The Basic Rule: Age 65 or Certain Disabilities

You can get Medicare if you are 65 or older, or if you are younger than 65 and have been receiving Social Security disability benefits for 24 months, or if you have end-stage renal disease (permanent kidney failure) or ALS (Lou Gehrig's disease). Most people fall into the first group — those who turn 65.

Age alone is not enough. You also need a work history. You or your spouse must have paid Medicare taxes for at least 10 years (40 quarters) while working. If you do not have that work history, you may still get Medicare at 65, but you will pay a monthly premium with no discount.

If you are not yet 65 and do not have a disability or end-stage renal disease, you cannot get Medicare. You would need to look at other coverage options, such as the Affordable Care Act marketplace or employer coverage.

Key Takeaways

  • You become may be able to access for Medicare at age 65 if you or your spouse paid Medicare taxes for at least 10 years while working.
  • You can get Medicare before 65 if you have received Social Security disability benefits for 24 months, or if you have end-stage renal disease or ALS.
  • If you do not have 10 years of work history, you can still enroll at 65 but will pay a higher monthly premium for Part A.
  • Your may be able to access is tied to your Social Security record, so you should check your record at ssa.gov before you turn 65.

How Work History Affects Your Medicare Cost

Medicare Part A (hospital insurance) is free at 65 if you have 40 quarters of work history. A quarter is three months. You do not have to have worked those 40 quarters in a row — they can be spread across your entire working life. If you worked part-time, seasonal work, or had gaps in employment, the quarters still count as long as you paid Medicare taxes.

If you have fewer than 40 quarters, you can still get Part A at 65, but you will pay a monthly premium. The premium is higher if you have 30 to 39 quarters and lower if you have fewer than 30 quarters. Your spouse's work history can also count toward your may be able to access — if your spouse has 40 quarters, you may get free Part A even if you do not.

Part B (doctor and outpatient care) always has a monthly premium, regardless of your work history. The standard premium changes each year. Higher earners pay a higher Part B premium based on their income from two years ago.

Disability Before Age 65

If you are under 65 and have been receiving Social Security Disability Insurance (SSDI) for 24 months, you become may be able to access for Medicare. The 24 months starts from the month you were first approved for disability, not from the month you applied. You do not have to wait until you turn 65 — Medicare begins automatically after those 24 months pass.

If you are approved for Supplemental Security Income (SSI) because of disability, the rules are different. You may have to wait longer or meet other requirements. Contact Social Security to find out your specific situation.

Some people with disabilities also may have access to for Medicaid, which is a separate program run by states. Having Medicare does not prevent you from also having Medicaid.

End-Stage Renal Disease and ALS

If you have end-stage renal disease (ESRD) — permanent kidney failure that requires dialysis or a transplant — you become may be able to access for Medicare regardless of age or work history. Your may be able to access usually begins the first day of the month in which you start dialysis, or the month of your transplant. If you are already on dialysis when you turn 65, your Medicare coverage continues without change.

If you have ALS (amyotrophic lateral sclerosis, also called Lou Gehrig's disease), you become may be able to access for Medicare the first month you receive an ALS diagnosis and are approved for Social Security disability benefits. You do not have to wait 24 months like other disability beneficiaries.

How to Check Your Work History Before You Turn 65

Your Medicare may be able to access is based on your Social Security earnings record. You can view your record online at ssa.gov by creating a my Social Security account. The record shows how many quarters of coverage you have earned and whether you are on track for free Part A at 65.

Check your record at least three months before you turn 65. If you see errors — such as missing years of work or earnings credited to the wrong person — contact Social Security to request a correction. Corrections can take several months, so do not wait until you are already 65.

If you do not use the internet, you can call Social Security at 1-800-772-1213 (TTY 1-800-325-0778) and ask for a printed statement of your earnings record. You can also visit your local Social Security office in person.

What Happens If You Do Not Have Enough Work History

If you reach 65 and do not have 40 quarters of work history, you have two options. You can enroll in Medicare Part A and pay a monthly premium, or you can delay enrollment and look for other coverage.

If you delay Medicare and instead buy coverage through the Affordable Care Act marketplace, you may face a penalty when you finally enroll in Medicare. The penalty is a permanent increase to your Part B and Part D premiums. The penalty is 10 percent for each 12-month period you could have enrolled but did not. For this reason, most people enroll even if they have to pay a Part A premium.

Your spouse's work history may help. If your spouse has 40 quarters, you may get free Part A based on their record. You can also work longer — each additional quarter of work history lowers your Part A premium.

Enrollment important date and When Coverage Starts

You should enroll in Medicare during your Initial Enrollment Period, which 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 can start as early as the month you turn 65.

If you miss this window, you can still enroll, but your coverage will not start until the following month, and you may face a late enrollment penalty. The penalty is a permanent increase to your Part B premium of 10 percent for each 12-month period you could have enrolled but did not.

If you are still working at 65 and have health coverage through your employer, you may be able to delay enrollment without penalty. Ask your employer's benefits office whether you may have access to for this exception.

Questions to Ask Your Doctor or Social Security

Before you turn 65, write down these questions and bring them to your appointment with your doctor or to your local Social Security office:

  • How many quarters of work history do I have, and will I get free Part A at 65?
  • If I do not have 40 quarters, how much will my Part A premium be?
  • If I am still working at 65, can I delay enrollment without penalty?
  • Does my spouse's work history help me get free Part A?
  • When should I enroll to make sure my coverage starts on time?

Frequently Asked Questions

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

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 also have lived in the United States for at least five years. Contact Social Security if you are unsure about your status.

What if I worked outside the United States?

Work you did outside the United States generally does not count toward Medicare. However, if you worked for the U.S. government or a U.S. employer abroad, those quarters may count. Contact Social Security with details about where you worked.

Does my spouse's age matter if I use their work history?

No. Your spouse does not have to be 65 or enrolled in Medicare for you to use their work history. If your spouse has 40 quarters, you can get free Part A at 65 even if your spouse is younger or still working.

What if I was married more than once?

You can use the work history of a current or former spouse if you were married for at least 10 years. You can use only one spouse's record — Social Security will use whichever gives you the better outcome.

Can I get Medicare if I am in prison?

No. You cannot get Medicare while you are incarcerated. Your coverage will restart the month after you are released. Contact Social Security before your release date to restart your coverage.