Medicare may be able to access depends mainly on age, but also on work history and disability status

You can get Medicare when you turn 65, regardless of your health or income — that is the main rule. But you do not have to wait until 65 if you have been on Social Security Disability Insurance (SSDI) for 24 months, or if you have end-stage renal disease or ALS. The program is run by the Centers for Medicare & Medicaid Services (CMS), a federal agency, and enrollment happens through Social Security.

Most people become may be able to access at 65 straightforward by reaching that age. You do not need to have worked a certain number of years, though if you or your spouse worked and paid Medicare taxes for at least 10 years combined, you will not pay a premium for Part A (hospital insurance). If you have not worked that long, you can still get Medicare at 65, but you will pay a monthly premium for Part A.

Key Takeaways

  • You become may be able to access for Medicare at age 65 with no income or health requirements, and you should sign up during your Initial Enrollment Period, which runs three months before and three months after your 65th birthday.
  • If you have been receiving SSDI for 24 months, you become may be able to access for Medicare before age 65, and Social Security will enroll you automatically.
  • If you have end-stage renal disease or ALS, you may become may be able to access for Medicare regardless of age, and you should contact Social Security to start the process.
  • Missing your Initial Enrollment Period can result in a permanent penalty on your Part B and Part D premiums, so timing your enrollment matters even if you plan to delay coverage.

may be able to access at age 65

The simplest path to Medicare is turning 65. You do not need to prove income, health status, or work history — age alone qualifies you. However, to avoid paying a penalty later, you should enroll during your Initial Enrollment Period, which begins three months before the month you turn 65 and ends three months after. For example, if you turn 65 in June, your enrollment period runs from March through September.

If you are already receiving Social Security retirement benefits when you turn 65, Social Security will enroll you in Medicare Part A and Part B automatically. You will receive your Medicare card in the mail about two weeks before your 65th birthday. If you are not yet taking Social Security, you must contact Social Security yourself to enroll in Medicare, either online at ssa.gov, by phone at 1-800-772-1213, or in person at your local Social Security office.

Even if you do not plan to use Medicare right away — for example, if you are still working and covered by an employer plan — you should still enroll during your Initial Enrollment Period. Delaying enrollment after this window closes can trigger a permanent increase to your Part B premium (currently about 10% per year of delay) and your Part D premium (prescription drug coverage). These penalties stay with you for life.

may be able to access before 65 if you receive disability benefits

If you have been receiving SSDI for 24 consecutive months, you become may be able to access for Medicare before turning 65. Social Security will enroll you automatically once you hit the 24-month mark. You do not need to do anything — your Medicare card will arrive in the mail. This rule applies whether you became disabled at age 30 or age 64; the 24-month clock starts from the first month you received a disability payment.

Family members who receive benefits on your SSDI record — such as your spouse or children — do not automatically become may be able to access for Medicare when you do. They remain on Social Security benefits but do not get Medicare coverage unless they themselves turn 65 or meet another may be able to access category.

may be able to access if you have end-stage renal disease or ALS

You may become may be able to access for Medicare at any age if you have end-stage renal disease (ESRD), meaning your kidneys no longer work well enough to sustain life without dialysis or a transplant. You may also become may be able to access at any age if you have been diagnosed with ALS (amyotrophic lateral sclerosis, also called Lou Gehrig's disease). Unlike the SSDI rule, you do not have to wait 24 months — you can become may be able to access as soon as your condition is diagnosed and documented.

To start the process, contact Social Security at 1-800-772-1213 or visit your local Social Security office. Bring medical documentation of your diagnosis. Social Security will work with your doctor's office to verify your condition and determine your Medicare start date. For ESRD, your coverage typically begins the first day of the month in which you start dialysis or receive a kidney transplant, whichever comes first. For ALS, coverage usually begins the first day of the month after Social Security approves your claim.

