Not everyone qualifies for Medicare, even at age 65

Medicare is available to people who are 65 or older, people under 65 with certain disabilities, and people of any age with end-stage renal disease or ALS. But you must also have worked and paid Medicare taxes, or be married to someone who did. If you have never worked in the United States or did not pay Medicare taxes for long enough, you may not be able to get Medicare at all — even when you turn 65.

The rules are strict and do not have exceptions for hardship. This means some seniors reach retirement age and discover they cannot sign up for Medicare because they do not meet the work requirement. Understanding who qualifies now can help you plan ahead.

Key Takeaways

  • You need 40 work credits (roughly 10 years of work) under Social Security to get Medicare at 65, even if you have never used Social Security benefits.
  • If you worked for a railroad, government agency, or outside the United States, different rules may explore to your work credits.
  • Spouses and ex-spouses can sometimes get Medicare based on someone else's work record if they meet age and marriage requirements.
  • If you do not may have access to for Medicare, you may be able to buy a private health plan through your state's marketplace or look into Medicaid if your income is low enough.

The work credit requirement: 40 credits in a lifetime

To get Medicare at 65, you must have earned 40 work credits during your lifetime. One work credit is earned for each $1,640 of wages you made in 2024 (this amount changes each year). You can earn up to four credits per year, which means you need roughly 10 years of work to may have access to.

The work does not have to be recent. If you worked 10 years in your 20s and then stopped, those credits still count. What matters is the total number of credits you have earned at any point in your life. You can check how many credits you have by creating an account on ssa.gov and viewing your Social Security statement, or by calling Social Security at 1-800-772-1213.

If you have fewer than 40 credits, you cannot get Medicare at 65. There is no way to waive this requirement or make an exception.

Special work situations that affect your credits

If you worked for a railroad, your credits may be handled differently. Railroad Retirement Board employees have their own system and do not earn Social Security credits in the usual way. You should contact the Railroad Retirement Board at 1-877-772-5772 to find out whether you may have access to for Medicare.

If you worked for a government agency — federal, state, or local — you may not have paid Social Security taxes. Some government workers have their own pension systems instead. You can still get Medicare if you have 40 credits from other work, but if all your work was for government and you did not pay Social Security taxes, you may not may have access to. Contact your government employer's benefits office to understand your situation.

If you worked outside the United States, those years may not count toward your 40 credits unless you were a U.S. citizen or permanent resident at the time. Work done in other countries for a U.S. employer sometimes counts, but the rules are complicated. Contact Social Security to discuss your specific work history.

Getting Medicare based on a spouse's work record

If you do not have 40 credits yourself but are married to someone who does, you may be able to get Medicare based on their work record. You must be at least 65 years old and married for at least one year. Your spouse does not have to be receiving Social Security benefits yet — they just need to have earned 40 credits.

If you are divorced, you may also may have access to based on an ex-spouse's record if you were married for at least 10 years, are at least 65, and are not currently married. Your ex-spouse does not need to know you are using their record, and it does not affect the benefits they receive.

To use a spouse's or ex-spouse's record, you will need to contact Social Security when you are ready to sign up for Medicare. Bring your marriage certificate (or divorce decree if applicable) and your spouse's Social Security number.

Medicare for people under 65 with disabilities or kidney disease

You can get Medicare before age 65 if you have been receiving Social Security disability benefits for 24 months. You do not need to have 40 work credits — your disability benefits themselves show that you have enough work history to may have access to.

You can also get Medicare at any age if you have end-stage renal disease (permanent kidney failure requiring dialysis or transplant) or ALS (amyotrophic lateral sclerosis, also called Lou Gehrig's disease). For kidney disease, you must be a U.S. citizen or permanent resident and have worked long enough to be insured under Social Security, or be married to someone who has. For ALS, you need only one work credit earned in the 13 quarters before diagnosis.

What to do if you do not may have access to for Medicare

If you reach 65 and do not have 40 work credits, you have other options. You can buy a private health plan through your state's health insurance marketplace (healthcare.gov). These plans are not Medicare, but they provide coverage and may be subsidized based on your income.

If your income is very low, you may be able to get Medicaid, which is a joint federal and state program for people with limited income and resources. Medicaid rules vary by state, and some states cover more people than others. You can find out whether you may have access to by contacting your state's Medicaid office or using the healthcare.gov marketplace, which will screen you for both Medicare and Medicaid at the same time.

Some people who do not may have access to for Medicare can continue working and earn more credits. If you are still working and have not yet reached 40 credits, each additional year of work brings you closer. However, you must earn enough in that year to get four credits (at least $6,560 in 2024).

How to check your work credits and explore

The easiest way to find out how many credits you have is to go to ssa.gov, create a "my Social Security" account, and view your Social Security statement. This statement shows your earnings history and the number of credits you have earned each year. You can do this at any age — you do not have to wait until you are close to 65.

If you do not want to create an online account, you can call Social Security at 1-800-772-1213 and ask for a statement by mail. It takes about two weeks to arrive.

When you are ready to sign up for Medicare, you can do so online at ssa.gov, by phone at 1-800-772-1213, or in person at your local Social Security office. You should sign up three months before your 65th birthday. If you do not sign up on time and you do not have other health coverage, you may have to pay a penalty when you do sign up.

Frequently Asked Questions

What if I worked in another country before I came to the United States?

Work done outside the U.S. generally does not count toward your 40 credits, even if you paid taxes on it. However, if you were a U.S. citizen or permanent resident working for a U.S. employer abroad, those credits may count. Contact Social Security with details about where and when you worked, and they can tell you whether that work counts.

Can I buy Medicare if I do not have 40 credits?

No. Medicare is not for sale — you either may have access to based on work credits, disability, or kidney disease, or you do not. If you do not may have access to, you can buy private health insurance through the marketplace or look into Medicaid if your income is low enough.

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

No. Your spouse's Medicare does not cover you. You must meet the requirements yourself — either by having 40 work credits or by may have access to based on disability or kidney disease. You can use your spouse's work record if you meet the age and marriage requirements, but you still have to sign up separately.

What happens if I reach 65 and find out I do not have enough credits?

You cannot get Medicare, but you can buy a private plan through healthcare.gov or check whether you may have access to for Medicaid. If you are still able to work, you can continue earning credits — each year of work with sufficient earnings adds one to four credits to your record.

Do I lose my work credits if I do not use them right away?

No. Work credits never expire. If you earned credits 30 years ago and then stopped working, those credits are still there when you turn 65. You only need 40 credits total in your entire lifetime to may have access to for Medicare.