Most people get Medicare when they turn 65, but you may be able to join earlier

Medicare is not automatic at 65 — you have to sign up. But you do become may be able to access at 65 if you are a U.S. citizen or permanent resident who has lived in the country for at least five years. You also need a work history: either you or your spouse must have paid Medicare taxes for at least 10 years (40 quarters). If you meet these conditions, you can enroll in Medicare Part A (hospital insurance) and Part B (medical insurance) starting three months before the month you turn 65.

You can also join Medicare before 65 if you have been receiving Social Security disability benefits for 24 months, or if you have end-stage renal disease (permanent kidney failure) or ALS (amyotrophic lateral sclerosis). These routes exist because people in these situations often need health coverage urgently, regardless of age.

Key Takeaways

  • You become may be able to access for Medicare at 65 if you are a U.S. citizen or permanent resident and you or your spouse paid Medicare taxes for at least 10 years.
  • You can join Medicare before 65 if you have received Social Security disability benefits for 24 months, have end-stage renal disease, or have ALS.
  • You must sign up during your enrollment window — missing it can mean paying higher premiums for life on Part B and Part D.
  • If you are still working at 65 and have health coverage through your employer, you may be able to delay Part B enrollment without penalty.
  • Immigrants who are permanent residents can join Medicare, but they must have lived in the U.S. for five consecutive years.

The 10-year work history requirement and how it is counted

Medicare counts work history in quarters — three-month periods during which you paid Medicare taxes through payroll deductions. You need 40 quarters total, which usually means 10 years of work, but the years do not have to be recent or consecutive. If you worked for 15 years starting at age 22 and then stopped, those 15 years still count toward your 40 quarters at 65.

If you do not have 40 quarters yourself, your spouse's work history can count. If you are married, divorced (after at least 10 years of marriage), or widowed, you may be able to use your spouse's record instead. This matters most for people who took time out of the workforce to raise children, care for a family member, or for other reasons. You do not need to have worked the same number of years as your spouse — only that one of you has the 40 quarters.

You can check your own work record by creating an account on the Social Security website and viewing your earnings history. This takes about 15 minutes and shows you exactly how many quarters you have earned. If the number is wrong, you can request a correction.

Joining Medicare before 65: disability, kidney disease, and ALS

If you have been receiving Social Security Disability Insurance (SSDI) for 24 consecutive months, you become may be able to access for Medicare even if you are younger than 65. The 24-month clock starts the month your disability benefits begin, not the month you filed. This means if you were approved for SSDI in January, you would become may be able to access for Medicare in January of the following year.

People with end-stage renal disease (ESRD) — permanent kidney failure requiring dialysis or a transplant — can join Medicare regardless of age or work history. You become may be able to access the month your dialysis or transplant treatment begins. Similarly, anyone diagnosed with ALS becomes may be able to access for Medicare when ready, without waiting for disability approval or reaching 65.

If you fall into one of these categories, you will receive a notice from Social Security explaining your Medicare may be able to access. You still have to sign up during your enrollment window, which is usually the same three-month window as for age-based may be able to access.

Permanent residents and citizenship requirements

You must be a U.S. citizen or a permanent resident (green card holder) to join 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. The five years do not have to be when ready before you turn 65 — they can be any five years since you received your green card — but they must be continuous without leaving the country for more than six months at a time.

If you are a permanent resident and you have lived in the U.S. for fewer than five years, you cannot join Medicare at 65 even if you have the work history. You will need to wait until you have completed five years of residency. Once you meet the five-year requirement, you can enroll in the same way as a citizen.

Temporary visa holders, undocumented immigrants, and people in the process of becoming permanent residents are not may be able to access for Medicare. Some may have other coverage options through their state or employer, but Medicare specifically requires permanent residency or citizenship.

What happens if you miss your enrollment window

Your Initial Enrollment Period (IEP) runs for seven months: three months before the month you turn 65, the month you turn 65, and three months after. If you do not sign up during this window, you may have to pay a penalty on your Part B and Part D premiums for as long as you have Medicare.

The Part B penalty is 10 percent of the standard premium for each 12 months you were may be able to access but not enrolled. If you delayed enrollment by two years, you would pay 20 percent more than the standard rate. This extra amount does not go away — you pay it every month for the rest of your life.

There are exceptions. If you were covered by an employer health plan while you were working, or if your spouse was working and you were on their plan, you may have a Special Enrollment Period that lets you sign up without penalty. You have eight months after your coverage ends to enroll. You will need to show proof of the employer coverage, such as a letter from your employer or a copy of your health plan documents.

Signing up for Medicare when you are still working

If you are 65 and still working, you do not have to sign up for Medicare right away — but the rules are specific. If you have health coverage through your current employer (not COBRA or retiree coverage), you can delay Part B enrollment without penalty. You must sign up within eight months after your employment ends or your coverage stops, whichever comes first.

You should still sign up for Part A (hospital insurance) at 65, even if you are working, because Part A is usually free and has no penalty for late enrollment. Part B is where the penalty applies, so that is the one you can safely delay if you have employer coverage.

If you are self-employed or your employer does not offer health insurance, you should sign up for both Part A and Part B during your Initial Enrollment Period. Delaying Part B when you do not have other coverage will trigger the lifetime penalty.

Non-citizens and other situations that affect may be able to access

If you are not a U.S. citizen or permanent resident, you cannot join Medicare, even if you have paid Medicare taxes for many years. This includes people on temporary visas (H-1B, L-1, student visas), people in the U.S. without authorization, and people in the process of explore for permanent residency.

If you are a permanent resident but you leave the United States for more than six months without a re-entry permit, your five-year residency clock may reset. If you plan to travel outside the U.S. for an extended period, check with U.S. Citizenship and Immigration Services (USCIS) before you leave to understand how it will affect your residency status and Medicare may be able to access.

If you are a widow or widower, you may be able to use your deceased spouse's work record to become may be able to access for Medicare at 65, even if you did not work yourself. You must have been married for at least nine months (unless your spouse's death was accidental). This rule also applies if you are divorced and were married for at least 10 years.

Frequently Asked Questions

What if I worked in another country before moving to the U.S.?

Work you did outside the United States does not count toward your 40 quarters. Only work you did in the U.S. while paying Medicare taxes counts. However, some countries have agreements with the U.S. Social Security Administration that allow work in those countries to count. Check the Social Security website or call 1-800-772-1213 to ask whether your country has a totalization agreement.

Can I get Medicare if I am on a visa but married to a U.S. citizen?

Being married to a citizen does not make you may be able to access for Medicare. You must be a citizen or permanent resident yourself. If you are on a temporary visa, you would need to become a permanent resident first, then wait five years before becoming may be able to access for Medicare at 65.

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

No. You can be working full-time, part-time, or not at all — Medicare may be able to access is based on age and work history, not on whether you are currently employed. If you are still working and have employer health coverage, you can delay Part B enrollment, but you are still may be able to access to sign up.

What if I turned 65 and did not sign up because I did not know I had to?

You can still enroll, but you may owe a lifetime penalty on Part B and Part D premiums. Contact Social Security or Medicare to explain your situation. In rare cases, if you can show you received incorrect information from a government agency, the penalty may be waived, but this is not common.

Can my adult child use my work record to get Medicare?

No. Medicare is based on your own work history or your spouse's work history. Adult children cannot use a parent's record. Only spouses, former spouses (married at least 10 years), and widows or widowers can use someone else's work history.