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 be retired to sign up at 65 — you just have to reach that birthday.

The work history requirement is separate from the age requirement. To get Medicare Part A (hospital insurance) at 65, you or your spouse must have worked and paid Medicare taxes for at least 10 years (40 quarters). If you do not meet the 10-year rule, you may still get Medicare Part A by paying a monthly premium, but you need to check with Social Security to know the exact amount.

If you are under 65 and disabled, you must have been on SSDI for 24 months before Medicare begins. If you have ALS, Medicare starts the month you are approved for SSDI — no waiting period. If you have ESRD, you become may be able to access once you start dialysis or receive a kidney transplant, regardless of age or work history.

Key Takeaways

  • You become may be able to access for Medicare at age 65 if you or your spouse paid Medicare taxes for at least 10 years.
  • If you are under 65, you may get Medicare if you have been on SSDI for 24 months, have ALS, or have end-stage renal disease.
  • Citizenship or legal residency in the United States is required; you must also be a U.S. citizen or permanent resident for at least five years.
  • You do not have to be retired or stop working to sign up for Medicare at 65.
  • If you do not have 10 years of work history, you can still get Part A by paying a premium, but the amount depends on how many quarters you worked.

Work History and Medicare Taxes

Medicare is funded by payroll taxes, and your may be able to access is tied to how long you or your spouse paid those taxes. Each year you work and pay Medicare tax counts as one quarter toward the 40-quarter (10-year) requirement. You do not have to have worked those 10 years consecutively — they can be spread across your entire working life.

If you worked for a government employer that did not withhold Medicare taxes (some state and local government jobs fall into this category), those years may not count. If this applies to you, contact Social Security directly to find out whether your work history qualifies.

If your spouse worked and paid Medicare taxes for 10 years but you did not, you may still get Medicare Part A at 65 based on their work record. You do not have to be married now — you can may have access to on an ex-spouse's record if you were married for at least 10 years and are now 65 or older and unmarried.

Citizenship and Residency Requirements

You must be a U.S. citizen or a 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 before you can sign up. Temporary visa holders, undocumented immigrants, and people with other immigration statuses do not may have access to for Medicare.

You must also be a resident of the United States when you sign up. If you spend time outside the U.S., you can still have Medicare, but you cannot be out of the country for more than six months at a time without losing coverage. Some territories and possessions have different rules — if you live in Puerto Rico, Guam, the U.S. Virgin Islands, or another U.S. territory, contact Social Security to learn how the rules explore to you.

Disability Before Age 65

If you are under 65 and have been receiving SSDI for 24 months, you automatically become may be able to access for Medicare. The 24 months starts from the month Social Security approved your disability claim, not from the month you applied. Once those 24 months pass, Medicare Part A and Part B coverage begins automatically — you do not have to do anything.

Some people on SSDI also may have access to for Medicaid (the state program for low-income people), which is separate from Medicare. Having one does not mean you have the other. If you are on SSDI and have questions about Medicaid, contact your state Medicaid office.

End-Stage Renal Disease and ALS

If you have end-stage renal disease and need dialysis or have had a kidney transplant, you become may be able to access for Medicare regardless of your age or work history. Your may be able to access begins the month you start dialysis or the month of your transplant. You do not have to wait 24 months like people on SSDI do.

If you have amyotrophic lateral sclerosis (ALS), you become may be able to access for Medicare the month Social Security approves you for SSDI. Unlike other disabilities, there is no 24-month waiting period. Your Medicare coverage starts when ready.

What Happens If You Do Not Meet the 10-Year Rule

If you reach 65 but you or your spouse have not worked and paid Medicare taxes for 10 years, you can still get Medicare Part A by paying a monthly premium. The premium amount depends on how many quarters you worked — the more quarters, the lower the premium. If you worked fewer than 30 quarters, the premium is higher than if you worked 30 to 39 quarters.

You can also get Medicare Part B (medical insurance) and Part D (prescription drug coverage) at 65 regardless of your work history, though Part B has a monthly premium that increases if you delay signing up past 65. Part A is the only part with a work history requirement.

If you are not sure how many quarters you have worked, you can check your Social Security record online at ssa.gov or call Social Security at 1-800-772-1213 to ask.

Signing Up at 65

You should sign up for Medicare during your Initial Enrollment Period, which is the seven-month window that includes the month you turn 65, the three months before, and the three months after. If you sign up during this window, your coverage starts on the first day of the month you turn 65 (or the first day of the following month if you sign up after your birthday month).

If you miss this window and sign up later, your coverage will be delayed, and you may have to pay a penalty on your Part B and Part D premiums for as long as you have Medicare. The only exception is if you or your spouse are still working and covered by an employer health plan — in that case, you may be able to sign up later without penalty.

You can sign up online at Medicare.gov, by phone at 1-800-MEDICARE, or in person at your local Social Security office.

Frequently Asked Questions

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

You must be a U.S. citizen or permanent resident who has held that status for at least five years. If you are a permanent resident, bring your green card when you sign up. Temporary visa holders and undocumented immigrants do not may have access to for Medicare.

Do I have to be retired to sign up for Medicare at 65?

No. You can sign up at 65 whether you are still working or not. If you are still working and covered by your employer's health plan, you may want to delay Part B to avoid paying for duplicate coverage, but you should still sign up for Part A.

What if I worked outside the United States?

Work done outside the U.S. generally does not count toward the 10-year requirement, even if you paid U.S. taxes. Some countries have agreements with the U.S. that allow certain work to count — contact Social Security to learn about your situation qualifies.

Can I get Medicare based on my spouse's work record?

Yes. If your spouse worked and paid Medicare taxes for 10 years, you can get Medicare Part A at 65 based on their record. You can also may have access to on an ex-spouse's record if you were married for at least 10 years, are now 65 or older, and are unmarried.

What if I have been on SSDI for less than 24 months?

You are not yet may be able to access for Medicare. Once you reach 24 months on SSDI, Medicare begins automatically. If you have ALS, you become may be able to access the month you are approved for SSDI with no waiting period.