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 amyotrophic lateral sclerosis (ALS). Most people fall into the first group — those who reach 65 automatically become may be able to access on the first day of the month in which they turn 65.

Age alone is not enough. You also need a work history — either your own or your spouse's. The Social Security Administration tracks this through work credits. You earn one credit for each quarter of the year you work and pay Social Security taxes, up to a maximum of four credits per year. Most people need 40 credits total (roughly 10 years of work) to may have access to for Medicare based on their own record.

If you do not have 40 credits yourself, you may still may have access to based on your spouse's work history if you are married, divorced (and the marriage lasted at least 10 years), or widowed. Your spouse does not need to be receiving benefits — they only need to have earned enough credits.

Key Takeaways

  • You become may be able to access for Medicare at 65 if you have worked and paid Social Security taxes for at least 10 years (40 credits), whether or not you have claimed Social Security benefits yet.
  • If you are under 65, you may still may have access to if you have been receiving SSDI for 24 months, have ESRD, or have ALS.
  • If you do not have enough work credits yourself, you may may have access to based on a spouse's work history, even if you are divorced or widowed.
  • You do not have to stop working to get Medicare, and getting Medicare does not automatically enroll you in all parts — you must take action during your enrollment window or face late penalties.
  • The Social Security Administration maintains your work credit record; you can check it online or by calling 1-800-772-1213 to confirm you have enough credits before you turn 65.

Work Credits and How They Count

A work credit is earned when you work in a job covered by Social Security and your employer withholds Social Security taxes from your paycheck. Self-employed people also earn credits when they pay self-employment tax. You earn one credit for each quarter (three-month period) in which you earn at least a certain amount — in 2024, that amount is $1,730 per quarter, but this figure changes each year.

You can earn up to four credits per year, so reaching 40 credits typically takes 10 years of work. The work does not have to be continuous — if you worked for five years, then stopped, then worked again for five years, those credits still count toward your total. However, credits earned more than 10 years in the past do not count toward Medicare may be able to access; only your most recent 10 years of work matter for this purpose.

Government jobs, railroad work, and some other employment may follow different rules. If you worked for a government agency that did not withhold Social Security taxes, you may not have earned credits for that time. The Social Security Administration can tell you whether your specific work history counts.

may have access to Through a Spouse's Work Record

If you are married, divorced, or widowed, you may may have access to for Medicare based on your spouse's work history even if you have not worked enough yourself. Your spouse must have at least 40 credits — they do not need to be receiving Social Security benefits, and they do not even need to be alive (if you are widowed). You must be at least 65 years old to use a spouse's record, with one exception: if you are caring for your spouse's child who is under 16, you can may have access to at any age.

If you are divorced, the marriage must have lasted at least 10 years. You can use an ex-spouse's record even if they have remarried, and even if they have not yet claimed their own benefits. If you are widowed, you can use your deceased spouse's record regardless of how long you were married.

You do not need your spouse's permission to use their record, and doing so does not affect the benefits they receive. When you contact Social Security to enroll in Medicare, tell them you want to use a spouse's work history, and bring a marriage certificate, divorce decree, or death certificate as proof.

Disability and End-Stage Renal Disease

If you are under 65 and have been receiving SSDI for 24 consecutive months, you become may be able to access for Medicare automatically. You do not need to do anything — Medicare begins the month after your 24-month period ends. This applies whether your disability is physical, mental, or both, as long as the Social Security Administration has determined you cannot work.

If you have end-stage renal disease (ESRD) — permanent kidney failure requiring dialysis or a transplant — you may may have access to for Medicare regardless of age or work history. You must have worked and paid Social Security taxes, or be the spouse or dependent child of someone who has. Once you begin dialysis or receive a kidney transplant, you have a three-month waiting period before Medicare begins.

If you have amyotrophic lateral sclerosis (ALS), you do not have a waiting period. You become may be able to access for Medicare when ready upon approval for SSDI, rather than waiting 24 months. You still need the required work credits or to may have access to through a family member's record.

What Happens If You Do Not Have Enough Credits

If you reach 65 and do not have 40 credits — either your own or through a spouse — you cannot get Medicare. There is no alternative program that covers the same services. Some people in this situation are immigrants who worked outside the United States, or people who worked in jobs not covered by Social Security.

If you are close to 40 credits, you may be able to work a bit longer to earn the remaining ones. Each additional quarter of work at the required earnings level adds one credit. If you are far short and cannot work more, you may be able to purchase Medicare coverage directly, though this is expensive. Contact Social Security at 1-800-772-1213 to discuss your specific situation.

Some states offer programs for uninsured seniors who do not may have access to for Medicare. These vary widely by state and are usually means-tested (based on income and assets). Your state health department or local Area Agency on Aging can tell you what is available where you live.

Checking Your Work Record Before You Turn 65

The Social Security Administration maintains a record of your work credits. You can check this record online through your my Social Security account at ssa.gov. Create an account, log in, and view your earnings record and estimated benefits. This shows how many credits you have earned and whether the record is accurate.

Review your record carefully, especially if you have changed names, worked under a different name, or had gaps in employment. If you see an error — a year of work that is missing, or earnings that are too low — contact Social Security right away. You have a limited time to correct errors, and mistakes can delay your Medicare enrollment or reduce your benefits.

If you do not have internet access or prefer to speak with someone, call Social Security at 1-800-772-1213. They can tell you how many credits you have and whether you are on track to may have access to at 65. This conversation takes about 10 minutes and can save you from surprises later.

Frequently Asked Questions

Do I have to be receiving Social Security to get Medicare?

No. You can get Medicare at 65 even if you have not claimed Social Security benefits yet. However, you must have the required work credits. If you delay claiming Social Security past 65, you can still enroll in Medicare at 65 without affecting your future Social Security payments.

Can I get Medicare if I worked outside the United States?

Work outside the United States generally does not count toward Medicare credits, with some exceptions. If you worked for the U.S. government abroad, or if you worked in a country that has a Social Security agreement with the United States, those credits may count. Contact Social Security to discuss your specific work history.

What if I am still working at 65?

You can get Medicare at 65 whether you are still working or not. Working does not delay or prevent your may be able to access. If you are still employed and your employer offers health insurance, you can keep that coverage and also enroll in Medicare, though you will want to understand how the two coordinate.

If my spouse gets Medicare, do I automatically get it too?

No. Your spouse's Medicare enrollment does not affect your may be able to access. You must meet the requirements yourself — either through your own work credits, through your spouse's work record (if you are 65 or older), or through disability or ESRD. You must also take steps to enroll; nothing happens automatically based on someone else's enrollment.

What happens if I miss the enrollment window?

If you do not enroll when you first become may be able to access, you may face a late enrollment penalty that increases your premiums permanently. The enrollment window is normally three months before the month you turn 65, the month itself, and three months after. If you miss this window and do not have a valid reason, contact Social Security as soon as possible to understand your options.