Medicare has strict age and work-history requirements that leave some people without coverage

You are not covered by Medicare if you are under 65 and do not have a disability or end-stage renal disease that Medicare recognizes. You also cannot get Medicare if you have not worked long enough in a job where you paid Medicare taxes — typically 10 years of work history is required. Non-citizens without permanent resident status or a valid visa may not be covered. If you fall into any of these categories, you will need to find coverage through another route.

The rules are strict because Medicare is designed as an earned benefit tied to your work record and age. That means your path forward depends on which rule is keeping you out. A person under 65 with no disability has different options than someone who immigrated recently or someone whose work history is too short.

Key Takeaways

  • You cannot get Medicare before age 65 unless you have a disability or end-stage renal disease that the Social Security Administration has already recognized.
  • Medicare requires 40 work credits (roughly 10 years of employment where you paid Medicare taxes), and you cannot substitute volunteer work, self-employment without tax payments, or work done outside the United States.
  • Non-citizens without permanent resident status or a may have access to visa may not be covered, even if they have worked in the United States.
  • If you are not covered by Medicare, you can look into Medicaid (if your income is low enough), marketplace insurance through Healthcare.gov, or employer coverage if you are still working.
  • Some people who do not meet Medicare's rules can still get coverage through a spouse's or parent's work record if they meet other conditions.

Age requirements: Why you cannot get Medicare before 65

The standard Medicare age is 65. If you are younger than that and do not have a disability or end-stage renal disease, you cannot get Medicare, period. There is no exception for hardship, medical need, or low income.

The only way to get Medicare before 65 is if the Social Security Administration has already approved you for Social Security Disability Insurance (SSDI) or if you have end-stage renal disease (ESRD) requiring dialysis or a transplant. Even then, you must wait 24 months after your SSDI approval before Medicare begins. If you have ESRD, Medicare can start sooner — sometimes right away — but you must have the diagnosis confirmed by a doctor and reported to Social Security.

If you are under 65 and do not have a recognized disability, your options are Medicaid (if your income qualifies), marketplace insurance through Healthcare.gov, or coverage through an employer or family member's plan.

Work history: The 40-credit requirement and why it matters

Medicare is an earned benefit. To get it, you need 40 work credits, which means you must have paid Medicare taxes for roughly 10 years. You earn one credit for every three months you work in a job where your employer withholds Medicare tax from your paycheck. Most people earn four credits per year, so 10 years of full-time work gets you to 40.

Work credits do not carry over from other countries. If you worked in Canada, Mexico, or anywhere else before moving to the United States, those years do not count toward the 40-credit requirement. Only work in the United States where you paid Medicare taxes counts. Self-employment income counts only if you paid self-employment tax on it. Volunteer work, family business work where you were not on the payroll, and informal jobs do not count.

If you have fewer than 40 credits, you cannot get Medicare on your own record. You may be able to get coverage based on a spouse's or parent's work record if you meet other conditions — for example, if you are 62 or older and married to someone with 40 credits, or if you are under 19 and your parent is retired or deceased and had 40 credits.

Citizenship and immigration status: Who is excluded and why

Non-citizens without permanent resident status or a may have access to visa generally cannot get Medicare. This includes people who are in the United States on a temporary visa, undocumented immigrants, and people whose immigration status is pending.

Permanent residents (green card holders) can get Medicare if they meet the age and work-credit requirements, just like citizens. Some visa holders with specific statuses — such as refugees and asylees after five years in the United States — may also be covered. The rules are complex and depend on your exact visa type and how long you have been in the country.

If you are not a citizen or permanent resident, you cannot get Medicare even if you have worked in the United States and paid Medicare taxes. Your options include Medicaid (which some states offer to certain non-citizens), marketplace insurance, or community health centers that offer sliding-scale fees based on income.

Spousal and family coverage: When you might still be covered

If you do not have 40 work credits of your own, you may still get Medicare based on someone else's record. A spouse, ex-spouse, parent, or adult child's work history can count if certain conditions are met.

For spousal coverage, you must be at least 62 years old and married to someone who is 62 or older and has 40 work credits. An ex-spouse's record can work too if the marriage lasted at least 10 years and you have been divorced for at least two years. If your spouse or ex-spouse is deceased, you may be covered as a surviving spouse or child, depending on your age.

If you are an adult child of someone who is retired, disabled, or deceased, you may get coverage on their record if you are under 19 (or under 23 if you are a full-time student) and unmarried. These rules are strict about age and family relationship, so contact Social Security directly to find out whether you may have access to.

What to do if you are not covered by Medicare

If Medicare is not an option for you, start by checking whether you may have access to for Medicaid. Medicaid is a joint federal-state program for people with low income, and the rules vary by state. Some states cover people earning up to 138% of the federal poverty level; others have lower limits. You can check your state's rules on your state Medicaid website or by calling your state health department.

If Medicaid does not cover you, look into marketplace insurance through Healthcare.gov. You can enroll during the open enrollment period (usually November through January) or if you have had a life change like losing a job or moving. Depending on your income, you may be able to get a tax credit that lowers your monthly premium.

If you are still working, ask your employer whether they offer health insurance. If you are under 65 and have a disability, check whether you may have access to for SSDI, which leads to Medicare after 24 months. Community health centers also offer care on a sliding-fee scale based on what you can afford, even if you have no insurance.

Special situations: Noncitizens, recent immigrants, and people with gaps in work history

If you are a recent immigrant with permanent resident status, you have the same Medicare rules as a citizen — you need 40 work credits and to be 65 or older (or have a may have access to disability). Work you did before getting your green card does not count. If you are close to 40 credits, you may want to keep working to reach the threshold.

If you have gaps in your work history — years when you were unemployed, caring for family, or out of the workforce — those years do not count toward the 40-credit requirement. You cannot make up for lost time by working extra hours now. However, if you are close to 40 credits and still working, continuing to work will eventually get you there.

If you are a non-citizen without permanent resident status, Medicare is not an option. Medicaid rules for non-citizens vary widely by state. Some states cover emergency services only; others cover more. Call your state Medicaid office to ask what is available to you based on your immigration status.

Frequently Asked Questions

Can I get Medicare if I am 64 and will turn 65 next year?

No, you cannot get Medicare until the month you turn 65. You should enroll during the three months before your 65th birthday (the month you turn 65 and the month after) to avoid a late-enrollment penalty. If you do not have coverage before then, marketplace insurance or Medicaid may be options.

What if I worked for 15 years but took 10 years off to raise children?

Only the 15 years you actually worked count toward the 40-credit requirement. The 10 years you were not working do not count, even though you were doing important work at home. You would have 60 credits from your 15 years of employment, which is more than the 40 required, so you would be covered.

Can I get Medicare if I am a permanent resident but have only worked five years in the United States?

No. Permanent residents must meet the same 40-credit requirement as citizens. You would need to work another five years (roughly) to reach 40 credits. After that, you would be covered when you turn 65, assuming you remain a permanent resident.

If I am not covered by Medicare, can I buy it directly?

No. Medicare is not sold on the open market. You either meet the requirements (age 65, work credits, citizenship or permanent residency) or you do not. If you do not meet the requirements, marketplace insurance through Healthcare.gov or Medicaid are your main options.

What happens if I become a permanent resident at age 70 but have no work history in the United States?

You would not be covered by Medicare because you do not have 40 work credits. Work you did before becoming a permanent resident does not count. You would need to work in the United States for roughly 10 years to build up 40 credits, even though you are already 70. Medicaid or marketplace insurance would be your options in the meantime.