The Basic Rule: Age 65 or Older, or Certain Younger People with Disabilities

You become may be able to access for Medicare at age 65, regardless of your work history or income. If you are younger than 65, you may still be covered if you have been receiving Social Security Disability Insurance (SSDI) for 24 months, have end-stage renal disease (ESRD), or have been diagnosed with amyotrophic lateral sclerosis (ALS). Medicare does not check your bank account or ask how much money you have.

You do not have to be a U.S. citizen to join Medicare, but you must be a permanent resident who has lived in the United States for at least five years. If you are still working at 65, you can delay signing up without penalty, but the rules around when to enroll are strict — missing your window can cost you more in premiums for the rest of your life.

Key Takeaways

  • You are may be able to access for Medicare the month you turn 65, even if you are still working and have health coverage through your job.
  • If you have been on SSDI for 24 months, you become may be able to access before age 65, and Medicare begins automatically the 25th month.
  • Your initial enrollment window lasts seven months — three months before the month you turn 65, the month itself, and three months after — and missing it can raise your premiums permanently.
  • You must be a permanent resident and have lived in the United States for at least five years to be covered.
  • Working past 65 does not disqualify you, but you may still need to enroll in Part B to avoid late-enrollment penalties.

How Age 65 may be able to access Works

The month you turn 65, you become may be able to access for Medicare Part A (hospital insurance) and Part B (medical insurance). You do not have to retire or stop working. You do not have to be sick. The only requirement is that you have reached that birthday.

If you were born on the first of the month, Medicare considers your may be able to access to begin the month before. For all other birthdays, your coverage begins the month you turn 65. For example, if you turn 65 on March 15, your coverage begins in March. If you turn 65 on April 1, your coverage begins in March.

Part A is usually free if you or your spouse paid Medicare taxes for at least 10 years (40 quarters). If you do not meet that requirement, you can still buy Part A, but there is a monthly premium. Part B has a monthly premium that most people pay, and the amount depends on your income from two years prior.

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

If you have been receiving SSDI for 24 consecutive months, you become may be able to access for Medicare in the 25th month, regardless of your age. You do not have to do anything — Social Security will enroll you automatically. Your coverage begins on the first day of that 25th month.

If you have end-stage renal disease (ESRD) and need dialysis or a kidney transplant, you become may be able to access when ready, even if you have never worked. You will need to enroll yourself; Social Security does not do this automatically. Contact Social Security or Medicare directly to sign up.

If you have been diagnosed with amyotrophic lateral sclerosis (ALS, also called Lou Gehrig's disease), you become may be able to access for Medicare when ready upon diagnosis, with no waiting period. Like ESRD, you must enroll yourself. Bring your diagnosis letter from your doctor when you contact Medicare.

Your Initial Enrollment Window and Why It Matters

Your initial enrollment window is seven months long: three months before the month you turn 65, the month you turn 65 itself, and three months after. If you turn 65 in June, your window runs from March through September. This is your only chance to enroll without paying a penalty for the rest of your life.

If you miss this window and do not have other health coverage that Medicare considers "creditable," you will owe a late-enrollment penalty on top of your regular Part B premium. The penalty is 10 percent of the standard Part B premium for each full 12 months you were may be able to access but not enrolled. That penalty stays with you permanently, even if you enroll years later.

There is one major exception: if you are still working and covered by your employer's health plan, you may be able to delay Part B enrollment without penalty. This is called the "special enrollment period," but you must enroll within eight months of leaving your job or losing that coverage. You will need to show proof that you had employer coverage.

Citizenship and Residency Requirements

You must be either a U.S. citizen or a permanent resident (green card holder) to be covered by Medicare. 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.

Temporary visas, work permits, and other non-permanent immigration statuses do not may have access to you for Medicare. If your immigration status changes after you enroll, contact Medicare to report it. If you lose permanent resident status, your coverage may end.

What Happens If You Are Still Working at 65

Working past 65 does not make you ineligible for Medicare. You can be employed full-time and still sign up. However, the rules differ depending on whether your employer has 20 or more employees.

If your employer has 20 or more employees, your employer's health plan is the primary payer, and Medicare is secondary. You can delay enrolling in Part B without penalty as long as you have that coverage. Once you leave the job or lose the coverage, you have eight months to enroll in Part B without penalty.

If your employer has fewer than 20 employees, Medicare becomes primary when ready at age 65, even if you are still working. You should enroll in Part B during your initial enrollment window to avoid penalties, even though you have employer coverage.

Frequently Asked Questions

What if I turn 65 but I'm still working and happy with my current health insurance?

You can delay Part B enrollment if your employer has 20 or more employees and you have coverage through them. However, you must still enroll in Part A, which is usually free. When you leave your job, you have eight months to enroll in Part B without penalty. If your employer has fewer than 20 employees, you should enroll in Part B during your initial window to avoid a permanent penalty.

Can I enroll in Medicare after my initial seven-month window closes?

Yes, but you will owe a late-enrollment penalty on Part B for as long as you have Medicare, unless you had creditable coverage (like an employer plan) during the time you were may be able to access but not enrolled. The penalty is 10 percent of the standard Part B premium for each 12 months you were late. There is no penalty for Part A if you enroll late.

I'm on disability and under 65. When do I become may be able to access for Medicare?

If you have been receiving SSDI for 24 consecutive months, you become may be able to access in the 25th month. Social Security enrolls you automatically — you do not need to do anything. Your coverage begins on the first day of that 25th month. If you have ALS or ESRD, you become may be able to access when ready and must contact Medicare or Social Security to enroll yourself.

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

No, but you must be a permanent resident (green card holder) and have lived in the United States for at least five consecutive years. Temporary visas and work permits do not may have access to you. If your immigration status changes after you enroll, contact Medicare to report it.

What if I miss my enrollment window by just a few weeks?

Unfortunately, the seven-month window is firm. If you miss it and do not have creditable coverage from another source, you will owe a late-enrollment penalty. The penalty is permanent and applies every month you have Part B. Contact Medicare when ready to enroll and ask about your specific situation — there may be exceptions in rare cases.