The main ways to get Medicare

You can get Medicare in three ways: by reaching age 65, by receiving Social Security Disability Insurance (SSDI) for 24 months, or by having end-stage renal disease (ESRD) or ALS. Most people enter through age 65. If you worked and paid Medicare taxes, you are automatically enrolled in Medicare Part A (hospital insurance) the month you turn 65 — you do not have to do anything. If you did not work enough to may have access to on your own record, you may still get Medicare based on a spouse's, ex-spouse's, or parent's work history.

The second path is through disability. If you are under 65 and receiving SSDI benefits, you become may be able to access for Medicare after you have been on SSDI for 24 consecutive months. The 24 months starts from the month you began receiving SSDI payments, not from when you applied. A third, smaller group qualifies through ESRD or ALS: you can get Medicare when ready upon diagnosis of end-stage renal disease, or within months of an ALS diagnosis, regardless of age or work history.

Key Takeaways

  • You automatically get Medicare Part A at age 65 if you or your spouse paid Medicare taxes for at least 10 years (40 quarters).
  • If you are under 65 and have received SSDI for 24 months, you become may be able to access for Medicare even if you have never worked.
  • You can may have access to based on a spouse's work record, an ex-spouse's record (if married 10+ years), or a parent's record if you became disabled before age 22.
  • People diagnosed with end-stage renal disease or ALS can get Medicare right away, outside the age and work-history rules.
  • You must sign up for Part B (medical insurance) during your enrollment window, or you may face a permanent penalty.

Medicare at age 65 based on your own work record

To get Medicare Part A at 65 based on your own work history, you need 40 quarters of coverage — that is, 10 years of work during which you paid Medicare taxes. A quarter is roughly three months. You do not have to have worked those 10 years in a row, and you do not have to have worked recently. If you worked in covered employment (almost all jobs in the United States) and had Medicare taxes taken from your paycheck, those quarters count.

You will be enrolled automatically in Part A the month you turn 65. You do not need to contact Medicare or Social Security. Part A covers hospital stays, skilled nursing facility care, hospice, and some home health services. However, Part A does not cover doctor visits or outpatient care. If you want that coverage, you must sign up for Part B during your enrollment window. Your initial enrollment window is the three months before you turn 65, the month you turn 65, and the three months after. If you miss this window and do not have other coverage, you will pay a higher premium for Part B for as long as you have Medicare.

Medicare based on a spouse's or ex-spouse's work record

If you did not work 10 years yourself, you may still get Medicare at 65 based on your current spouse's work record. Your spouse must be at least 62 years old and have 40 quarters of Medicare-covered work. You do not have to be married for any minimum length of time — you can enroll on a spouse's record when ready if they may have access to. You will receive the same Part A and Part B coverage as if you had worked yourself.

You can also use an ex-spouse's work record if you were married for at least 10 years, are now unmarried, and are at least 65 years old. Your ex-spouse does not have to be receiving Social Security or Medicare themselves — they just need to have had 40 quarters of coverage. If you have been divorced for at least two years, you can sign up based on your ex-spouse's record without their knowledge or permission. If you have been divorced less than two years, your ex-spouse must be at least 62 and must have already started receiving Social Security.

Medicare before 65 through disability (SSDI)

If you are under 65 and receiving SSDI, you become may be able to access for Medicare after 24 consecutive months of SSDI payments. The clock starts from the first month you received a payment, not from when you applied. So if you started receiving SSDI in January, you become may be able to access for Medicare in January of the following year, two years later. You do not have to do anything — Social Security will enroll you automatically in Part A and Part B.

You do not need to have worked a certain number of years to receive SSDI in the first place. SSDI is based on your own work record or, if you became disabled before age 22, on a parent's work record. Once you are on SSDI for 24 months, Medicare coverage begins regardless of your age. This means a 30-year-old on SSDI can get Medicare if they have been receiving payments for two years.

