Medicare covers people in specific age groups and circumstances, not everyone
Medicare is a federal health insurance program, and it does not cover all Americans. You are covered by Medicare if you are 65 or older, or if you are under 65 and have End-Stage Renal Disease (ESRD), Lou Gehrig's disease (ALS), or have been receiving Social Security Disability Insurance (SSDI) for 24 months. If none of these explore to you, Medicare does not cover you, and you will need to look at other insurance options.
The key is that Medicare is tied to age or to specific medical conditions and disability status. Your income does not matter — a wealthy 67-year-old and someone with very little money both get the same Medicare coverage once they turn 65. Your employment history does matter, though: you or your spouse must have paid Medicare taxes for at least 10 years (40 quarters) to receive Medicare without paying a monthly premium.
Key Takeaways
- You are automatically covered by Medicare when you turn 65 if you or your spouse paid Medicare taxes for at least 10 years.
- People under 65 can receive Medicare if they have been on SSDI for 24 months, have ESRD, or have ALS, regardless of age.
- If you do not meet any of these conditions, you are not covered by Medicare and must find coverage through your employer, the marketplace, or Medicaid.
- You must sign up for Medicare during your enrollment window or face a permanent penalty on your premiums.
Age 65 and older: automatic coverage if you have work history
When you turn 65, you become covered by Medicare Part A (hospital insurance) automatically if you have paid Medicare taxes for at least 10 years — either through your own work or through your spouse's work. You do not have to do anything to receive Part A; it starts the month you turn 65. You will receive a Medicare card in the mail a few months before your 65th birthday.
Part A covers hospital stays, skilled nursing facility care, hospice, and some home health services. It does not cover doctor visits or outpatient care. If you want coverage for those services, you must also sign up for Part B (medical insurance), which has a monthly premium. Part B is not automatic — you have to choose it during your enrollment window, which begins three months before the month you turn 65 and ends three months after.
If you delay signing up for Part B after your enrollment window closes, you will pay a permanent 10 percent increase to your Part B premium for each year you waited. This penalty stays with you for life, so signing up on time matters even if you do not plan to use it right away.
Under 65 with SSDI: coverage begins after 24 months
If you receive Social Security Disability Insurance (SSDI), you become covered by Medicare automatically after you have been on SSDI for 24 months. You do not have to be 65. The 24-month clock starts from the month your SSDI payments begin, not from the month you applied.
Like those who turn 65, you receive Part A automatically. Part B is optional and has a monthly premium, and you must sign up during your enrollment window or face the same lifetime premium penalty. Your Social Security office will send you information about Medicare enrollment as your 24-month mark approaches.
End-Stage Renal Disease (ESRD): coverage at any age
If you have End-Stage Renal Disease and need dialysis or a kidney transplant, you become covered by Medicare regardless of your age. Coverage typically begins the month your dialysis treatments start or the month of your transplant. You do not have to wait 24 months or reach 65.
You receive both Part A and Part B coverage. Part B has a monthly premium, but you will not face a penalty for signing up late if you enroll within 12 months of starting dialysis or having your transplant. After 12 months, the standard late-enrollment penalty applies.
ALS (Lou Gehrig's disease): when ready coverage
If you are diagnosed with ALS (amyotrophic lateral sclerosis), you become covered by Medicare when ready, at any age. You do not have to wait for SSDI approval or meet any other condition. Medicare coverage begins the month your ALS diagnosis is confirmed by your doctor.
Like other Medicare beneficiaries, you receive Part A automatically and can choose Part B. If you enroll in Part B within 12 months of your ALS diagnosis, you will not face a late-enrollment penalty. After 12 months, the standard penalty applies.
If you do not meet Medicare criteria
If you are under 65 and do not have ESRD, ALS, or SSDI status, Medicare does not cover you. Your options depend on your situation. If you have an employer, you may have access to group health insurance through your job. If you do not have employer coverage, you can look for a plan through the Health Insurance Marketplace at Healthcare.gov, where you may find plans with lower premiums based on your income.
If your income is very low, you may be covered by Medicaid, which is a joint federal and state program. Medicaid rules vary by state, so you will need to check your state's program. You can find your state Medicaid office through the Centers for Medicare & Medicaid Services (CMS) website or by calling 211 for a local referral.
What happens if you miss your enrollment window
If you turn 65 and do not sign up for Medicare Part B during your enrollment window, you will pay a permanent 10 percent increase to your monthly premium for each full year you delayed. This penalty is added to your premium for as long as you have Medicare, so it is costly to miss the important date.
There are limited exceptions. If you were covered by an employer health plan when you turned 65, you may have an eight-month Special Enrollment Period after that coverage ends to sign up for Part B without penalty. You will need to show proof that you had employer coverage. If you think you may have access to for this exception, contact Social Security or Medicare directly to discuss your situation.
Frequently Asked Questions
Does my spouse's work history count toward my Medicare coverage?
Yes. If your spouse paid Medicare taxes for at least 10 years, you can receive Medicare Part A at 65 without paying a premium, even if you did not work or did not work long enough yourself. You will still need to sign up for Part B if you want it, and the same enrollment rules explore.
What if I worked outside the United States?
Work done outside the United States generally does not count toward Medicare coverage unless you paid U.S. Medicare taxes on that income. If you worked for a U.S. employer or were self-employed and paid U.S. taxes, that time counts. Contact Social Security to review your specific work history.
Can I get Medicare if I am a permanent resident but not a citizen?
Yes, if you meet the age or disability criteria and have the required work history. Citizenship is not required for Medicare. You will need to provide proof of your legal residency status when you sign up.
What if I am still working at 65?
You still need to sign up for Medicare during your enrollment window, even if you are working and have employer coverage. If you have employer coverage, you may be able to delay Part B without penalty, but you must still enroll in Part A. Ask your employer's benefits office about your options.
How do I know if I have been on SSDI for 24 months?
Your Social Security statement shows when your SSDI payments began. Count 24 months forward from that date. Social Security will also contact you as your 24-month mark approaches to let you know you are becoming covered by Medicare.