You must be 65 or older to get Medicare, with rare exceptions

Medicare starts at age 65 for most people in the United States. You become may be able to access on the first day of the month you turn 65, or the month after, depending on your birthday. There is no way around this age requirement — it is set by federal law.

A small number of people under 65 can get Medicare if they have received Social Security Disability Insurance (SSDI) for 24 months, or if they have end-stage renal disease or ALS (amyotrophic lateral sclerosis). These are the only exceptions, and they require medical documentation and approval from Social Security.

If you are not yet 65 and do not fall into one of these categories, you will need to find coverage through your employer, the individual market, Medicaid, or another source until you reach 65.

Key Takeaways

  • Medicare may be able to access begins at age 65 for U.S. citizens and permanent residents who have worked and paid Medicare taxes for at least 10 years (or whose spouse has).
  • You can sign up for Medicare starting three months before the month you turn 65, and you should do so to avoid late-enrollment penalties.
  • People under 65 who have received SSDI for 24 months, or who have end-stage renal disease or ALS, may be able to get Medicare before reaching 65.
  • If you delay signing up for Medicare after you turn 65 without a valid reason, your premiums will be permanently higher for as long as you have the program.

How the 65-year-old rule works in practice

The month you turn 65, you enter your "initial enrollment period." This period runs for seven months: three months before the month you turn 65, the month you turn 65, and three months after. During this window, you can sign up for Medicare Part A (hospital insurance) and Part B (medical insurance) without penalty.

If you miss this window and do not sign up, you will pay a permanent surcharge on your Part B and Part D (prescription drug) premiums for as long as you have Medicare. The surcharge is 10 percent per year you delayed, and it never goes away. This is why signing up on time matters, even if you do not plan to use Medicare right away.

You do not have to be retired to sign up for Medicare at 65. You can still be working and earning income. If you are still covered by your employer's health plan, you may be able to delay Part B without penalty, but you must meet specific conditions — your employer must have 20 or more employees, and you must be actively employed.

Who qualifies based on work history

To get Medicare at 65, you or your spouse must have worked and paid Medicare taxes for at least 10 years (40 quarters). If you meet this requirement, you pay no premium for Part A. If you do not have 10 years of work history, you can still buy Part A, but the monthly cost is higher.

If you are not a U.S. citizen, you must be a permanent resident (green card holder) and have lived in the United States for at least five years to be may be able to access at 65. Undocumented immigrants and temporary visa holders cannot get Medicare, regardless of age.

Divorced people can use their ex-spouse's work record if the marriage lasted at least 10 years, they are at least 62 years old, and they are not remarried. This rule applies even if your ex-spouse has not yet signed up for Medicare themselves.

The exceptions: Medicare before 65

If you have been receiving SSDI for 24 months, you become may be able to access for Medicare automatically. The 24-month clock starts from the month Social Security approves your disability claim, not from the month you applied. Once you hit 24 months of SSDI, Medicare begins the following month.

If you have end-stage renal disease (ESRD) — permanent kidney failure requiring dialysis or a transplant — you can get Medicare at any age. You must be a U.S. citizen or permanent resident, and you must be either working, receiving SSDI, or receiving retirement benefits. ESRD may be able to access begins the month your kidney disease is diagnosed, though coverage usually starts after you begin dialysis or receive a transplant.

If you have ALS, you become may be able to access for Medicare when ready upon approval of your SSDI claim — you do not have to wait 24 months like other disability recipients. This is the only condition that bypasses the 24-month waiting period.

What happens if you turn 65 while still working

You can keep your employer health insurance and delay Medicare Part B if your employer has 20 or more employees and you are actively employed. "Actively employed" means you are working for pay, not just receiving benefits from a former employer. If you choose this route, you have eight months after you leave your job (or your coverage ends, whichever comes first) to sign up for Part B without penalty.

Part A (hospital insurance) works differently. Even if you have employer coverage, you should sign up for Part A at 65 because it has no monthly premium if you have 10 years of work history, and it covers hospital stays that employer plans might not fully cover. Delaying Part A does not trigger a penalty, but there is no financial reason to delay it.

If you are self-employed or own a business, you cannot use the employer exception. You must sign up for Medicare during your initial enrollment period or face a permanent penalty on Part B.

Signing up before your 65th birthday

You can begin the sign-up process three months before the month you turn 65. For example, if your birthday is in June, you can sign up starting in March. You can sign up online through Medicare.gov, by phone at 1-800-MEDICARE, or in person at your local Social Security office.

Online sign-up through Medicare.gov is usually the fastest route. You will need your Social Security number, proof of citizenship or permanent residency, and information about any current health coverage. The process takes about 15 minutes.

If you sign up before your birthday, your coverage will start on the first day of the month you turn 65. If you sign up after that month, your coverage will start the first day of the following month. There is no advantage to signing up early beyond avoiding the penalty window — coverage does not start before the month you turn 65 regardless of when you explore.

Late enrollment penalties and how to avoid them

If you do not sign up for Part B during your initial enrollment period and you do not have a valid reason for the delay, your Part B premium increases by 10 percent for each full 12 months you were may be able to access but not enrolled. This penalty is permanent — it stays with you for life, even after you finally sign up.

A valid reason to delay Part B includes having employer coverage through active employment, or having coverage through a spouse's employer. COBRA coverage (temporary coverage after job loss) does not count as a valid reason. If you had employer coverage and lost it, you have eight months to sign up for Part B without penalty.

Part A has no late-enrollment penalty, so there is no financial consequence to delaying it. However, if you delay Part A and then need hospital care, you will be responsible for costs that Part A would have covered. Part D (prescription drug coverage) also has a late-enrollment penalty if you go 63 days or longer without coverage and you do not have creditable coverage from another source.

Frequently Asked Questions

Can I get Medicare before I turn 65?

Only if you have received SSDI for 24 months, have end-stage renal disease, or have ALS. Otherwise, you must wait until 65. There are no other exceptions, and no way to buy in early.

What if I am still working at 65?

You can keep your employer health insurance and delay Part B if your employer has 20 or more employees. You should still sign up for Part A because it has no premium and no penalty for delaying. When you leave your job, you have eight months to sign up for Part B without penalty.

Do I have to be a U.S. citizen to get Medicare at 65?

You must be a U.S. citizen or a permanent resident who has lived in the United States for at least five years. Temporary visa holders and undocumented immigrants cannot get Medicare at any age.

What happens if I miss my initial enrollment period?

You can still sign up, but you will pay a permanent 10 percent surcharge on your Part B premium for each year you delayed. This penalty never goes away. If you had employer coverage when you turned 65, you have eight months after losing that coverage to sign up without penalty.

Can I use my ex-spouse's work record for Medicare?

Yes, if you were married for at least 10 years, you are at least 62 years old, you are not remarried, and your ex-spouse is at least 62. You do not need your ex-spouse's permission or even their knowledge to use their record.