Who Can Get Medicare: Age, Disability, and Other Paths to Coverage

The main routes to Medicare coverage

You can get Medicare if you are 65 or older, or if you are younger and have a may have access to disability or medical condition. Most people become covered automatically when they turn 65 if they have already paid into Social Security or Railroad Retirement for at least 10 years. If you are under 65, you may be covered through Social Security Disability Insurance (SSDI), Supplemental Security Income (SSI), or because you have end-stage renal disease or ALS. A small number of people under 65 with employer coverage can also buy into Medicare directly.

The path you take depends on your age, work history, and current situation. Some routes are automatic; others require you to take a step. Understanding which one applies to you helps you know what to expect and when coverage begins.

Key Takeaways

You become covered automatically at 65 if you have paid into Social Security or Railroad Retirement for at least 10 years — no action needed unless you are still working.
If you are under 65 and receiving SSDI or SSI, you become covered automatically after a waiting period (24 months for SSDI, when ready for SSI in most cases).
People under 65 with end-stage renal disease or ALS can get Medicare regardless of work history, though the timing differs for each condition.
If you are under 65 and do not fit these categories, you may be able to buy Medicare directly, though this is uncommon and costs more than standard enrollment.
Timing matters: signing up late can result in permanent premium increases, so knowing your coverage date helps you avoid penalties.

Automatic coverage at 65 based on work history

If you are 65 or older and have paid into Social Security for at least 10 years (40 quarters of coverage), you are covered automatically. You do not need to do anything — coverage starts the month you turn 65. The same applies if you paid into Railroad Retirement instead of Social Security. This is the most common path to Medicare and covers the vast majority of people who reach 65.

If you are still working at 65, you are still covered by Medicare even if you have not yet claimed Social Security benefits. Your coverage begins the same way, regardless of whether you are drawing retirement income. However, if your employer offers health insurance, you may want to keep that coverage and delay Medicare enrollment — but you will need to understand the rules about coordinating the two plans to avoid penalties.

If you have not reached 10 years of work history, you may still be covered through a spouse's work record. If you are 62 or older and married to someone who has 10 years of coverage, you can be covered based on their record. The same applies if you are divorced from someone who had 10 years of coverage and your marriage lasted at least 10 years.

Coverage under 65 through SSDI or SSI

If you are receiving Social Security Disability Insurance (SSDI), you become covered by Medicare automatically after you have been on SSDI for 24 months. You do not need to turn 65 or meet any other requirement — the 24-month waiting period is the only gate. After those 24 months, your coverage begins without any action on your part.

If you are receiving Supplemental Security Income (SSI), the path is faster. You are covered by Medicaid, not Medicare, while you are on SSI. However, if you later move off SSI and onto SSDI, you will transition to Medicare after the 24-month SSDI waiting period. Some people receive both SSDI and SSI at the same time; in those cases, Medicaid is your primary coverage until the SSDI waiting period ends.

The key difference is timing: SSDI recipients wait 24 months from the date their benefits begin, while SSI recipients are covered by Medicaid from the start. If you are unsure which program you are on, your Social Security statement will say "SSDI" or "SSI" clearly.

Coverage under 65 with end-stage renal disease or ALS

If you have end-stage renal disease (ESRD) — permanent kidney failure requiring dialysis or transplant — you can get Medicare at any age. Coverage typically begins the month your dialysis treatments start, or the month of your kidney transplant. If you are on home dialysis, coverage may begin the month before your first treatment. You do not need to have worked or paid into Social Security; the condition itself qualifies you.

If you have ALS (amyotrophic lateral sclerosis, also called Lou Gehrig's disease), you are covered by Medicare when ready upon approval of your SSDI claim, with no 24-month waiting period. This is a unique rule that applies only to ALS. You will still need to file for SSDI first, but once approved, Medicare coverage is automatic.

Both of these conditions bypass the usual work-history requirement. If you have either condition and are under 65, contact Social Security to confirm your coverage date and what documents you will need to provide.

