Who Qualifies for Medicare and When You Can Enroll

The Basic Rule: Age 65 or Disability

You become may be able to access for Medicare at age 65, regardless of income or work history. You do not have to be retired. If you are under 65, you may be may be able to access if you have been receiving Social Security disability benefits for 24 months, or if you have end-stage renal disease or ALS (amyotrophic lateral sclerosis). These are the three paths to Medicare may be able to access.

may be able to access is separate from enrollment. Being may be able to access means you meet the age or disability requirement. Enrolling means you actually sign up and your coverage begins. Many people become may be able to access at 65 but do not enroll right away — and that choice can cost them money in penalties later.

Key Takeaways

You are may be able to access for Medicare at 65 if you are a U.S. citizen or permanent resident who has lived in the country for at least five years.
If you are under 65, you may be may be able to access through Social Security disability (after 24 months), end-stage renal disease, or ALS diagnosis.
Your initial enrollment window is seven months long — three months before the month you turn 65, the month itself, and three months after — and missing it triggers a permanent penalty on your Part B premium.
You must enroll even if you are still working and have employer coverage, unless your employer has 20 or more employees.
If you miss your initial window, you can enroll during the general enrollment period (January 1 to March 31 each year), but the penalty applies.

Age 65: Citizenship and Residency Requirements

To be may be able to access at 65, you must be a U.S. citizen or a permanent resident (green card holder) who has lived in the United States for at least five consecutive years. The five-year clock resets if you leave the country for more than six months in a row. If you are a permanent resident, you will need to show your green card when you enroll.

Work history does not matter. You do not need to have paid into Social Security. If you are 65 and meet the citizenship or residency requirement, you are may be able to access, even if you have never worked in the United States.

Under 65: Disability, ESRD, and ALS

If you are under 65 and receiving Social Security Disability Insurance (SSDI), you become may be able to access for Medicare after you have been on disability for 24 months. The 24 months is measured from the date your disability benefits began, not from the date you applied. You do not have to wait until you are 65.

If you have end-stage renal disease (ESRD) — permanent kidney failure requiring dialysis or a transplant — you are may be able to access for Medicare regardless of age. You must have a diagnosis from a physician and be either a U.S. citizen, permanent resident, or railroad retiree. may be able to access begins the first day of the month you start dialysis, or the month of your transplant.

If you have been diagnosed with ALS (Lou Gehrig's disease), you are may be able to access for Medicare when ready, without waiting for Social Security to approve a disability claim. You will need medical documentation of the diagnosis.

Your Enrollment Window and What Happens If You Miss It

Your initial enrollment period is seven months long: the three months before the month you turn 65, the month of your birthday, and the three months after. For example, if you turn 65 in June, your window runs from March through September. During this window, you can enroll in Medicare Part A and Part B without penalty.

If you do not enroll during this window, you will pay a permanent penalty on your Part B premium for as long as you have Medicare. The penalty is 10 percent of the standard Part B premium for each full year you were may be able to access but not enrolled. If you were may be able to access for three years and did not enroll, your premium will be 30 percent higher than the standard rate, and that increase never goes away.

There is one exception: if you were covered by an employer health plan when you turned 65, and that employer had 20 or more employees, you can enroll without penalty during an eight-month window that begins the month your employer coverage ends. You must have been actively employed or covered as a spouse or dependent of an active employee.

Special Enrollment Periods for Life Changes

If you miss your initial window but experience certain life changes, you may be able to enroll during a special enrollment period without the permanent penalty. These changes include losing employer coverage, moving out of your plan's service area, or having Medicare or Medicaid coverage end involuntarily.

A special enrollment period is usually 63 days long and begins the day your may have access to event happens. You must enroll within this window to avoid the penalty. If you are unsure whether your situation qualifies, contact Social Security at 1-800-772-1213 or visit your local Social Security office with documentation of the change.

General Enrollment and the Penalty

If you miss both your initial enrollment period and any special enrollment periods, you can still enroll during the general enrollment period, which runs January 1 through March 31 each year. Coverage begins July 1 of that year. However, the permanent Part B penalty applies, and it will be based on how many years you were may be able to access but not enrolled.

The penalty is recalculated each year you remain uninsured. If you enroll in 2025 after being may be able to access since 2022, the penalty will be 30 percent of the standard premium. If you wait until 2026, it will be 40 percent. The only way to avoid this penalty is to enroll during your initial window or a may have access to special enrollment period.

Enrollment Steps and Where to Enroll

You can enroll in Medicare through three channels: online at Medicare.gov, by phone at 1-800-MEDICARE (1-800-633-4227), or in person at your local Social Security office. If you are already receiving Social Security benefits, you will be enrolled in Part A and Part B automatically three months before you turn 65, unless you tell Social Security not to enroll you.

If you are not yet receiving Social Security, you must contact Social Security to enroll. Have your Social Security number, birth certificate, proof of citizenship or permanent residency, and proof of residence (a utility bill or lease) ready. The enrollment process takes about 15 minutes by phone.

After you enroll, you will receive your Medicare card in the mail within two to four weeks. Your coverage begins on the first day of the month you turn 65, or the first day of the month after you enroll, whichever is later.

Frequently Asked Questions

What if I am still working at 65?

You must enroll in Medicare at 65 even if you are still working and have employer coverage, unless your employer has 20 or more employees and you are covered as an active employee. If your employer has 20 or more employees, you can delay Part B enrollment without penalty, but you should still enroll in Part A because it is free and covers hospital care.

Can I delay Medicare if I have good health insurance from my job?

You can delay Part B (medical insurance) without penalty only if your employer has 20 or more employees and you are an active employee covered by their plan. Part A (hospital insurance) has no penalty for delay, but it is free at 65, so there is no reason to wait. Once you leave your job, you have eight months to enroll in Part B without penalty.

Do I lose my disability benefits when I turn 65?

No. Your Social Security disability benefits convert to retirement benefits at 65, but the amount stays the same. You will be switched from SSDI to Social Security retirement, and your Medicare coverage continues without interruption.

What if I am a permanent resident but not yet a citizen?

You can enroll in Medicare at 65 if you have been a permanent resident for at least five consecutive years. You will need to show your green card and proof of your five-year residency when you enroll. Residency is measured from the date your green card was issued.

Can I enroll before I turn 65?

Yes. Your enrollment window opens three months before the month you turn 65. You can enroll as early as that date, and coverage will begin on the first day of the month you turn 65. Enrolling early ensures your coverage starts on time and avoids delays.

This guide is for general information only and is not medical, financial, legal, or other professional advice. For decisions specific to your situation, consult a qualified professional. See our Editorial Policy.