The Core Rule: Age 65 or Disability

You become may be able to access for Medicare Part A and Part B when you turn 65, regardless of your income or health history. If you are younger than 65, you may still get Medicare if you have received Social Security Disability Insurance (SSDI) for 24 months, or if you have end-stage renal disease (ESRD) or amyotrophic lateral sclerosis (ALS). These are the three pathways in. There is no fourth.

Part A covers hospital stays, skilled nursing care, hospice, and home health services. Part B covers doctor visits, outpatient care, lab tests, and medical equipment. Both are run by the federal government, and both have the same may be able to access rules — you do not get one without the other unless you actively decline Part B.

You do not have to be retired to get Medicare at 65. You do not have to stop working. You do not have to be a U.S. citizen, though you must be a permanent resident or have lived in the U.S. for at least five years. If you were born outside the U.S., bring your green card or naturalization papers when you enroll.

Key Takeaways

  • You become may be able to access for Medicare Part A and Part B at age 65, or earlier if you have been on SSDI for 24 months, have ESRD, or have ALS.
  • You must enroll during your Initial Enrollment Period — the three months before you turn 65, the month you turn 65, and the three months after — or face a permanent penalty on Part B premiums.
  • If you are still working and covered by your employer's health plan, you may delay Part B without penalty, but you must enroll in Part A.
  • Permanent residents and non-citizens who have lived in the U.S. for at least five years are may be able to access, but must provide proof of residency.
  • You cannot get Part A without Part B unless you are working and covered by an employer plan, in which case you can delay Part B only.

may be able to access at Age 65

The simplest path is turning 65. On the first day of the month you turn 65, you are may be able to access. You do not have to wait for your birthday to pass. You do not have to file paperwork before that date — though you should, because enrollment windows are strict.

Age 65 may be able to access applies whether you are working, retired, wealthy, or poor. It applies whether you are healthy or have a serious illness. Medicare does not ask about your income, your job, or your medical history. If you are 65 and a U.S. citizen or permanent resident, you meet the basic test.

The catch is timing. You have a seven-month window to enroll: three months before you turn 65, the month you turn 65, and three months after. If you miss this window and do not have a valid reason, you pay a permanent 10% increase on your Part B premium for every year you were may be able to access but not enrolled. That penalty stays with you for life.

may be able to access Before 65: SSDI, ESRD, and ALS

If you are under 65 and receive SSDI, you become may be able to access for Medicare after you have been on SSDI for 24 consecutive months. The 24-month clock starts the month your SSDI payments begin, not the month you filed. Once you hit 24 months, Medicare Part A and Part B start automatically — you do not have to enroll. Social Security will send you a notice when this happens.

If you have end-stage renal disease (ESRD) — permanent kidney failure requiring dialysis or a transplant — you are may be able to access for Medicare regardless of age. You must be a U.S. citizen or permanent resident, and you must have worked long enough to have earned Medicare credits (usually 40 credits, or about 10 years of work). If you do not have enough work credits, your spouse's or parent's work record may count instead. You enroll through your dialysis center or transplant program.

If you have amyotrophic lateral sclerosis (ALS), also called Lou Gehrig's disease, you are may be able to access for Medicare when ready upon diagnosis, without waiting for SSDI. You do not need to have worked a certain number of years. You must enroll yourself — Social Security does not do it automatically. Contact your local Social Security office or call 1-800-772-1213 to start the process.

The Work Credit Requirement

To get Medicare Part A, you or your spouse must have earned enough work credits. One work credit is roughly equal to $1,730 of earnings in a year (this amount changes annually). Most people need 40 credits total — about 10 years of work — though some people need fewer if they are younger. If you became disabled before age 24, you may need only six credits in the three years before you became disabled.

If you do not have enough work credits yourself, Social Security can count your spouse's work record if you are married. If you are divorced, your ex-spouse's record may count if the marriage lasted at least 10 years and you are at least 62. If you are a widow or widower, your deceased spouse's record counts. If you do not have enough credits through any of these routes, you cannot get Medicare Part A, though you may still purchase Part B.

