Not everyone gets Medicare at full retirement age — you have to meet specific requirements first

Medicare is not automatic for all American citizens at 65. You must have worked and paid Medicare taxes for a certain length of time, or be a spouse or dependent of someone who did. If you do not meet these work requirements, you may still be able to join Medicare, but you will likely pay a higher monthly premium with no discount based on your work history.

The most common path is through Social Security. If you have worked at least 10 years (40 quarters) and paid Medicare taxes during that time, you become may be able to access for Medicare Part A (hospital insurance) at 65 at no monthly cost. Part B (medical insurance) costs a monthly premium, which varies by income. If you have not worked 10 years, you do not automatically may have access to, though other routes exist.

Key Takeaways

  • You need at least 10 years of work history with Medicare tax contributions to get free Part A hospital insurance at 65.
  • Spouses and dependents of workers who meet the requirement can also join Medicare at 65, even if they did not work themselves.
  • If you do not have 10 years of work history, you can still buy into Medicare Part A by paying a monthly premium, currently between $278 and $557 depending on your work record.
  • You must sign up for Medicare during your enrollment window or face a permanent penalty on your Part B premium.
  • Non-citizens and people without permanent residency status are not may be able to access for Medicare, regardless of age or work history.

The 10-Year Work Requirement and How It Works

Medicare Part A may be able to access is tied to your Social Security work record. You need 40 quarters of coverage — roughly 10 years of work — during which you and your employer paid Medicare taxes. A quarter is a three-month period, and you can earn up to four quarters per year. This means you could reach 40 quarters in as little as 10 years of full-time work, or over a longer period if you worked part-time.

Your work record is tracked by Social Security. You can view your record online at ssa.gov by creating a my Social Security account, or you can call Social Security at 1-800-772-1213 to ask how many quarters you have. If you are close to 40 quarters but not quite there, you may still have time to work and add more quarters before you turn 65.

The work does not have to be recent. If you worked 10 years at any point in your life and paid Medicare taxes, those quarters count toward your may be able to access. You do not have to be working when you turn 65.

What Happens If You Do Not Have 10 Years of Work History

If you have fewer than 10 years of work history, you are not automatically may be able to access for free Part A. However, you can still buy into Medicare Part A by paying a monthly premium. The premium amount depends on how many quarters of coverage you do have. If you have 30 to 39 quarters, the premium is lower than if you have fewer than 30 quarters. As of 2024, the premium ranges from $278 to $557 per month, though this amount changes yearly.

You would still need to pay the Part B premium (medical insurance) on top of Part A. Part B premiums are based on your income and start at $174.70 per month in 2024, but higher earners pay more. This route is more expensive than the free Part A that workers with 10 years of history receive, but it allows you to join Medicare if you otherwise would not be able to.

Some people in this situation choose to delay and work longer to reach 40 quarters, if they are still able to work. Others buy in and pay the premium. The choice depends on your health needs, income, and how close you are to reaching 40 quarters.

Medicare for Spouses and Dependents Without Their Own Work History

You do not have to have worked yourself to join Medicare at 65. If you are the spouse of someone who has 10 years of work history, you can join Medicare Part A at no cost when you turn 65, even if you never worked or worked fewer than 10 years. The same applies if you are a dependent of a worker who meets the requirement.

To use your spouse's work record, you must be at least 62 years old and married to the worker for at least one year. If you are divorced, you can use an ex-spouse's record if you were married for at least 10 years and are at least 62. You do not need your spouse's permission, and using their record does not reduce their own Medicare benefits.

You will still pay the Part B premium based on your own income. Part A is free, but Part B costs explore to you as an individual.

Citizenship and Residency Requirements

To join Medicare, you must be a U.S. citizen or a lawful permanent resident (green card holder). Non-citizens and people without permanent residency status are not may be able to access for Medicare, even if they have worked in the United States and paid Medicare taxes for 10 years or more.

If you are a lawful permanent resident, you must have held that status for at least five years before you can join Medicare. Some people with temporary visas or work permits do not meet this requirement and cannot join, even at 65.

If you are unsure about your residency status or whether it qualifies you for Medicare, contact Social Security or visit ssa.gov to learn more about your specific situation.

How to Sign Up and What Happens If You Miss the important date

You do not automatically receive Medicare at 65. You must sign up during your Initial Enrollment Period, which runs for seven months: 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, your enrollment period runs 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. You will need your Social Security number and proof of citizenship or permanent residency. If you are signing up based on your spouse's work record, you will also need their Social Security number.

If you miss your Initial Enrollment Period, you can still sign up during the General Enrollment Period, which runs from January 1 to March 31 each year. However, if you sign up late for Part B, you will pay a permanent 10 percent penalty on your Part B premium for each year you were may be able to access but did not sign up. This penalty stays with you for life, so it is important to sign up on time even if you do not think you need Medicare yet.

Special Cases: Government Workers and Railroad Employees

Some government workers and railroad employees have different Medicare rules. Federal employees hired after 1983 pay Medicare taxes and are covered by the standard 10-year work requirement. However, some state and local government workers do not pay Medicare taxes and may not be may be able to access for free Part A, even if they worked 10 years or more.

Railroad workers are covered by a separate system called the Railroad Retirement Board. If you worked for a railroad, your may be able to access for Medicare may be different. You can contact the Railroad Retirement Board at 1-877-772-5772 to learn about your specific situation.

If you are unsure whether your government or railroad work counts toward Medicare, ask Social Security to review your record before you turn 65.

Frequently Asked Questions

Can I get Medicare before age 65?

Yes, if you have been receiving Social Security disability benefits for 24 months, or if you have end-stage renal disease or ALS (Lou Gehrig's disease). Otherwise, you must wait until 65. Some people with low income may be able to join Medicaid instead, which is a separate program run by your state.

What if I worked outside the United States?

Work done outside the United States generally does not count toward Medicare, unless you worked for the U.S. government or a U.S. employer. Some countries have agreements with the United States that allow work done there to count. Contact Social Security to ask whether your foreign work history qualifies.

Do I have to be retired to join Medicare at 65?

No. You can still be working when you turn 65 and join Medicare. Your work status does not affect your may be able to access. However, if you are still working and earning above a certain amount, your Part B premium may be higher based on your income.

What if I never worked but I am married to someone who did?

You can join Medicare Part A at no cost using your spouse's work record if you are at least 62 and have been married for at least one year. You will still pay the Part B premium. This applies whether you are currently married or divorced (if the marriage lasted at least 10 years).

Can I delay Medicare and sign up later without a penalty?

Part A has no penalty for signing up late if you are not working. Part B does carry a permanent 10 percent penalty for each year you delay after your Initial Enrollment Period ends. If you are still working and have health insurance through your job, you may be able to delay Part B without penalty — ask your employer's benefits office about this before you turn 65.