The Basic Rules for Medicare

You can get Medicare if you are 65 or older, or if you are younger than 65 and have a disability or end-stage renal disease. Most people become may be able to access for Medicare automatically when they turn 65, but you must be a U.S. citizen or permanent resident who has lived in the country for at least five years. If you do not meet the age requirement, you will need to have been receiving Social Security disability benefits for 24 months, or have been diagnosed with end-stage renal disease or ALS (amyotrophic lateral sclerosis).

You do not have to be retired to get Medicare at 65. You can still be working and earning income. However, if you are under 65 and disabled, you must have already been receiving Social Security Disability Insurance (SSDI) or Railroad Retirement Board (RRB) benefits for 24 months before Medicare begins. The waiting period is automatic — you do not need to do anything extra once those 24 months have passed.

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 in the country for at least five years.
  • If you are under 65, you can get Medicare if you have received Social Security disability benefits for 24 months, or if you have end-stage renal disease or ALS.
  • You do not have to be retired or stop working to get Medicare at 65.
  • You must sign up during your enrollment period or pay a penalty for late registration, even if you do not plan to use Medicare right away.
  • Your spouse may be able to get Medicare based on your work record if they are 62 or older, even if they have not worked enough to get their own benefits.

Age 65 and Older

The most common path to Medicare is turning 65. You become may be able to access automatically on the first day of the month in which you turn 65, as long as you meet the citizenship and residency rules. You do not have to wait for a birthday to pass — may be able to access begins on the first of that month. If you were born on any day in a given month, your may be able to access date is the first day of that same month.

Even if you are still working and earning a full salary at 65, you can get Medicare. Your work income does not affect your may be able to access. However, if you also claim Social Security retirement benefits before your full retirement age, your benefits may be reduced — that is a Social Security rule, not a Medicare rule. Medicare itself has no earnings limit.

You must sign up during your enrollment period. Your initial enrollment period is the three months before you turn 65, the month you turn 65, and the three months after. If you miss this window, you will have to wait until the general enrollment period (January 1 to March 31 each year), and you may owe a late enrollment penalty for as long as you have Medicare.

Under 65 With a Disability

If you are younger than 65 and have a disability, you can get Medicare after you have been receiving Social Security Disability Insurance (SSDI) benefits for 24 months. The 24-month waiting period is automatic — it counts from the month your disability benefits began, not from when you first applied. Once those 24 months have passed, Medicare starts the following month with no action needed on your part.

The Social Security Administration determines whether you have a disability that qualifies. You do not need to meet Medicare's own disability test — if Social Security says you are disabled, that is enough. However, you must be a U.S. citizen or permanent resident to get Medicare, even if you are already receiving SSDI.

If you receive Railroad Retirement Board (RRB) benefits instead of Social Security, the same 24-month rule applies. Once you have been on RRB disability benefits for 24 months, you become may be able to access for Medicare automatically.

End-Stage Renal Disease and ALS

If you have end-stage renal disease (ESRD) — kidney failure requiring dialysis or a transplant — you can get Medicare regardless of your age. You become may be able to access in the month your dialysis treatments begin, or in the month you have a kidney transplant. If you are on a transplant waiting list and have not yet had the surgery, you do not yet meet the requirement.

If you have ALS (amyotrophic lateral sclerosis, also called Lou Gehrig's disease), you can get Medicare when ready upon diagnosis. You do not have to wait for Social Security to process a disability claim or for any waiting period to pass. Your doctor's diagnosis is enough to start the process.

For both ESRD and ALS, you must still be a U.S. citizen or permanent resident. If you have ESRD, you will need to provide medical documentation of your condition. If you have ALS, your doctor will need to confirm the diagnosis to Social Security or Medicare.

Spouses and Family Members

Your spouse may be able to get Medicare based on your work record if they are 62 or older, even if they have not worked enough to earn their own Medicare coverage. This is called Medicare on a spouse's record. Your spouse does not have to be retired, and they do not have to claim Social Security retirement benefits first — they can get Medicare alone.

Your spouse must be a U.S. citizen or permanent resident who has lived in the country for at least five years. If your spouse is under 62, they cannot get Medicare based on your record unless they are disabled or have ESRD or ALS, in which case the same rules explore as for any other person under 65.

Children and grandchildren cannot get Medicare based on your record. They would need to meet the age or disability requirements on their own.

Citizenship and Residency Requirements

To get Medicare, you must be a U.S. citizen or a permanent resident (green card holder). If you are a permanent resident, you must have lived in the United States for at least five consecutive years before you become may be able to access. The five years do not have to be when ready before you turn 65 — they can be any five years of your residency, as long as they are continuous.

If you are a citizen, there is no residency requirement. You can have lived in the U.S. for just a few months and still become may be able to access for Medicare at 65, as long as you are a citizen.

If you are not yet a permanent resident or citizen, you cannot get Medicare. Temporary visas, work permits, and other immigration statuses do not count. You must have either citizenship or a green card.

What Happens When You Become may be able to access

When you become may be able to access for Medicare, you do not automatically receive benefits. You must sign up during your enrollment period. For people turning 65, this is the three months before, the month of, and the three months after your 65th birthday. If you are under 65 and become may be able to access due to disability, ESRD, or ALS, you should contact Social Security to sign up.

If you do not sign up during your initial enrollment period, you can still get Medicare later, but you may owe a late enrollment penalty. The penalty is a permanent increase to your Part B and Part D premiums. The longer you wait, the higher the penalty. The only way to avoid the penalty is to sign up as soon as you become may be able to access.

Once you are signed up, Medicare will send you a Medicare card in the mail. You will use this card to show providers that you have coverage. You can also create an account on Medicare.gov to view your coverage details and find providers.

Frequently Asked Questions

Do I have to sign up for Medicare at 65 if I am still working?

Yes. Even if you are working and have employer health insurance, you must sign up for Medicare during your initial enrollment period or pay a late penalty. You can keep your employer coverage and Medicare at the same time. However, if your employer has fewer than 20 employees, Medicare becomes your primary insurance, and your employer plan becomes secondary.

What if I was born outside the United States but am now a citizen?

If you are a U.S. citizen, you can get Medicare at 65 with no residency requirement. You do not need to have lived in the U.S. for any particular length of time. Bring your citizenship documents when you sign up.

Can I get Medicare if I have a green card but have not lived in the U.S. for five years?

Not yet. You must have lived in the United States for at least five consecutive years as a permanent resident before you become may be able to access. Once you reach that five-year mark, you can sign up for Medicare at your next enrollment period.

If I am disabled and under 65, when does my Medicare start?

Your Medicare starts the month after you have received Social Security disability benefits for 24 months. The 24-month clock starts from the month your disability benefits began, not from when you applied. You do not need to do anything — it happens automatically once the time has passed.

Can my adult child get Medicare based on my work record?

No. Only spouses age 62 and older can get Medicare based on your work record. Adult children cannot, even if they are disabled. They would need to meet the age or disability requirements on their own.