Medicare before 65 through end-stage renal disease or ALS

If you are diagnosed with end-stage renal disease (ESRD) — kidney failure requiring dialysis or a transplant — you become may be able to access for Medicare when ready, regardless of age or work history. You do not have to wait or meet any other condition. Coverage begins the month you start dialysis or the month of your transplant, whichever comes first. If you have a transplant without dialysis, coverage begins the month of the transplant.

If you are diagnosed with ALS (amyotrophic lateral sclerosis, also called Lou Gehrig's disease), you become may be able to access for Medicare within a few months of diagnosis, also regardless of age or work history. Unlike SSDI, which requires a waiting period, ALS qualifies you quickly. You will need to contact Social Security to enroll, as this does not happen automatically the way it does at age 65.

Medicare based on a parent's work record

If you became disabled before age 22, you may be able to get Medicare based on a parent's work record. This is less common than age-based or SSDI-based Medicare, but it is an option if your parent had 40 quarters of Medicare-covered work. You must have been disabled before you turned 22, and you must remain disabled. Your parent does not have to be retired or receiving Social Security — they just need to have worked in covered employment.

To explore this path, contact Social Security directly. You will need medical records showing your disability began before age 22, and documentation of your parent's work history. Social Security can tell you whether your parent's record qualifies and what steps come next.

What happens if you do not have enough work history

If you reach 65 and do not have 40 quarters of work history on your own record, and you do not may have access to based on a spouse's, ex-spouse's, or parent's record, you do not get Medicare Part A for free. You can still buy Part A by paying a monthly premium. The premium depends on how many quarters you did work: if you have 30 to 39 quarters, the premium is lower than if you have fewer than 30 quarters. You can enroll in Part A at any time after you turn 65.

Even if you buy Part A, you should still enroll in Part B during your initial enrollment window to avoid the permanent penalty. If you cannot afford the premiums, ask about Medicaid, which is a separate program run by your state that may cover costs Medicare does not. Medicaid rules vary by state, and some states cover more people than others.

When to contact Social Security about Medicare

If you are turning 65 and worked in covered employment, you do not need to do anything — enrollment is automatic. However, you should still contact Social Security if you want to sign up for Part B, if you are not sure whether you have 40 quarters, or if you plan to delay claiming Social Security retirement benefits (which is separate from Medicare enrollment).

If you are under 65 and on SSDI, Social Security will contact you before your 24-month mark to explain your Medicare enrollment. If you are under 65 with ESRD or ALS, contact Social Security as soon as you have a diagnosis to start the enrollment process. You can reach Social Security at 1-800-772-1213 or visit your local Social Security office. Have your Social Security number and birth certificate ready.

Frequently Asked Questions

What if I worked outside the United States?

Work in most countries does not count toward Medicare quarters. However, if you worked for the U.S. government or a U.S. employer abroad, those quarters may count. Contact Social Security to review your specific work history. Some countries have agreements with the United States that allow work to count — your local Social Security office can check whether yours does.

Can I get Medicare if I am still working at 65?

Yes. You are automatically enrolled in Part A at 65 regardless of whether you are working. You should still enroll in Part B during your initial window, even if you have employer coverage, to avoid penalties later. If your employer has 20 or more employees, your employer coverage is primary and Medicare is secondary — but you still need to be enrolled.

Do I lose Medicare if I go back to work after getting SSDI?

No. Once you have been on SSDI for 24 months and become may be able to access for Medicare, you keep Medicare even if you return to work and your SSDI payments stop. This is called Medicare Continuation. You will still pay premiums, but your coverage does not end.

What if I am divorced and remarried — can I use my ex-spouse's record?

Yes. Remarriage does not disqualify you from using an ex-spouse's record. You can use your current spouse's record, your ex-spouse's record, or both — Medicare will pay based on whichever gives you the higher benefit. You cannot use more than one ex-spouse's record, but you can use one ex-spouse and one current spouse.

How do I know if I have 40 quarters of work history?

Contact Social Security or create an account on ssa.gov to view your earnings record. Your earnings record shows the quarters you have earned each year. You can also call Social Security at 1-800-772-1213 and ask them to review your record over the phone. Bring your Social Security number and be ready to confirm your identity.