Who Can Get Medicare and When You Become Eligible

Medicare is for people 65 and older, some younger people with disabilities, and people with end-stage renal disease

You become may be able to access for Medicare the month you turn 65, regardless of whether you are still working. You do not have to retire or stop earning income. If you were born on the first of the month, your coverage begins the month before; otherwise it begins the month of your birthday.

You can also get Medicare before 65 if you have been receiving Social Security disability benefits for 24 months, or if you have end-stage renal disease (permanent kidney failure requiring dialysis or transplant) or ALS (amyotrophic lateral sclerosis). These routes exist because these conditions create the same healthcare costs and risks that Medicare was designed to cover.

Your spouse, children, or other family members do not automatically get Medicare because you do. Each person must meet the may be able to access rules on their own.

Key Takeaways

You become may be able to access for Medicare at 65, and coverage begins automatically if you are already receiving Social Security.
You can get Medicare before 65 if you have been on Social Security disability for 24 months, have end-stage renal disease, or have ALS.
You must sign up during your enrollment window or pay a penalty for late registration, even if you do not plan to use Medicare right away.
Working past 65 does not delay Medicare, but it may affect whether you should delay Social Security to increase your monthly benefit.
Medicare is not the same as Medicaid; Medicaid is a separate program for people with low income, regardless of age.

Turning 65 and automatic enrollment

If you are already receiving Social Security retirement benefits when you turn 65, Medicare Part A and Part B are enrolled automatically. You will receive your Medicare card in the mail about three months before your 65th birthday. You do not need to do anything.

If you are not yet receiving Social Security, you must sign up for Medicare yourself during your enrollment window. Your initial enrollment period runs for three months before the month you turn 65, the month you turn 65, and three months after. For example, if you turn 65 in June, you can sign up from March through September. You can sign up online at Medicare.gov, by phone at 1-800-MEDICARE, or in person at your local Social Security office.

If you miss this window and do not sign up when you become may be able to access, you will pay a penalty on your Part B and Part D premiums for as long as you have Medicare. The penalty is 10 percent of the standard Part B premium for each full year you were may be able to access but not enrolled. This penalty is permanent and does not go away.

People under 65 with disabilities

You can get Medicare at any age if you have been receiving Social Security Disability Insurance (SSDI) for 24 consecutive months. The 24 months starts from the month Social Security approves your disability claim, not from the month you applied. Once you reach 24 months of SSDI, you become may be able to access for Medicare automatically.

You do not have to be unable to work completely; you have to meet Social Security's definition of disability, which is strict. Social Security considers you disabled if you cannot work because of a medical condition that is expected to last at least 12 months or result in death, and you have worked long enough to have earned sufficient work credits.

If you are receiving Supplemental Security Income (SSI) instead of SSDI — because you have never worked enough to earn work credits — you do not become may be able to access for Medicare through SSI. SSI recipients may be covered by Medicaid instead, depending on their state.

People with end-stage renal disease or ALS

You can get Medicare when ready if you have end-stage renal disease and need dialysis or a kidney transplant. You do not have to wait until 65 or meet any work requirement. Your coverage begins the first day of the month you start dialysis or the month of your transplant, whichever comes first.

You can also get Medicare when ready if you have been diagnosed with ALS (Lou Gehrig's disease). Unlike end-stage renal disease, you do not have to wait for treatment to begin; diagnosis alone qualifies you. Your coverage begins the first day of the month after Social Security approves your claim.

If you have either condition, contact Social Security to start the process. You will need medical documentation from your doctor confirming the diagnosis or that you have begun treatment.

Working past 65 and Medicare enrollment

You can keep working past 65 and still enroll in Medicare. Working does not delay your may be able to access or change when you can sign up. However, if you are still employed and your employer offers health insurance, you may have the option to delay Medicare Part B and avoid the late enrollment penalty — but only if your employer has 20 or more employees and you are covered under the employer plan as an active employee.

If your employer has fewer than 20 employees, you should enroll in Medicare Part B when you turn 65, even if you have employer coverage. Otherwise you will owe the late enrollment penalty.

Delaying Social Security to increase your monthly benefit is a separate decision from Medicare enrollment. You can enroll in Medicare at 65 and delay Social Security until 70 if you wish. Many people do this because the monthly benefit increases by about 8 percent for each year you delay between 62 and 70.

Medicare versus Medicaid

Medicare and Medicaid are separate programs with different rules. Medicare is based on age (65 and older) or disability or end-stage renal disease. Medicaid is based on income and is run by states, so the rules vary by where you live.

You can have both Medicare and Medicaid at the same time. Some people over 65 with low income are covered by both programs. In that case, Medicaid helps pay Medicare premiums and cost-sharing. You do not have to choose between them.

If you are under 65 and have low income, you may be covered by Medicaid alone, not Medicare. Contact your state Medicaid office or call 211 to learn what programs are available where you live.

Enrollment windows and what happens if you miss them

Your initial enrollment period is seven months long: three months before the month you turn 65, the month itself, and three months after. If you miss this window, you can still sign up during the general enrollment period, which runs from January 1 to March 31 each year. Coverage begins July 1 if you sign up during general enrollment.

However, if you sign up late, you will pay a penalty. For Part B, the penalty is 10 percent of the standard premium for each full year you were may be able to access but not enrolled. For Part D (prescription drug coverage), the penalty is 1 percent of the national base beneficiary premium for each month you were may be able to access but not enrolled. Both penalties are permanent.

There are limited exceptions to the late enrollment penalty. If you had creditable coverage (health insurance that is as good as or better than Medicare) through an employer or spouse's employer, you may not owe a penalty. You will need to show proof of that coverage when you sign up.

Frequently Asked Questions

Do I have to be a U.S. citizen to get Medicare?

You must be a U.S. citizen or a permanent resident (green card holder) who has lived in the United States for at least five years. If you are not a citizen or permanent resident, you may not be able to get Medicare, but you may be covered by other programs depending on your state and immigration status.

Can my adult child get Medicare because I do?

No. Your adult child must meet the may be able to access rules on their own — they must be 65 or older, or have a disability that qualifies them, or have end-stage renal disease or ALS. Being related to someone on Medicare does not make you may be able to access.

What if I am still working and my employer offers health insurance?

You can stay on your employer plan and delay Medicare Part B if your employer has 20 or more employees and you are an active employee. You will not owe a late enrollment penalty when you do sign up for Part B later. If your employer has fewer than 20 employees, you should enroll in Part B at 65 to avoid the penalty.

Can I get Medicare if I have never worked?

If you are 65 or older, yes — you do not need work history for Medicare Part A and Part B. If you are under 65, you would need to may have access to through disability (SSDI), end-stage renal disease, or ALS. SSI recipients (who have not worked enough to earn work credits) may be covered by Medicaid instead.

What happens if I sign up for Medicare but do not use it?

You can sign up for Medicare and keep your employer health insurance if your employer has 20 or more employees. Medicare becomes your secondary insurance and covers costs your employer plan does not. You will still pay Medicare premiums, but you will not face a penalty for having both.

This guide is for general information only and is not medical, financial, legal, or other professional advice. For decisions specific to your situation, consult a qualified professional. See our Editorial Policy.