The main routes to Medicare

You can get Medicare in three main ways: by turning 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 not yet 65 but have been on SSDI for two years, you move to Medicare automatically. A smaller group qualifies because of a specific medical diagnosis.

You do not need to have worked to get Medicare at 65 — you need to have paid Medicare taxes for at least 10 years (40 quarters) during your working life. Your spouse, ex-spouse, or adult child may also may have access to based on your work record, even if they never worked themselves. The work history belongs to you; the benefit can extend to family members.

Age alone is not enough. You must also be a U.S. citizen or have been a permanent resident for at least five years. If you are not yet a citizen, bring your green card and passport when you enroll.

Key Takeaways

  • You become may be able to access for Medicare at 65 if you have paid Medicare taxes for at least 10 years, even if you never worked full-time or worked in different jobs.
  • You can get Medicare before 65 if you have been receiving SSDI for 24 months, or if you have end-stage renal disease or ALS, regardless of age or work history.
  • Your spouse, ex-spouse, or adult child can get Medicare based on your work record if you have the required 10 years of Medicare tax payments.
  • You must be a U.S. citizen or permanent resident of at least five years to enroll in Medicare.
  • You should enroll during the three months before you turn 65 to avoid late penalties on your premiums.

Medicare at 65: The work history requirement

The 10-year rule means 40 quarters of work covered by Medicare tax. A quarter is roughly three months. You do not need to work 10 years in a row — the quarters can be spread across your entire working life. If you worked part-time, full-time, or switched jobs many times, the Social Security Administration (SSA) adds up all the quarters you paid in.

You can check your own work record by creating an account at ssa.gov and viewing your Social Security Statement. The statement shows how many quarters you have earned and estimates your future benefits. If you see an error — a job that should have been counted but was not — you can contact SSA to correct it. Corrections sometimes take several months, so check early if you are approaching 65.

If you have not worked 10 years yourself, you may still may have access to through a family member. A spouse, ex-spouse (if the marriage lasted at least 10 years), or adult child can use your work record to get Medicare at 65, even if they have never worked or paid Medicare taxes. They must be at least 65 years old, and you must have the required 40 quarters.

Getting Medicare before 65: SSDI and medical conditions

If you receive SSDI (Social Security Disability Insurance), you automatically move to Medicare after you have been on SSDI for 24 months. The 24 months starts from the month you began receiving SSDI payments, not from the month you applied. You do not need to do anything — SSA transfers you to Medicare and sends you a new card.

Two other medical conditions allow Medicare enrollment before 65, regardless of work history or age. If you have end-stage renal disease (ESRD) — permanent kidney failure requiring dialysis or transplant — you can get Medicare as soon as your doctor certifies the diagnosis. If you have ALS (amyotrophic lateral sclerosis, also called Lou Gehrig's disease), you can get Medicare when ready upon diagnosis, with no waiting period. In both cases, your doctor submits the medical documentation to SSA, and you receive your Medicare card within weeks.

If you have ESRD and are already on SSDI, you still may have access to for Medicare through ESRD — you do not have to wait the full 24 months. The medical diagnosis takes priority.

Enrollment timing and late penalties

You should enroll in Medicare during the three months before you turn 65. This window is called your Initial Enrollment Period (IEP). It runs from the first day of the month you turn 65 back three months. If you turn 65 on March 15, your IEP starts December 1 and ends March 31. Enrolling during this window means your coverage starts on the first day of the month you turn 65, with no gaps.

If you miss your IEP, you can still enroll, but you may face a permanent penalty on your Part B and Part D premiums. The penalty is 10 percent of the Part B premium for each full 12 months you were late, and 1 percent of the Part D premium for each full month you were late. These penalties stay with you for life, even after you enroll. The only exception is if you or your spouse were still working and covered by an employer health plan — in that case, you have a grace period to enroll without penalty after you leave that job.

If you are on SSDI and will move to Medicare after 24 months, SSA sends you enrollment materials about three months before the transfer. Follow the instructions to choose your coverage. If you have ESRD or ALS, your doctor's office usually handles the referral to SSA, but confirm that the paperwork was submitted.

Non-citizens and permanent residents

You must be a U.S. citizen or a lawful permanent resident (green card holder) to get Medicare. If you are a permanent resident, you must have held that status for at least five years. The five years do not have to be continuous — SSA counts all the time you have held a green card, even if you left the country and returned.

When you enroll, bring your passport or birth certificate (to prove citizenship) and your green card (if you are a permanent resident). If you are a permanent resident, also bring documentation showing when you first received your green card — this can be your original green card, an I-797 approval notice, or a letter from U.S. Citizenship and Immigration Services (USCIS).

If you are not yet a permanent resident but are working on a visa, you cannot get Medicare until you become a permanent resident and meet the five-year requirement. You may be able to buy private health insurance in the meantime.

Government employees and railroad workers

Most government employees and railroad workers are covered by Medicare, but the rules differ slightly. Federal employees hired after 1983 pay Medicare tax and are covered by Medicare at 65, just like private-sector workers. Federal employees hired before 1984 may not have paid Medicare tax and may not may have access to for Medicare based on their own work record — they should check their earnings record at ssa.gov.

Railroad workers who worked for a railroad for at least 10 years are covered by the Railroad Retirement Board (RRB), not Social Security. They become may be able to access for Medicare at 65 based on their railroad service. If you worked for a railroad, contact the RRB at rrb.gov or call 1-877-772-5772 to confirm your may be able to access and enroll.

Some state and local government employees did not pay Medicare tax during their careers. If you are in this group, you may not may have access to for Medicare at 65 based on your work record. You can check your earnings record at ssa.gov to see whether your government employment included Medicare tax payments.

Frequently Asked Questions

What if I worked in another country before moving to the United States?

Work you did outside the United States does not count toward the 40 quarters needed for Medicare. Only work covered by U.S. Medicare tax counts. If you have worked in the U.S. for at least 10 years since becoming a permanent resident or citizen, those quarters count. Check your Social Security Statement at ssa.gov to see your U.S. work history.

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

Yes. You become may be able to access for Medicare at 65 regardless of whether you are still working. If your employer offers health insurance, you can keep that coverage and delay enrolling in Medicare Part B without penalty, as long as you enroll within eight months of leaving the job or losing the employer coverage. However, you should still enroll in Part A (hospital insurance) at 65, as it is usually free and has no penalty for late enrollment.

What happens if I move out of the United States?

You can keep Medicare Part A (hospital insurance) if you move abroad, but Part B (medical insurance) coverage ends after you have been outside the U.S. for more than six months. If you return, you can re-enroll in Part B without penalty. Some countries have agreements with the U.S. that allow limited Medicare coverage for U.S. citizens living there — contact Medicare at 1-800-MEDICARE to learn whether your destination is covered.

Can my adult child get Medicare on my work record?

Yes, if your child is at least 65 years old and you have 40 quarters of Medicare-covered work. Your child does not need to have worked or paid taxes themselves. They must be a U.S. citizen or permanent resident of at least five years. Contact Social Security to add your adult child to your record.

What if I never worked but am married to someone who did?

If your spouse has 40 quarters of Medicare-covered work, you can get Medicare at 65 based on their work record. You do not need to have worked yourself. If you are divorced, the same rule applies if the marriage lasted at least 10 years and you are at least 65 years old. Your spouse does not need to have enrolled in Medicare first — you can enroll based on their record independently.