You must be 65 years old to receive Medicare, with rare exceptions for younger people with disabilities or end-stage renal disease

Medicare may be able to access is tied to age 65 for most people. You become covered the month you turn 65, provided you or your spouse paid Medicare taxes while working. There is no waiting period after your birthday — coverage begins on the first day of the month in which you turn 65.

The age requirement is fixed by federal law and does not vary by state or income. However, some people under 65 can receive Medicare if they have been receiving Social Security Disability Insurance (SSDI) for 24 months, or if they have end-stage renal disease (ESRD) or amyotrophic lateral sclerosis (ALS), regardless of age.

Key Takeaways

  • Standard Medicare may be able to access begins at age 65 and requires that you or your spouse paid Medicare taxes for at least 10 years of work.
  • You can sign up for Medicare starting three months before the month you turn 65, and you should do so even if you plan to keep working.
  • People under 65 who receive SSDI for 24 months, or who have ESRD or ALS, are also covered by Medicare regardless of age.
  • If you delay signing up after turning 65 without a valid reason, your premiums may increase permanently for Part B and Part D coverage.

What "paid Medicare taxes" means and how long you need to work

You do not need to be retired to receive Medicare at 65. You can still be working and earning income. What matters is your work history: you or your spouse must have paid Medicare payroll taxes (the 2.9% deduction on your paychecks labeled "Medicare") for at least 40 quarters, which equals 10 years of work.

The 40 quarters do not need to be consecutive. If you worked 15 years, took time off, then worked 5 more years, that counts. Self-employed people also pay Medicare tax (the self-employment tax includes the Medicare portion) and can build toward the 40-quarter requirement the same way.

If you do not have 40 quarters of your own work history, you may still be covered based on your spouse's work record. This applies whether you are currently married, divorced (if the marriage lasted at least 10 years), or widowed.

How to sign 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. The sign-up window closes three months after your birthday, so you have a total of seven months to enroll without penalty.

Sign up through Medicare.gov, by phone at 1-800-MEDICARE, or in person at your local Social Security office. You will need your Social Security number, proof of citizenship or legal residency, and information about your current health coverage if you have it.

Even if you are still working and covered by an employer health plan, you should sign up for Medicare Part A (hospital insurance) at 65. Part A has no monthly premium if you have the required work history, so there is no cost to enroll. Delaying Part B (medical insurance) is sometimes the right choice if your employer plan is still active, but Part A should not be delayed.

What happens if you miss the sign-up window

If you do not sign up during your initial enrollment period and you do not have a valid reason for the delay, you will face a permanent premium increase when you eventually enroll. This penalty applies to Part B and Part D (prescription drug coverage) but not to Part A.

The Part B penalty is 10% of the standard 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 without signing up, your premium increases by 30% — and that increase stays with you for life, even if you later switch plans.

The Part D penalty works the same way: 1% of the national average premium for each month you were may be able to access without coverage. If you had creditable prescription drug coverage through an employer or other source during the gap, you may be able to avoid this penalty. You will need to provide proof of that coverage when you enroll.

Medicare for people under 65 with disabilities or specific conditions

You can receive Medicare before age 65 if you have been receiving SSDI for at least 24 consecutive months. This means you must have been approved for disability benefits and received payments for two full years. Once you reach that 24-month mark, Medicare coverage begins automatically — you do not need to explore separately.

People with end-stage renal disease (ESRD) — kidney failure requiring dialysis or a transplant — are covered by Medicare regardless of age. Coverage typically begins the month after you start dialysis or the month of your transplant. If you have ESRD, you should contact Social Security or Medicare directly to confirm your coverage date.

People diagnosed with amyotrophic lateral sclerosis (ALS) are also covered by Medicare when ready upon approval for SSDI, without waiting the usual 24 months. This is a specific exception made for ALS patients.

How your age affects which Medicare parts you need

Age does not change which parts of Medicare are available to you — Part A, Part B, Part C, and Part D exist for everyone 65 and older. However, your age at enrollment can affect your costs and your options for coverage timing.

If you are still working at 65 and covered by an employer health plan, you may be able to delay Part B enrollment without penalty, as long as your employer has 20 or more employees. This is called the special enrollment period for group health plan coverage. You will need to provide proof of your employer coverage when you eventually enroll in Part B.

If you are self-employed or work for a small employer with fewer than 20 employees, you cannot delay Part B. You must enroll at 65 or face the permanent premium penalty.

State-by-state differences in Medicare may be able to access

Medicare is a federal program, so the age requirement and work history requirement are the same in every state. However, some states have additional programs that work alongside Medicare for people with low income or high medical costs.

These state programs — called Medicaid in most states — may have their own age and income rules. If you are 65 or older and have limited income, you may be covered by both Medicare and Medicaid at the same time. Your state's Medicaid office can tell you whether you meet their income limits.

Frequently Asked Questions

Can I get Medicare before 65 if I am retired?

No. Retirement status does not matter — only age 65 or the specific conditions listed (SSDI for 24 months, ESRD, or ALS). If you retired early and are not yet 65, you will need to purchase coverage through the health insurance marketplace or through a former employer's retiree plan until Medicare begins.

What if I worked outside the United States?

Work performed outside the U.S. generally does not count toward the 40-quarter requirement, even if you paid taxes. However, some countries have agreements with the U.S. Social Security Administration that allow certain work to count. Contact Social Security to discuss your specific work history.

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

No, but you must be a permanent legal resident (green card holder) or have been lawfully present in the U.S. for at least five consecutive years. Citizenship is not required if you meet the work history requirement and residency rules.

If my spouse is 65 but I am younger, can I get Medicare?

Not based on your spouse's age alone. You can receive Medicare at 65 based on your spouse's work record, or earlier if you have SSDI for 24 months, ESRD, or ALS. Your spouse's age does not lower the requirement for you.

What if I turned 65 but have not received my Social Security yet?

You can still enroll in Medicare at 65 even if you have not applied for Social Security benefits. Medicare and Social Security are separate programs. You can sign up for Medicare without claiming retirement benefits, though you will eventually need to explore for Social Security to receive monthly payments.