The Basic Rules for Medicare may be able to access

You can get Medicare when you turn 65, regardless of your work history or income — that is the main rule. You do not have to be retired, and you do not have to be poor. If you are a U.S. citizen or permanent resident who has lived in the country for at least five years, you become may be able to access on your 65th birthday.

There are three other paths to Medicare before 65. You can join if you have been receiving Social Security Disability Insurance (SSDI) for 24 months, if you have end-stage renal disease (permanent kidney failure requiring dialysis or transplant), or if you have ALS (amyotrophic lateral sclerosis, also called Lou Gehrig's disease). For ALS, you become may be able to access when ready upon approval for SSDI — you do not wait 24 months.

If you worked long enough to earn Social Security credits, Medicare Part A (hospital insurance) is free. If you did not work enough, you can still buy Part A at age 65. Part B (medical insurance) costs a monthly premium that varies based on your income.

Key Takeaways

  • You become may be able to access for Medicare at age 65 if you are a U.S. citizen or permanent resident who has lived here for at least five years.
  • You can join before 65 if you have received SSDI for 24 months, have end-stage renal disease, or have ALS (which qualifies you when ready).
  • Part A is free if you earned enough Social Security credits through work; otherwise you can buy it at 65.
  • Part B requires a monthly premium based on your income, and you should enroll when you first become may be able to access to avoid paying more later.
  • You have a three-month window before and after your 65th birthday to enroll without penalty — missing this window can cost you permanently.

may be able to access at Age 65

The simplest path is turning 65. On that birthday, you are may be able to access for Medicare Part A and Part B if you are a U.S. citizen or have been a permanent resident for at least five years. You do not have to stop working, and your income does not matter. Social Security will contact you automatically a few months before your 65th birthday to walk you through enrollment.

If you are already receiving Social Security benefits when you turn 65, you will be enrolled in Part A and Part B automatically. If you are not yet taking Social Security, you will need to enroll in Medicare yourself. You can do this online at Medicare.gov, by phone at 1-800-MEDICARE, or in person at your local Social Security office.

The enrollment window is three months before your 65th birthday, your birthday month, and three months after. If you miss this window and do not have other health insurance, you will pay a permanent penalty on your Part B premium — an extra 10 percent for each year you were may be able to access but did not enroll. This penalty stays with you for life, so enrolling on time matters.

may be able to access Before 65 Due to Disability or Illness

If you have been receiving SSDI for 24 months, you become may be able to access for Medicare at that point, even if you are younger than 65. The 24 months starts from the month you were approved for SSDI, not from when you applied. Social Security will notify you when you reach 24 months and will enroll you automatically in Part A and Part B.

If you have end-stage renal disease, you are may be able to access for Medicare regardless of age or work history. You become may be able to access the month your kidney disease is diagnosed if you need dialysis or a transplant, or the month after you receive a transplant. You will need to provide documentation from your nephrologist (kidney doctor) or dialysis center. Contact Medicare directly at 1-800-MEDICARE to enroll.

If you have ALS, you are may be able to access for Medicare when ready upon approval for SSDI — you do not wait 24 months like other disability cases. Social Security will enroll you automatically once your SSDI claim is approved. This is the only condition that bypasses the 24-month waiting period.

Work History and Part A Coverage

Part A (hospital insurance) is free at 65 if you or your spouse earned enough Social Security credits through work. You need 40 credits total, which is roughly 10 years of work. Each year you work and pay payroll taxes, you earn up to four credits. If you reached 40 credits at any point in your life, you may have access to for free Part A at 65.

If you did not work enough to earn 40 credits, you can still get Part A at 65, but you will pay a monthly premium. The premium amount depends on how many credits you did earn. If you earned 30 to 39 credits, the premium is lower than if you earned fewer than 30. You can check your work record and credit count on your Social Security account at ssa.gov.

If your spouse worked enough to earn 40 credits, you may be able to get free Part A based on their work record, even if you did not work. You must be at least 62 years old and married to them, or be any age and caring for their child who is under 16 or disabled. Contact Social Security to explore this option.

Income and Part B Premiums

Part B (medical insurance) always costs a monthly premium, and the amount depends on your income. The standard premium in 2024 is $164.90 per month, but if your income is higher, you will pay more. Medicare uses your tax return from two years ago to calculate your income, so your 2024 premium is based on your 2022 income.

If your income changes significantly — you retire, lose a job, get divorced, or have a major life event — you can request that Medicare recalculate your premium based on your current income instead of the old tax return. You will need to file a form called the Income Related Monthly Adjustment Amount (IRMAA) Life-Changing Event with Social Security within 60 days of the event. This can lower your premium if your income has dropped.

Your Part B premium is deducted from your Social Security check automatically if you are receiving benefits. If you are not yet taking Social Security, you will receive a bill from Medicare each month.

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 lived in the United States for at least five years continuously. Time spent outside the country can break this five-year requirement, so if you travel or live abroad for extended periods, contact Social Security to confirm your status.

If you are a citizen or permanent resident but do not have a Social Security number, you will need to explore for one before you can enroll in Medicare. You can explore at your local Social Security office. Bring your citizenship or permanent resident documentation, a photo ID, and proof of your current address.

If you are not a U.S. citizen or permanent resident, you are not may be able to access for Medicare, even if you have lived and worked in the country for many years. Some states offer health insurance programs for immigrants; contact your state health department to learn what may be available to you.

Special Situations: Government Workers and Railroad Employees

If you worked for the federal government and are covered by the Federal Employees Health Benefits Program (FEHB), you are still may be able to access for Medicare at 65. You can keep your FEHB coverage and add Medicare, or switch to Medicare alone. Some federal retirees find that keeping both provides better coverage than Medicare alone.

If you worked for a railroad and are covered by the Railroad Retirement Board (RRB), you follow similar rules to Social Security. You become may be able to access for Medicare at 65 if you earned enough railroad retirement credits. Contact the RRB at 1-877-772-5772 to confirm your may be able to access and enroll.

Frequently Asked Questions

What happens if I turn 65 but do not enroll in Medicare right away?

If you have other health insurance through your job or a spouse's job, you can delay enrollment without penalty as long as that coverage is active. Once you lose that coverage, you have a two-month window to enroll in Medicare without penalty. If you miss that window, you will pay a permanent 10 percent penalty on Part B for each year you were may be able to access but did not enroll.

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

No, Medicare requires U.S. citizenship or permanent residency with at least five years of continuous residence. If you are an immigrant, contact your state health department or a local community health center to learn what insurance programs may be available to you.

Do I have to retire to get Medicare at 65?

No. You can be working full-time and still enroll in Medicare at 65. Your work status does not affect your may be able to access. You can continue working and have Medicare coverage at the same time.

If I was denied SSDI, can I still get Medicare at 65?

Yes. Denial of SSDI does not affect your may be able to access for Medicare at 65 based on age. You will still become may be able to access when you turn 65 if you are a citizen or permanent resident. The SSDI denial only means you cannot use the disability pathway to Medicare before 65.

How do I check if I have enough work credits for free Part A?

Create an account at ssa.gov and view your Social Security Statement. It shows your total credits earned and estimates your future benefits. You can also call Social Security at 1-800-772-1213 and ask a representative to review your work record with you.