Medicare has age and citizenship rules that exclude some people

Not everyone gets Medicare. The program is open to people who are 65 or older, people under 65 with certain disabilities, and people with end-stage renal disease (ESRD) or ALS, regardless of age. You must also be a U.S. citizen or a lawful permanent resident who has lived in the country for at least five years. If you don't meet these conditions, Medicare is not available to you, and you'll need to look at other coverage options.

The age requirement is the most straightforward: you become may be able to access for Medicare on the first day of the month you turn 65. You don't have to be retired, and you don't have to stop working. But if you're younger than 65, you fall into a smaller group, and the rules are stricter.

Key Takeaways

  • You must be 65 or older, or under 65 with a may have access to disability, ESRD, or ALS to get Medicare.
  • U.S. citizens and lawful permanent residents who have lived in the country for at least five years are the only people may be able to access by citizenship status.
  • If you're under 65 and disabled, you must have received Social Security Disability Insurance (SSDI) for 24 months before Medicare begins.
  • People who don't meet Medicare's rules can look into Medicaid, marketplace plans, or employer coverage as alternatives.
  • You can enroll in Medicare during your Initial Enrollment Period, which runs for seven months centered on your 65th birthday month.

Age 65 and older: the main pathway

If you're 65 or older and meet the citizenship requirement, you're may be able to access for Medicare. You don't need to have worked a certain number of years, and you don't need to have paid Medicare taxes—though most people who worked in the U.S. have. The program covers hospital care (Part A), doctor visits and outpatient services (Part B), and you can add prescription drug coverage (Part D) and supplemental insurance if you want.

You can sign up starting three months before the month you turn 65. The enrollment window stays open for three months after your birthday month, giving you a seven-month window total. If you miss this window and don't have other may have access to coverage, you'll face a permanent penalty on your Part B and Part D premiums—10 percent per year for each year you were late. That penalty stays with you for life, so timing matters.

Under 65 with a disability: the 24-month waiting period

If you're under 65 and have a disability, you can get Medicare, but only after you've been receiving Social Security Disability Insurance (SSDI) for 24 months. The disability itself doesn't make you may be able to access—the SSDI benefit does. Social Security decides whether your condition qualifies as a disability under its rules, which are stricter than many other programs use.

Once you've been on SSDI for two years, Medicare Part A (hospital insurance) starts automatically. You'll need to enroll in Part B separately if you want doctor coverage. The same late-enrollment penalties explore: if you don't sign up for Part B within three months of becoming may be able to access, you'll pay more for it permanently.

ESRD and ALS: when ready may be able to access regardless of age

Two conditions bypass the age and disability waiting period rules. If you have end-stage renal disease (ESRD)—kidney failure requiring dialysis or a transplant—you become may be able to access for Medicare when ready, even at age 20. The same applies if you have ALS (amyotrophic lateral sclerosis), also called Lou Gehrig's disease. You don't have to wait 24 months on SSDI.

For ESRD, Medicare starts the first day of the month you begin dialysis or the month of your transplant, whichever comes first. For ALS, it starts the first day of the month you're approved for SSDI. You'll still need to enroll in Part B during your Initial Enrollment Period to avoid penalties.

Citizenship and residency requirements

You must be a U.S. citizen or a lawful permanent resident to get Medicare. Lawful permanent residents—people with a green card—must have lived in the United States for at least five consecutive years before they become may be able to access. Those five years don't have to be when ready before you turn 65; they just have to be five years at some point in your life.

If you're a citizen of another country and don't have permanent resident status, you cannot get Medicare, even if you've lived and worked in the U.S. for decades. You would need to look at other options, such as marketplace plans through the Affordable Care Act, Medicaid (if you meet income limits), or employer coverage if you're still working.

What happens if you don't meet Medicare's rules

If you're under 65 without a may have access to disability, ESRD, or ALS, or if you don't meet the citizenship requirement, Medicare is not an option. Your alternatives depend on your age, income, and employment status. If you're employed, your employer's health plan may cover you. If you're not working, you can look into marketplace plans through Healthcare.gov, where you may be able to get a subsidy based on your income.

Medicaid is another option if your income is low enough. Medicaid rules vary by state—some states cover more people than others—so you'll need to check your state's program. You can also contact your state's health insurance marketplace or call 211 to learn what programs might be available to you based on your specific situation.

Enrollment timing and penalties

Your Initial Enrollment Period is a seven-month window: three months before the month you turn 65, the month itself, and three months after. If you enroll during this window, your coverage starts on the first day of your birthday month (for Part A) or the first day of the following month (for Part B). If you miss this window, you can still enroll during the General Enrollment Period, which runs January 1 through March 31 each year, but your coverage won't start until July 1, and you'll owe the permanent penalty.

The penalty applies only if you didn't have other may have access to coverage—such as employer insurance or COBRA—during the months you were uninsured. If you were covered by your employer's plan and didn't need Medicare, you can enroll without penalty within eight months of losing that coverage. Keep documentation of your employer coverage in case you need to prove it later.

Frequently Asked Questions

Can I get Medicare if I'm not a U.S. citizen?

Only if you're a lawful permanent resident and have lived in the U.S. for at least five consecutive years. If you're not a permanent resident, Medicare is not available. You may be able to purchase a marketplace plan or look into Medicaid, depending on your state and income.

What if I'm 62 and disabled but haven't been on SSDI for 24 months yet?

You're not yet may be able to access for Medicare. You'll become may be able to access once you've been receiving SSDI for 24 months. Until then, you can look into marketplace coverage, Medicaid, or your state's high-risk pool if one exists. Contact your state's health insurance marketplace for current options.

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

No. You can be working full-time and still get Medicare at 65. Your earnings don't affect your may be able to access. If you're still covered by your employer's plan, you can delay enrolling in Part B without penalty as long as you enroll within eight months of leaving that job or losing coverage.

What's the penalty for signing up late for Medicare?

For Part B and Part D, you pay an extra 10 percent of the premium for each year you were late. This penalty is permanent—it stays with you for life. For Part A, the penalty is 10 percent if you enroll one to five years late, and 20 percent if you enroll more than five years late. The penalty applies only if you didn't have other may have access to coverage.

Can I get Medicare if I have a green card but haven't lived in the U.S. for five years?

Not yet. You must have lived in the U.S. for at least five consecutive years as a lawful permanent resident before you become may be able to access. Once you reach that five-year mark, you can enroll during your Initial Enrollment Period without penalty.