Medicare is not automatic for everyone, and age alone does not may provide it

Medicare covers people who meet specific requirements set by federal law. You are not automatically enrolled just because you turn 65. You must be a U.S. citizen or permanent resident who has lived in the country for at least five years, and you must meet one of these conditions: you are 65 or older, you have received Social Security Disability Insurance (SSDI) for at least 24 months, you have end-stage renal disease (ESRD), or you have amyotrophic lateral sclerosis (ALS). If none of these explore to you, Medicare is not available, though other coverage options may be.

The most common path is age 65. But even then, you have to sign up during your enrollment window or face penalties that last as long as you have Medicare. If you are younger than 65 and do not have SSDI, ESRD, or ALS, you will need to look at other sources of coverage—your employer's plan, the Marketplace, Medicaid, or a combination of these.

Key Takeaways

  • You must be 65 or older, or have SSDI for 24 months, or have ESRD or ALS to be covered by Medicare—age alone is not enough.
  • U.S. citizenship or permanent residency with five years in the country is required; undocumented immigrants do not may have access to.
  • You must enroll during your initial enrollment window (usually the three months before and after your 65th birthday) or pay a permanent penalty on your premiums.
  • If you do not meet Medicare requirements, Medicaid, employer coverage, or Marketplace plans are the main alternatives.
  • Some people may have access to for both Medicare and Medicaid (called "dual may be able to access"), which can lower your out-of-pocket costs.

Age 65 and older: the main group covered

If you are 65 or older and a U.S. citizen or permanent resident, you are the primary group Medicare serves. You do not need to have worked or paid taxes—Medicare Part A (hospital insurance) is free for most people 65 and older. Part B (medical insurance) costs a monthly premium, and Part D (prescription drug coverage) is optional but recommended if you take medications.

You must enroll during your initial enrollment window, which runs for seven months: the three months before the month you turn 65, the month you turn 65, and the three months after. If you miss this window and do not have other may have access to coverage, you will pay a 10 percent penalty on your Part B premium for as long as you have Medicare. For Part D, the penalty is one percent of the national average premium for each month you were not enrolled, also for life.

If you are still working at 65 and have health insurance through your employer, you may be able to delay Part B enrollment without penalty, but you must tell Medicare about your coverage. The rules are different if your employer has 20 or more employees versus fewer than 20, so check with your employer's benefits office before you decide to wait.

People under 65 with disabilities or specific conditions

You can get Medicare before 65 if you have received SSDI for at least 24 months. This means you must have been approved for disability benefits and waited two years from the date your benefits started. You do not have to be any particular age—people in their 20s and 30s who receive SSDI can may have access to for Medicare once the 24-month period ends.

Two other conditions also may have access to you for Medicare regardless of age: end-stage renal disease (ESRD, also called kidney failure) and amyotrophic lateral sclerosis (ALS, also called Lou Gehrig's disease). If you have ESRD, you can enroll as soon as you start dialysis or receive a kidney transplant. If you have ALS, you become may be able to access for Medicare when ready upon approval by Social Security—there is no waiting period.

If you have ESRD or ALS, you will be automatically enrolled in Medicare Part A and Part B. You do not have to do anything, though you should still choose a Part D plan if you take prescription medications. For SSDI beneficiaries, you will receive a notice in the mail about three months before your 24-month period ends, explaining how to enroll.

Citizenship and residency requirements

You must be a U.S. citizen or a permanent resident (green card holder) to get Medicare. If you are a permanent resident, you must have lived in the United States for at least five consecutive years. Temporary visa holders, undocumented immigrants, and people in the process of becoming permanent residents do not may have access to for Medicare, even if they are 65 or older.

If you are a permanent resident and have lived in the U.S. for fewer than five years, you will have to wait until the five-year mark to enroll. You can still look into Medicaid or Marketplace coverage in the meantime, depending on your state and income.

When you explore for Medicare, you will need to prove your citizenship or permanent residency. A birth certificate, passport, naturalization certificate, or green card will work. If you do not have these documents, you can contact your local Social Security office for help gathering what you need.

What happens if you do not meet Medicare requirements

If you are under 65 and do not have SSDI, ESRD, or ALS, Medicare is not an option for you. Your main alternatives are employer-sponsored coverage (if your job offers it), Medicaid (if your income is low enough in your state), or a plan through the Health Insurance Marketplace. Some people use a combination—for example, Medicaid for basic coverage and a Marketplace plan for additional benefits.

If you are 65 or older but not a citizen or permanent resident, you also cannot get Medicare. You may be able to purchase a Marketplace plan, though some states have restrictions. Some states also offer Medicaid to people regardless of immigration status if they meet income limits, so check with your state's Medicaid office.

If you are a permanent resident who has not yet lived in the U.S. for five years, you have the same options as people under 65: employer coverage, Medicaid (in some states), or a Marketplace plan. Once you reach the five-year mark, you can enroll in Medicare during the next enrollment period.

Dual may be able to access: when you may have access to for both Medicare and Medicaid

Some people meet the requirements for both Medicare and Medicaid at the same time. This usually happens when you are 65 or older (or may have access to for Medicare through disability) and your income is low enough to also may have access to for Medicaid in your state. When you have both, Medicare is your primary insurance and Medicaid fills in some of the gaps—it can pay your Medicare premiums, cover your deductibles, and pay for services Medicare does not cover.

If you think you might may have access to for both, contact your state Medicaid office. They will review your income and assets to see if you meet their rules. Income limits vary by state, so what qualifies you in one state may not in another. Some states also have special programs for people who are dual may be able to access, such as managed long-term care plans that coordinate both insurances.

Frequently Asked Questions

Do I have to be a U.S. citizen to get Medicare?

No, but you must be a permanent resident (green card holder) who has lived in the U.S. for at least five consecutive years. Temporary visa holders and undocumented immigrants do not may have access to. If you are a permanent resident but have not yet lived here for five years, you will have to wait until that time has passed.

What if I am 65 but still working?

You can still get Medicare at 65, but the rules for delaying Part B without penalty depend on your employer's size. If your employer has 20 or more employees, you can delay Part B while you have coverage through work. If your employer has fewer than 20 employees, you should enroll in Part B when you turn 65 or face a penalty. Talk to your employer's benefits office to find out which rule applies to you.

Can I get Medicare if I have never worked or paid taxes?

Yes. If you are 65 or older and a U.S. citizen or permanent resident, you can get Medicare Part A (hospital insurance) for free, even if you have never worked. You will still need to pay the monthly premium for Part B (medical insurance) and choose a Part D plan for prescriptions if you want that coverage.

What should I do if I do not meet Medicare requirements?

Look into Medicaid (if your income is low enough in your state), employer-sponsored coverage (if available through your job), or a Health Insurance Marketplace plan. Some people use more than one source of coverage. You can also contact your state's health department or a local community health center for guidance on what options are available to you.

If I miss my enrollment window, can I still sign up later?

Yes, but you will pay a permanent penalty on your premiums. For Part B, the penalty is 10 percent of the premium for each year you were not enrolled. For Part D, it is one percent of the national average premium per month you were not enrolled. These penalties stay with you as long as you have Medicare, so it is important to enroll during your initial window if you can.