The main routes to Medicare coverage

You can get Medicare if you are 65 or older, or if you are under 65 and have received Social Security Disability Insurance (SSDI) for 24 months, or if you have end-stage renal disease or ALS (amyotrophic lateral sclerosis). Most people enter Medicare through age — you become covered the month you turn 65 if you have worked and paid Medicare taxes for at least 10 years (40 quarters). You do not have to stop working to get Medicare, and you do not have to be retired.

If you are not yet 65 and do not have SSDI, end-stage renal disease, or ALS, you are not yet covered by Medicare. Some people in this situation buy private health insurance through the Affordable Care Act marketplace or through an employer. Others are covered by Medicaid, which is a separate program run by states and has different rules.

The 10-year work history requirement means you or your spouse must have paid Medicare taxes during that time. Self-employed people, W-2 employees, and railroad workers all count toward this. If you worked in another country, some of that time may count depending on agreements between the United States and that country. If you are unsure whether your work history qualifies, you can check your Social Security record online or call Social Security at 1-800-772-1213.

Key Takeaways

  • You become covered by Medicare at 65 if you have worked and paid Medicare taxes for at least 10 years, regardless of whether you are still working.
  • If you are under 65, you may be covered if you have received SSDI for 24 months, or if you have end-stage renal disease or ALS.
  • Your spouse's work history can count toward your coverage if you are married, even if you did not work yourself.
  • You can check your own work history and estimated benefits through your Social Security account at ssa.gov or by calling 1-800-772-1213.

Coverage through a spouse's work history

If you are married and your spouse has the required 10 years of work history, you may be covered as a spouse at 62 or older, even if you never worked or did not work long enough yourself. You do not need to be the same age as your spouse. Your spouse does not have to be on Medicare yet — they only need to be 62 or older and have the 10-year work history.

If you are divorced, you may also be covered on your ex-spouse's record if the marriage lasted at least 10 years, you are 62 or older, and you are not currently married. You do not need your ex-spouse's permission or knowledge to use their record. If your ex-spouse has not yet claimed benefits, you can still claim on their record once you reach 62.

Getting covered under 65 through disability or medical conditions

If you are under 65 and have received SSDI for 24 months, you automatically move to Medicare. The 24 months starts from the date Social Security approved your disability claim, not from when you first applied. During those 24 months, you remain on Medicaid or whatever coverage you had before.

If you have end-stage renal disease (permanent kidney failure requiring dialysis or a transplant), you may be covered by Medicare regardless of age or work history. Coverage usually begins the month your dialysis treatments start or the month of your transplant. If you receive a kidney transplant, your Medicare coverage continues for 36 months after the transplant, even if your new kidney works perfectly.

If you have ALS, you do not have to wait 24 months on SSDI — you move to Medicare when ready once Social Security approves your disability claim. This is the only condition with this faster pathway.

What happens if you do not have 10 years of work history

If you are 65 or older but have fewer than 10 years of work history, and you do not have a spouse or ex-spouse who qualifies, you are not covered by Medicare. You can purchase private health insurance through the Affordable Care Act marketplace at healthcare.gov. Depending on your income, you may be able to lower your monthly premium through tax credits.

Some people in this situation are also covered by Medicaid, which is run by your state and has its own income and asset limits. Medicaid rules vary widely by state. You can learn about your state's Medicaid program by calling your state health department or visiting your state's Medicaid website.

If you are a non-citizen, your coverage options depend on your immigration status and how long you have been in the United States. Lawful permanent residents (green card holders) can get Medicare at 65 if they have the required work history. Other immigration statuses have different rules. You can speak with a benefits counselor at your local Area Agency on Aging to understand your specific situation.

Checking your work history and getting ready

You can see your own Social Security work record by creating an account at ssa.gov and viewing your Social Security Statement. This statement shows the years you paid into Social Security and Medicare and estimates what your benefits will be. You can also request a paper statement by calling 1-800-772-1213.

If you see errors on your record — missing years, wrong employer names, or incorrect earnings — you can correct them. Social Security has a process for disputing errors, and it is easier to fix them before you turn 65. Bring documents like W-2s, tax returns, or pay stubs to prove the correct information.

If you are approaching 65, you should enroll in Medicare during your Initial Enrollment Period, which runs three months before the month you turn 65, through three months after. If you miss this window and do not have other health coverage, you may pay a penalty on your Medicare premiums for as long as you have Medicare. The penalty is 10 percent of the Part B premium for each year you were may be able to access but not enrolled.

Special situations: Government workers and railroad employees

If you worked for the federal government and were hired before 1984, you may not have paid Medicare taxes on your federal salary. You might still be covered if you have 10 years of non-federal work history that included Medicare taxes. If you were hired in 1984 or later, you paid Medicare taxes and those years count toward your 10-year requirement.

If you worked for a railroad, your work history is handled by the Railroad Retirement Board, not Social Security. You are still covered by Medicare at 65 if you have the required work history, but you should contact the Railroad Retirement Board at 1-877-772-5772 to verify your record and understand your benefits.

Frequently Asked Questions

What if I worked in another country — does that count toward the 10 years?

Some countries have agreements with the United States that allow work history to count toward Medicare coverage. The countries with agreements include Canada, the United Kingdom, Italy, Germany, and others. You will need to provide documentation of your work history from that country. Contact Social Security at 1-800-772-1213 to ask whether your specific work history qualifies.

Can I get Medicare before 65 if I am still working?

No. If you are under 65 and still working, you are not covered by Medicare unless you have SSDI (after 24 months), end-stage renal disease, or ALS. You can stay on your employer's health plan or buy private insurance. Once you turn 65, you become covered by Medicare whether you are working or not.

If my spouse gets Medicare, do I automatically get it too?

No. Your spouse's Medicare coverage does not automatically cover you. You must meet your own requirements — either be 65 with 10 years of work history, or be 62 or older and married to someone with 10 years of work history. You will need to enroll separately in Medicare.

What if Social Security says I do not have 10 years of work history?

You can dispute the record if you believe it is wrong. Gather W-2s, tax returns, or pay stubs showing the years you worked and paid taxes. Send these documents to Social Security with a written request to correct your record. The process takes time, so start early if you are approaching 65.

Do I lose Medicare if I go back to work after I turn 65?

No. Once you are on Medicare, you keep it whether you work or not. Your earnings do not affect your Medicare coverage. If you are also receiving Social Security retirement benefits, your benefits may be reduced if you earn above a certain amount before your full retirement age, but your Medicare stays active.