You can check your work credits by creating an account at ssa.gov or calling Social Security at 1-800-772-1213. They will tell you exactly how many credits you have and whether you meet the requirement. This takes about 15 minutes.

Enrollment Timing and Penalties

Your Initial Enrollment Period is seven months long: three months before the month you turn 65, the month you turn 65, and three months after. If you enroll during this window, your coverage starts on the first day of the month you turn 65 (or the first day of the month after you enroll, whichever is later).

If you miss this window, you can still enroll during the General Enrollment Period, which runs January 1 through March 31 each year. Coverage starts July 1 of that year. However, you will pay a permanent 10% penalty on your Part B premium for every 12 months you were may be able to access but not enrolled. If you were may be able to access for three years and did not enroll, your Part B premium is 30% higher than the standard amount, and that increase never goes away.

There is one exception: if you were covered by an employer health plan when you turned 65, you may delay Part B without penalty. You must enroll in Part A, but you can wait to enroll in Part B until you leave your job or lose your employer coverage. You then have eight months to enroll in Part B without penalty. This exception applies only if your employer has 20 or more employees.

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 U.S. for at least five years. The five-year clock starts when your green card is approved, not when you enter the country.

If you are a citizen or permanent resident living outside the U.S., you can still get Medicare. Part A and Part B work in any country. However, Original Medicare does not cover care outside the U.S. except in very limited cases (Canada and Mexico for emergencies, and some dialysis centers abroad). If you live abroad, you may want to look at Medicare Advantage plans that offer international coverage, though options are limited.

When you enroll, bring proof of citizenship or permanent residency. A passport, birth certificate, naturalization certificate, or green card all work. If you do not have these documents, Social Security can help you gather what you need.

Part A Without Part B, and Part B Without Part A

Normally, you get both Part A and Part B together. However, there are two exceptions.

First, if you are still working at 65 and covered by your employer's health plan, you can enroll in Part A only and delay Part B. This works only if your employer has 20 or more employees. You must enroll in Part A to protect yourself — if you wait and then lose your job, you may face a Part A premium. Once you leave your job or lose coverage, you have eight months to enroll in Part B without penalty.

Second, if you do not have enough work credits to get Part A, you can purchase Part B on its own. This is rare and expensive — Part B costs more when you buy it without Part A — but it is an option if you have worked in the U.S. for some time but not long enough to may have access to for Part A. You must still meet the age or disability requirement (65, or SSDI for 24 months, or ESRD, or ALS).

Frequently Asked Questions

What happens if I turn 65 while I am still working?

You are still may be able to access for Medicare at 65, even if you are working full-time. You do not have to retire. However, you must enroll during your Initial Enrollment Period (three months before, the month of, and three months after your 65th birthday) or face a permanent penalty. If you have employer coverage, you can delay Part B without penalty, but you must enroll in Part A.

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

Yes, if you are a permanent resident (green card holder) and have lived in the U.S. for at least five years. Bring your green card or naturalization papers when you enroll. If you are not a permanent resident, you cannot get Medicare, even if you have worked in the U.S. for many years.

What if I have been on SSDI for only 20 months?

You are not yet may be able to access. You must wait until you have been on SSDI for 24 consecutive months. The clock does not restart if your benefits are interrupted. Once you hit 24 months, Medicare starts automatically — you do not have to enroll.

Do I lose Medicare if I go back to work after I turn 65?

No. Once you are enrolled in Medicare, you keep it regardless of whether you work or how much you earn. Your income does not affect your coverage. You may owe taxes on your Social Security benefits if your income is high, but that is separate from Medicare.

What if I miss my enrollment window by one month?

You can still enroll during the General Enrollment Period (January 1 through March 31), but your coverage will not start until July 1, and you will pay a permanent 10% penalty on your Part B premium. The penalty applies for every 12 months you were may be able to access but not enrolled. It is worth enrolling late rather than not at all, but the penalty is permanent.