The Basic Rule: Age 65 or Disability

You become may be able to access for Medicare at age 65 if you or your spouse paid Medicare taxes while working. You may also become may be able to access before 65 if you have been receiving Social Security Disability Insurance (SSDI) for 24 months, or if you have end-stage renal disease (ESRD) or amyotrophic lateral sclerosis (ALS). Citizenship or permanent residency is required.

The most common path is reaching 65. You do not have to stop working, and you do not have to claim Social Security retirement benefits first — though the two are often linked in timing. If you were born on the first of the month, Medicare coverage begins the month before; otherwise it begins the month you turn 65.

If you are not yet 65 and do not have SSDI, ESRD, or ALS, you are not may be able to access for Medicare, even if you are retired or have low income. Medicaid, marketplace insurance, or coverage through a current employer are your other options during those years.

Key Takeaways

  • You are may be able to access at 65 if you or your spouse paid Medicare taxes for at least 10 years (40 quarters) of work history.
  • You may be may be able to access before 65 if you have been on SSDI for 24 months, have ESRD, or have been diagnosed with ALS.
  • You must be a U.S. citizen or permanent resident to enroll in Medicare.
  • Enrollment happens automatically at 65 if you are already receiving Social Security; otherwise you must enroll during your initial enrollment period or face late penalties.

Work History: The 10-Year Rule

Medicare may be able to access is tied to work credits, not to how much money you earned. You earn one credit for each quarter (three-month period) you paid Medicare taxes, up to a maximum of four credits per year. You need 40 credits total — which equals 10 years of work — to be may be able to access at 65.

The 10 years do not have to be consecutive. If you worked five years, took time off, then worked another five years, you still have 40 credits. Part-time work counts as long as you earned enough to trigger the tax. Self-employed people also build credits through self-employment tax.

If you do not have 40 credits yourself, you may still be may be able to access based on your spouse's work history — either a current spouse, a divorced spouse (if married at least 10 years), or a widow or widower. Your spouse does not have to be enrolled in Medicare for you to use their record.

may be able to access Before Age 65

If you are under 65, you can become may be able to access through three specific conditions. The first is SSDI: if you have been receiving disability benefits from Social Security for 24 consecutive months, you become may be able to access for Medicare. The 24-month waiting period begins the month your disability benefits start, not the month you applied.

The second is end-stage renal disease (ESRD). You are may be able to access when ready upon diagnosis if you need dialysis or a kidney transplant, regardless of age or work history. You remain may be able to access for Medicare even after a successful transplant.

The third is ALS (amyotrophic lateral sclerosis). You are may be able to access when ready upon diagnosis, without the 24-month waiting period that applies to other disabilities. This is the only condition with no waiting period.

If you are under 65 and do not fall into one of these three categories, you are not may be able to access for Medicare. You would need to look at Medicaid (if your state covers your situation), marketplace insurance through the Affordable Care Act, or coverage through an employer or family member's plan.

Citizenship and Residency Requirements

You must be a U.S. citizen or a permanent resident (green card holder) to enroll in Medicare. If you are a permanent resident, you must have held that status for at least five consecutive years before you turn 65.

Undocumented immigrants are not may be able to access for Medicare. Temporary visa holders (such as H-1B or student visa holders) are not may be able to access, even if they have paid Medicare taxes. If your immigration status changes — for example, if you become a permanent resident — you become may be able to access once the five-year residency requirement is met.

What Happens If You Do Not Meet the Requirements

If you are under 65 and do not have SSDI, ESRD, or ALS, you cannot enroll in Medicare. You will need to find coverage elsewhere. If you are unemployed or have low income, Medicaid may cover you — may be able to access and coverage vary by state. If you are employed, your employer's health plan is usually your option. If you are buying coverage on your own, the Affordable Care Act marketplace lets you compare plans and may offer subsidies based on income.

If you are 65 or older but do not have 40 work credits and cannot use a spouse's record, you are not may be able to access for Medicare Part A (hospital insurance) without paying a premium. You may still be able to buy into Part A if you are a permanent resident, but the monthly cost is high. Part B (medical insurance) has a similar rule. In either case, you should explore Medicaid and marketplace options.

When to Enroll

Your initial enrollment period is the seven-month window that includes the month you turn 65, the three months before, and the three months after. If you enroll during this window, your coverage begins the month you turn 65 (or the month before if you were born on the first of the month).

If you miss this window and do not have coverage through an employer or union, you will face a late enrollment penalty — a permanent increase to your Part B premium. The penalty is 10 percent of the standard Part B premium for each 12-month period you were not enrolled. If you delay for three years, your premium will be 30 percent higher for life.

There is an exception: if you or your spouse are still working and covered by an employer plan, you can delay enrollment without penalty. You have eight months after you or your spouse stop working (or lose the employer coverage) to enroll without penalty. You will need to show proof of employer coverage when you do enroll.

Frequently Asked Questions

Can I get Medicare if I never worked?

Not on your own record. But if you are married or were married for at least 10 years, you may be may be able to access based on your spouse's work history. If you are a widow or widower, you can use your deceased spouse's record. Otherwise, you would need to look at Medicaid or marketplace insurance.

What if I worked outside the United States?

Work done in another country does not count toward the 40 credits needed for Medicare, unless you were working for a U.S. employer or the U.S. government. If you immigrated to the United States later in life, only your U.S. work history counts. You may still be may be able to access based on a spouse's U.S. work record.

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

No, but you must be a permanent resident (green card holder) and have held that status for at least five consecutive years. Temporary visa holders and undocumented immigrants are not may be able to access, even if they have paid Medicare taxes.

What if I am on disability but have not been on SSDI for 24 months yet?

You are not yet may be able to access for Medicare. Once you reach 24 months of SSDI, you become may be able to access automatically — you do not have to do anything. If you have ALS, you are may be able to access when ready without waiting. For other conditions, the 24-month clock starts the month your disability benefits begin.

Can I delay Medicare and keep working?

Yes. You can work past 65 and delay Medicare enrollment without penalty if you are covered by your employer's health plan. Once you or your spouse stop working or lose that coverage, you have eight months to enroll in Medicare without facing a late penalty. Tell your employer's benefits office that you are delaying Medicare so they know to keep you on their plan.