Buying Medicare directly if you do not fit other categories

If you are under 65 and do not have SSDI, SSI, ESRD, or ALS, you cannot get Medicare through the standard routes. However, some people in this situation can buy Medicare Part A and Part B directly. This option is rare and applies mainly to people who have lost employer coverage or who are in a specific situation where they need coverage before age 65.

Buying Medicare directly is more expensive than standard enrollment because you pay the full premium without subsidies. The monthly cost varies by your age and how long you have been without coverage. This route is not common, and you should explore other options — such as the Affordable Care Act marketplace or Medicaid — before considering it.

If you think you might be in a situation where you can buy Medicare directly, contact Medicare at 1-800-MEDICARE to discuss your circumstances. They can tell you whether you are may be able to access and what the costs would be.

What happens if you are not yet 65 and do not have a may have access to condition

If you are under 65 and do not have SSDI, SSI, ESRD, ALS, or the ability to buy Medicare directly, you are not covered by Medicare. Instead, you will need to find coverage through another source. The most common options are employer health insurance, coverage through a spouse's employer, or a plan through the Affordable Care Act marketplace.

Medicaid is another option if your income is low enough. Medicaid rules vary by state, but many states cover adults under 65 with low incomes. You can check whether you may be covered by contacting your state's Medicaid office or using the Healthcare.gov tool to see what options are available in your area.

If you are approaching 65, you can sign up for Medicare starting three months before the month you turn 65. Signing up early helps you avoid a gap in coverage and prevents late-enrollment penalties that can increase your premiums permanently.

How to confirm your coverage path and enrollment date

The easiest way to find out which path applies to you is to create an account on Medicare.gov or call 1-800-MEDICARE. You can also visit your local Social Security office in person. Have your Social Security number ready, and be prepared to describe your situation — your age, work history, current benefits, or any medical conditions that might may have access to you.

If you are already receiving Social Security benefits, you can check your Social Security statement online at ssa.gov. Your statement will show whether you are on SSDI or SSI, and it will tell you your work-history credits. If you are 65 or older and have 40 credits, you are covered automatically.

If you are under 65 with a disability or medical condition, ask Social Security directly when your Medicare coverage will begin. They can give you a specific month and help you understand what documents you will need. Getting this information early prevents confusion and helps you plan for any gaps in coverage.

Frequently Asked Questions

What if I worked in another country — does that count toward the 10 years needed for Medicare?

Work in some countries counts toward Social Security credits through totalization agreements between the United States and that country. However, not all countries are covered. Contact Social Security to find out whether your work history in a specific country counts. If it does, those credits can help you reach the 40 credits needed for Medicare coverage.

Can I get Medicare if I am a permanent resident but not a U.S. citizen?

Yes, if you meet the other requirements. You must have a valid Social Security number and have paid into Social Security for at least 10 years, or be receiving SSDI or SSI, or have a may have access to medical condition. Citizenship is not required. Bring your permanent resident card and Social Security number when you enroll.

If I am on SSDI and turn 65, do I switch from Medicare to something else?

No. When you turn 65, you remain on Medicare. Your coverage does not change — you straightforward transition from being covered because of your disability to being covered because of your age. Your benefits and premiums stay the same.

What if I delayed claiming Social Security — am I still covered by Medicare at 65?

Yes. You are covered by Medicare at 65 based on your work history, regardless of whether you have claimed Social Security benefits yet. You can delay claiming benefits for a higher monthly payment while still having Medicare coverage. The two are separate.

How do I know if my condition qualifies me for Medicare before age 65?

Only SSDI, SSI, end-stage renal disease, and ALS may have access to you for Medicare before 65. If you have a different condition, you will not be covered by Medicare until you turn 65 or meet one of those four criteria. Contact Social Security or your doctor to confirm whether your condition fits one of these categories.

This guide is for general information only and is not medical, financial, legal, or other professional advice. For decisions specific to your situation, consult a qualified professional. See our Editorial Policy.