history.

Key Takeaways

  • You become may be able to access for Medicare at age 65, even if you are still working or have never paid into Social Security.
  • If you receive SSDI, you become may be able to access 24 months after your disability benefits begin, regardless of your age.
  • People diagnosed with end-stage renal disease or ALS can get Medicare when ready, without waiting for age 65 or the 24-month SSDI period.
  • You must sign up during your enrollment window or face a permanent penalty on your premiums, even if you have other insurance.
  • Your birth month determines when your initial enrollment window opens, so the exact dates vary from person to person.

may be able to access at age 65

The most common path to Medicare is turning 65. You do not have to retire, and you do not have to stop working. You do not have to have paid into Social Security for a certain number of years — if you are a U.S. citizen or permanent resident who has lived in the country for at least five years, you can get Medicare Part A (hospital insurance) at 65 even if you have never worked.

Your enrollment window opens three months before the month you turn 65 and closes three months after. For example, if you turn 65 in June, you can sign up starting in March and must sign up by September. If you miss this window and do not have other may have access to coverage, you will pay a permanent 10% increase on your Part B premium for as long as you have Medicare.

You can sign up online at Medicare.gov, by phone at 1-800-MEDICARE, or in person at your local Social Security office. You will need your Social Security number and proof of citizenship or permanent residency.

may be able to access through disability (SSDI)

If you receive Social Security Disability Insurance, you become may be able to access for Medicare 24 months after your disability benefits start. This is automatic — you do not have to explore separately for Medicare. Your Medicare coverage begins on the 25th month of your SSDI.

You must have been found disabled by Social Security, which means you have a medical condition that prevents you from working and is expected to last at least 12 months or result in death. The condition does not have to be visible or permanent, but it must be severe enough that Social Security approves it. Once you have been receiving SSDI for 24 months, Medicare Part A and Part B coverage begins without you having to do anything.

If you are unsure whether you are on SSDI or another type of Social Security benefit, you can check your Social Security statement online at ssa.gov or call Social Security at 1-800-772-1213. Your statement will show which type of benefit you receive.

may be able to access with end-stage renal disease or ALS

End-stage renal disease (ESRD) means your kidneys no longer work well enough to keep you alive without dialysis or a transplant. If you have ESRD, you become may be able to access for Medicare when ready, regardless of your age. You do not have to wait until 65 or until you have been on SSDI for 24 months.

Amyotrophic lateral sclerosis (ALS), also called Lou Gehrig's disease, also qualifies you for when ready Medicare coverage. Unlike ESRD, you do not have to wait for a specific stage of the disease — a diagnosis of ALS itself makes you may be able to access.

If you have either condition, your doctor or dialysis center can help you start the Medicare process. You will need medical documentation of your diagnosis. Medicare coverage typically begins the month after your process is processed.

What happens if you have other insurance

Having employer health insurance, a spouse's insurance, or private coverage does not delay your Medicare enrollment. You still must sign up during your enrollment window. If you do not, you will owe a penalty even if you have been covered by another plan the whole time.

The one exception is if you are still working and your employer has 20 or more employees. In that case, your employer's plan is primary, and you can delay Medicare Part B without penalty — but you must sign up within eight months after you leave that job or lose coverage. You still must sign up for Part A at 65.

If you are unsure whether your employer plan qualifies for this exception, ask your benefits department or call Medicare at 1-800-MEDICARE.

Non-citizens and permanent residents

U.S. citizens are may be able to access for Medicare at 65. Permanent residents (green card holders) are also may be able to access at 65, but they must have lived in the United States for at least five consecutive years. The five years do not have to be when ready before you turn 65 — they can be at any point in your life.

Undocumented immigrants are not may be able to access for Medicare. Refugees and asylees are treated as permanent residents for Medicare purposes once they are granted status.

If you are not sure about your immigration status or how it affects your Medicare may be able to access, you can call 1-800-MEDICARE and ask to speak with someone who handles immigration questions. You can also visit your local Social Security office.

Timing: when to sign up

Your initial enrollment window is seven months long: three months before the month you turn 65 (or become may be able to access through disability or ESRD/ALS), the month itself, and three months after. If you miss this window, you can still sign up during the general enrollment period, which runs January 1 through March 31 each year. However, your coverage will not start until July 1, and you may owe a permanent penalty.

The penalty for late enrollment is 10% of the Part B premium for each year you were may be able to access but not signed up. If you were may be able to access for three years and did not sign up, you pay 30% more than the standard premium for as long as you have Medicare. This penalty does not go away.

Sign up as soon as your enrollment window opens. You can do this online at Medicare.gov, by calling 1-800-MEDICARE, or by visiting your local Social Security office.

Frequently Asked Questions

Do I have to be retired to get Medicare at 65?

No. You can be working full-time and still get Medicare at 65. There is no retirement requirement. You straightforward become may be able to access based on your age, and you can choose to sign up whether you are working or not.

What if I was never a U.S. citizen but have a green card?

You are may be able to access for Medicare at 65 if you have been a permanent resident for at least five consecutive years. The five years do not have to be recent — they can be from any point in your life. You will need to show your green card when you sign up.

Can I get Medicare before 65 if I have a chronic illness like diabetes or heart disease?

No, unless your condition qualifies as a disability under Social Security rules. Chronic illnesses alone do not make you may be able to access before 65. You must be found disabled by Social Security, which means the condition prevents you from working. If you have been denied SSDI, you cannot get Medicare early based on that condition.

What happens if I sign up late for Medicare?

You will owe a permanent 10% increase on your Part B premium for each year you were may be able to access but did not sign up. This penalty stays with you for life. You can still sign up during the general enrollment period (January 1 to March 31), but your coverage will not start until July 1 of that year.

If I am on SSDI, do I have to do anything to get Medicare after 24 months?

No. Medicare is automatic. After you have been receiving SSDI for 24 months, Medicare Part A and Part B coverage begins on the 25th month without you having to explore or sign up. You will receive a Medicare card in the mail before your coverage starts.