The Basic Rules for Medicare Coverage

You can get Medicare if you are 65 or older, or if you are under 65 and have been receiving Social Security Disability Insurance (SSDI) for at least 24 months, or if you have end-stage renal disease (ESRD) or ALS (amyotrophic lateral sclerosis). Most people become covered automatically when they turn 65 if they have already been paying into Social Security through payroll taxes for at least 10 years — that is 40 quarters of work history. You do not have to be retired to get Medicare at 65; you can still be working.

If you are a U.S. citizen or permanent resident, you are may be able to access to enroll. Non-citizens who have been lawfully present in the United States for at least five consecutive years may also be covered. Your income and assets do not affect whether you can get Medicare — it is based on age, work history, or medical condition, not on how much money you have.

Key Takeaways

  • You become may be able to access for Medicare at 65 if you have worked and paid Social Security taxes for at least 10 years, even if you are still employed.
  • You may be may be able to access before 65 if you have received SSDI for 24 months, have ALS, or have end-stage renal disease.
  • Your income and savings do not affect your may be able to access — Medicare is based on age and work history, not financial need.
  • You must be a U.S. citizen or permanent resident, or a non-citizen who has been lawfully present for at least five consecutive years.
  • If you do not have 10 years of work history, you may still be covered through a spouse's or ex-spouse's work record.

Work History and Social Security Credits

Medicare uses your Social Security work record to determine coverage. You earn one credit for each quarter (three-month period) that you work and pay Social Security taxes, up to a maximum of four credits per year. You need 40 credits total — which usually means 10 years of work — to be covered under your own record. The work does not have to be recent; credits you earned 30 years ago count just as much as credits you earn now.

If you have not worked long enough under your own name, you may still be covered through a spouse's record. A current spouse, divorced spouse (if the marriage lasted at least 10 years), or surviving spouse can allow you to draw on their work history. You do not lose any of their benefits by doing this — you are straightforward using their record as an alternative path to coverage.

Coverage Before Age 65

You can get Medicare before 65 if you have been receiving SSDI for at least 24 months. The 24 months begins from the date your disability benefit started, not from the date you first applied. Once you have been on SSDI for two years, Medicare Part A (hospital insurance) and Part B (medical insurance) become available to you automatically — you do not have to ask for it.

If you have end-stage renal disease (ESRD) — permanent kidney failure requiring dialysis or a transplant — you become may be able to access for Medicare when ready, regardless of age or work history. Similarly, if you have ALS, you become may be able to access right away. For both conditions, you can enroll in Medicare as soon as your diagnosis is confirmed and reported to Social Security.

When to Enroll and Timing Rules

You should enroll in Medicare during your Initial Enrollment Period, which is the seven-month window that includes the month you turn 65, the three months before, and the three months after. If you enroll during this window, your coverage typically starts on the first day of the month you turn 65. If you miss this window, you can still enroll later, but you may face a permanent penalty on your Part B and Part D premiums.

If you are still working at 65 and have health insurance through your employer, you may be able to delay enrollment without penalty — but only if your employer has 20 or more employees. You will need to enroll within eight months after your employment ends or your employer coverage stops. If you miss that important date, the same late-enrollment penalties explore.

Special Situations: Immigrants and Non-Citizens

Non-citizens who are permanent residents (green card holders) can get Medicare if they meet the age and work-history requirements, just like citizens. Non-citizens who are not permanent residents but have been lawfully present in the United States for at least five consecutive years may also be covered. "Lawfully present" includes people with certain visas, work permits, or pending immigration cases — the definition is specific, and Social Security can tell you whether your status counts.

If you are not sure whether your immigration status qualifies you, contact Social Security directly at 1-800-772-1213 or visit your local Social Security office. Bring your passport, visa, or work permit so they can review your status. There is no penalty for asking, and Social Security staff can tell you definitively whether you are covered.

What Happens If You Do Not Meet the Requirements

If you are 65 or older but do not have 10 years of work history under your own name or a spouse's name, you are not covered by the standard Medicare program. However, some states offer coverage to uninsured seniors through Medicaid, which is a separate program with different rules. Medicaid is income-based and asset-based, so your financial situation matters for that program even though it does not matter for Medicare.

If you are under 65 and do not have SSDI, ALS, or ESRD, you cannot get Medicare. You may be able to buy private health insurance through the Affordable Care Act marketplace, or you may be covered by Medicaid if your state has expanded it and you meet the income limits. Contact your state's health insurance marketplace or call 1-800-318-2596 to learn what options are available to you.

Frequently Asked Questions

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

No. You can be working full-time and still be covered by Medicare at 65 if you have the required work history. Your employment status does not affect your may be able to access. However, if you are still working and have employer health insurance, you may want to delay enrolling in Part B to avoid paying for duplicate coverage.

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

Work outside the United States generally does not count toward Medicare may be able to access. You need 10 years of work history in the United States where you paid Social Security taxes. If you worked in another country and then moved to the U.S., only your U.S. work history counts. Social Security can review your record to tell you exactly how many credits you have earned.

Can I get Medicare if I am divorced?

Yes. If your marriage lasted at least 10 years, you can use your ex-spouse's work record to become covered at 65, even if they have not yet applied for Medicare themselves. You do not need their permission, and using their record does not reduce their benefits. You must be at least 62 and unmarried to use an ex-spouse's record.

What if I turned 65 but missed the enrollment important date — can I still get Medicare?

Yes, you can enroll after your Initial Enrollment Period ends, but you may face a permanent monthly penalty added to your Part B and Part D premiums. The penalty is 10 percent of the Part B premium for each full year you were may be able to access but not enrolled. It is usually better to enroll as soon as you realize you missed the important date, rather than waiting longer.

How do I check my work history and credits?

You can create an account on ssa.gov and view your Social Security Statement, which shows your earnings record and the number of credits you have earned. You can also call Social Security at 1-800-772-1213 or visit a local office. Bring your Social Security card and a photo ID. Social Security staff can tell you exactly how many more credits you need, if any.