Work history and premium costs

Your work history affects whether you pay a premium for Part A (hospital insurance). If you or your spouse worked and paid Medicare taxes for at least 10 years combined, you will not pay a monthly premium for Part A. If neither you nor your spouse meets this requirement, you will pay a monthly premium for Part A when you enroll.

Part B (medical insurance) and Part D (prescription drug coverage) have premiums that everyone pays, though the amount depends on your income. Higher earners pay more. These premiums are separate from Part A and are deducted from your Social Security check each month if you are receiving benefits, or billed directly if you are not.

What happens if you miss your enrollment window

If you do not enroll during your Initial Enrollment Period and you do not have what Medicare calls creditable coverage (employer insurance or other coverage that is as good as or better than Medicare), you will face a permanent penalty. For Part B, the penalty is roughly 10% of the standard premium for each full year you were may be able to access but did not enroll. For Part D, the penalty is roughly 1% of the national average premium for each month you were may be able to access but did not enroll. These penalties explore for as long as you have Medicare.

There are limited exceptions. If you were covered by an employer plan while you were working, or if your spouse was working and you were covered under their plan, you may have a Special Enrollment Period that lasts eight months after that coverage ends. During this window, you can enroll without penalty. You will need to provide proof of your employer coverage, such as a letter from your employer or a copy of your insurance card.

How to enroll in Medicare

You can enroll in Medicare through Social Security online, by phone, or in person. Visit ssa.gov and look for the Medicare section, or call 1-800-772-1213 (TTY 1-711 for those who are deaf or hard of hearing). If you prefer to enroll in person, find your local Social Security office at ssa.gov/locator. Have your Social Security number and birth certificate ready.

If you are already receiving Social Security retirement or disability benefits, you do not need to do anything — Social Security will enroll you automatically. If you are not yet receiving benefits, you must contact Social Security to enroll in Medicare. The process takes about two weeks, and your Medicare card will arrive by mail.

Questions to ask your doctor or Social Security

Before you enroll, consider asking your current doctor whether they accept Medicare. Ask whether you need to switch plans or providers. If you take prescription medications, ask your pharmacist which Part D plans cover your drugs, since coverage varies by plan. If you are still working and covered by an employer plan, ask your employer's benefits office whether you should delay Medicare enrollment and whether you have creditable coverage.

When you contact Social Security, ask whether you may have access to for any information programs that help pay your premiums, such as Medicaid or the Medicare Savings Program. These programs vary by state and income level, and Social Security can tell you whether you may be may be able to access.

Frequently Asked Questions

Do I have to enroll in Medicare at 65 if I am still working?

You do not have to use Medicare at 65 if you have employer coverage through your job, but you should still enroll to avoid a permanent penalty. If your employer has 20 or more employees, your employer plan is primary and Medicare is secondary. Once you leave your job, you can switch to using Medicare as your primary coverage.

What if I am not a U.S. citizen?

You must be a U.S. citizen or a permanent resident who has lived in the United States for at least five consecutive years to get Medicare. Permanent residents should bring their green card and proof of residency when they enroll. Contact Social Security for specific documentation requirements.

Can my spouse get Medicare on my work record?

Your spouse can get Medicare at 65 based on their own age, regardless of your work history. If your spouse is younger than 65 and you are receiving SSDI, your spouse does not automatically become may be able to access for Medicare. Your spouse would need to meet one of the may be able to access categories independently — such as reaching 65 or having their own disability.

What if I turned 65 but did not enroll — can I still sign up?

Yes, you can enroll after your Initial Enrollment Period ends, but you will likely face a permanent penalty on your Part B and Part D premiums. The only exception is if you had creditable coverage (such as an employer plan) during the time you were not enrolled. If you did, you have eight months after that coverage ends to enroll without penalty.

How do I know if I have been on SSDI for 24 months?

Contact Social Security at 1-800-772-1213 and ask when your 24-month SSDI may be able to access period for Medicare will end. Social Security keeps track of this and will tell you the exact month you become may be able to access. You can also check your Social Security statement online at ssa.gov if you have created an account.