The Basic Rule: Age 65 or Disability

You can get Medicare if you are 65 or older, or if you are under 65 and have been receiving Social Security Disability Insurance (SSDI) for at least 24 months, or if you have end-stage renal disease (ESRD) or ALS. Most people fall into the age 65 category. You do not have to retire to get Medicare — you can still be working.

The citizenship and residency requirement is straightforward: you must be a U.S. citizen or a lawful permanent resident (green card holder) who has lived in the United States for at least five consecutive years. If you are a non-citizen, you may still be able to get Medicare if you have been a permanent resident for the required time.

Key Takeaways

  • You become may be able to access for Medicare automatically at 65 if you have worked and paid Medicare taxes for at least 10 years (40 quarters), or if your spouse has.
  • You can get Medicare before 65 if you have been on SSDI for 24 months, have ALS, or have end-stage renal disease, regardless of work history.
  • You must be a U.S. citizen or lawful permanent resident who has lived in the country for at least five consecutive years.
  • If you do not have the required work history, you may still get Medicare at 65 by paying a monthly premium, though the cost will be higher.

Work History: The 10-Year Rule

Medicare is tied to your work record and the Medicare taxes you have paid during your working years. You need 40 quarters of coverage — roughly 10 years of work — to get Medicare Part A (hospital insurance) without paying a monthly premium at age 65. A quarter of coverage is earned when you have earned income and paid Medicare taxes in that three-month period. You do not need to have worked those 10 years consecutively; they can be spread across your entire working life.

If you do not have 40 quarters of coverage yourself, you may still get Medicare Part A without a premium if your spouse, ex-spouse, or parent has 40 quarters. You must be at least 62 years old to claim on a spouse's record, and at least 62 to claim on a parent's record (though your parent must be at least 62 as well). This rule applies even if your spouse or ex-spouse has not yet started receiving their own Social Security benefits.

If you reach 65 and do not have 40 quarters of coverage and cannot claim on someone else's record, you can still get Medicare Part A, but you will pay a monthly premium. The premium amount depends on how many quarters of coverage you do have. Part B (medical insurance) has its own premium regardless of your work history.

Getting Medicare Before Age 65

You can get Medicare at any age if you have been receiving SSDI for at least 24 months. The 24-month waiting period starts from the month you first became may have access to to disability benefits, not from the month you applied. Once you have been on SSDI for 24 months, you are automatically enrolled in Medicare Part A and Part B — you do not need to do anything.

Two other conditions allow Medicare before 65 without the 24-month wait. If you have end-stage renal disease (ESRD) — permanent kidney failure requiring dialysis or a transplant — you can get Medicare when ready, even if you have never worked or paid Medicare taxes. If you have amyotrophic lateral sclerosis (ALS), you can get Medicare when ready as well. In both cases, you become may be able to access the first month you meet the medical criteria, as determined by your doctor and verified through the Social Security Administration.

Citizenship and Residency Requirements

You must be a U.S. citizen or a lawful permanent resident to get Medicare. Lawful permanent residents are people with a valid green card. If you are a permanent resident, you must have lived in the United States for at least five consecutive years before you can get Medicare. The five-year clock starts from the date your green card was approved, not from the date you entered the country.

If you are a citizen, there is no residency requirement — you can get Medicare as soon as you turn 65 or meet the other conditions, even if you have only recently become a citizen. If you are a non-citizen without a green card, you cannot get Medicare, even if you have worked and paid Medicare taxes for many years. Refugees and asylees have different rules; they are treated as permanent residents for Medicare purposes after one year in the United States.

What Happens If You Do Not Meet the Requirements

If you are under 65 and do not have SSDI, ESRD, or ALS, you cannot get Medicare. You would need to look at other insurance options, such as coverage through your employer, the Affordable Care Act marketplace, or Medicaid if you meet your state's income limits. Some states have programs for uninsured or underinsured adults under 65.

If you are 65 or older but do not have the required work history and cannot claim on a spouse's or parent's record, you can still get Medicare Part A by paying a monthly premium. As of 2024, this premium ranges depending on how many quarters of coverage you have, but you should contact Social Security directly to find out your specific premium amount. Part B always has a monthly premium, and the amount is based on your income from two years prior.

How to Verify Your Work History

Before you turn 65, you can check your work record and quarters of coverage by creating an account on the Social Security website (ssa.gov) and viewing your Social Security Statement. This statement shows your earnings history and the number of quarters you have earned. You can also call Social Security at 1-800-772-1213 to ask about your record.

If you find errors in your work history — for example, earnings that were not credited to your account — you can request a correction. You have a limited time to correct errors, so if you spot a mistake, contact Social Security right away. Bring your W-2 forms or tax returns as proof of the earnings that were missed.

Special Cases: Government Employees and Non-Covered Work

Some government employees, particularly those hired before 1984, may not have paid Medicare taxes and may not be may be able to access for Medicare based on their government work. However, if they have other work history where they did pay Medicare taxes, those quarters count toward the 40-quarter requirement. If a government employee has no Medicare-covered work history, they cannot get Medicare, though they may have access to a government employee health plan.

Railroad workers have their own retirement system and may have different Medicare rules. If you worked for a railroad, contact the Railroad Retirement Board to understand how your service counts toward Medicare. Some railroad service counts toward Medicare, and some does not, depending on when you worked and the type of position you held.

Frequently Asked Questions

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

Yes. You can get Medicare at 65 regardless of whether you are still working. You do not have to retire. However, if you are still covered by an employer health plan, you may want to delay enrolling in Medicare Part B to avoid paying two premiums, though you should enroll in Part A if you are may be able to access.

What if I worked in another country?

Work you did outside the United States generally does not count toward the 40 quarters needed for Medicare. However, some countries have agreements with the United States that allow certain work to count. Contact Social Security to ask whether your foreign work history qualifies under a totalization agreement.

Can my spouse get Medicare on my record if they are younger than me?

Your spouse can get Medicare on your record at 62 if you are at least 62 and have 40 quarters of coverage. They do not have to wait until you turn 65. However, they will pay a higher premium for Part A if they claim before you do.

What if I never worked because I was a homemaker?

If you were a homemaker and did not work outside the home, you cannot get Medicare on your own work record. However, you may be able to get Medicare on your spouse's or ex-spouse's record if they have 40 quarters of coverage and you are at least 62.

Do I lose Medicare if I move out of the United States?

You can keep Medicare Part A and Part B if you move abroad, but coverage is limited. Medicare generally does not cover care received outside the United States, except in very specific situations near the border. You should research health insurance options in the country where you plan to live.