Medicare starts at 65 for most people, but you may may have access to earlier if you have a disability or end-stage renal disease

Medicare may be able to access is tied to age 65 for the vast majority of people. You become may be able to access the month you turn 65, as long as you or your spouse paid Medicare taxes while working. You do not have to retire to sign up — you can keep working and still enroll.

However, age 65 is not the only path in. If you have been receiving Social Security Disability Insurance (SSDI) for 24 months, you become may be able to access for Medicare regardless of your age — even in your 30s or 40s. If you have end-stage renal disease (ESRD) — permanent kidney failure requiring dialysis or transplant — you may may have access to at any age. If you have ALS (amyotrophic lateral sclerosis), you become may be able to access when ready upon approval for SSDI, without the 24-month waiting period.

Key Takeaways

  • You become may be able to access for Medicare the month you turn 65 if you or your spouse paid Medicare taxes for at least 10 years of work.
  • You can enroll in Medicare while still working; reaching 65 does not require you to retire.
  • If you receive SSDI, you become may be able to access for Medicare after 24 months on disability, regardless of your age.
  • People with end-stage renal disease or ALS may may have access to for Medicare before age 65 through different pathways.

How the age 65 rule works

The month you turn 65, you become may be able to access to enroll in Medicare Part A (hospital insurance) and Part B (medical insurance). You do not have to wait until the first of the month or until after your birthday passes — may be able to access begins in the month of your 65th birthday.

To may have access to at 65, you or your spouse must have paid Medicare taxes (the 1.45% deduction from paychecks labeled "Medicare") for at least 40 quarters — roughly 10 years of work. If you do not have 40 quarters of work history yourself, your spouse's work history may cover you, even if you are divorced (as long as the marriage lasted at least 10 years and you are at least 62).

You can enroll in Medicare before you retire. Many people keep working past 65 and carry both Medicare and employer health insurance at the same time. If your employer has 20 or more employees, your employer plan is primary and Medicare is secondary — meaning the employer plan pays first.

may have access to before 65 through disability

If you are approved for Social Security Disability Insurance (SSDI), you become may be able to access for Medicare after you have been receiving SSDI for 24 consecutive months. This means a 35-year-old or a 50-year-old can enroll in Medicare if they meet the disability criteria and have been on SSDI long enough.

The 24-month clock starts from the month your SSDI benefits begin, not from the month you applied. So if you were approved in January, your 24 months end in December of the following year, and you become Medicare-may be able to access in January of the year after that.

There is one exception: if you have ALS, you do not wait 24 months. You become may be able to access for Medicare the same month your SSDI is approved. This is the only condition with this when ready pathway.

may have access to before 65 through kidney disease

If you have end-stage renal disease (ESRD) — meaning your kidneys function at less than 15% capacity and you need dialysis or a transplant to survive — you may may have access to for Medicare regardless of age. You become may be able to access in the month dialysis treatment begins, or in the month a kidney transplant is performed.

You do not need to be on SSDI to may have access to through ESRD. However, you do need a formal diagnosis from a physician and documentation that you have started treatment. If you are waiting for a transplant and not yet on dialysis, you do not yet may have access to — the may be able to access date is tied to when treatment actually begins.

When to enroll and what happens if you miss the important date

If you are turning 65 and still working with employer coverage, you have a special enrollment period that lasts for 8 months after your employment ends or your employer coverage stops — whichever comes first. During this window, you can enroll in Medicare without penalty, even if you missed the initial enrollment window around your 65th birthday.

If you do not enroll when you first become may be able to access and you do not have employer coverage or other may have access to coverage, you may face a late enrollment penalty. This is a permanent increase to your Part B premium — roughly 10% more per year for each year you delayed. The penalty applies for as long as you have Medicare.

For people may have access to through disability or ESRD, the enrollment rules are different. You are automatically enrolled in Medicare Part A and Part B once you meet the criteria, so you do not have to take action yourself. However, you can decline Part B if you have other coverage.

What you need to know about your work history

Medicare may be able to access at 65 depends on quarters of coverage, not on how much money you earned. A quarter of coverage is granted for each quarter (three-month period) in which you earned at least a minimum amount in wages subject to Medicare tax — the threshold changes yearly but is typically around $1,600 per quarter in recent years.

You can earn all four quarters in a single year if you earn enough, so you do not need to work steadily for 10 years. Someone who worked intensively for 10 years and then stopped can still may have access to at 65. Self-employed people also earn quarters based on self-employment income subject to Medicare tax.

If you are unsure whether you have 40 quarters, you can create a my Social Security account at ssa.gov and view your earnings record. This record shows how many quarters you have earned and is the official count Social Security uses to determine your may be able to access.

Frequently Asked Questions

Can I get Medicare before 65 if I am retired but not disabled?

No. Early retirement does not create a pathway to Medicare before 65. You must either have a disability (and be on SSDI for 24 months), have end-stage renal disease, or have ALS. straightforward being retired at 62 or 63 does not may have access to you, even if you are no longer working.

What if I worked outside the United States?

Work performed in the U.S. counts toward the 40 quarters requirement. Work performed outside the U.S. generally does not count, unless you worked for the U.S. government or for a U.S. employer and paid Medicare taxes. Check your earnings record on your my Social Security account to see what quarters have been credited.

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

No, but you must be a permanent resident (green card holder) or a citizen. You must also have lived in the U.S. for at least 5 consecutive years when ready before enrolling. Temporary visa holders and undocumented immigrants do not may have access to, regardless of age or work history.

Can my spouse get Medicare at 65 based on my work history if they never worked?

Yes. A spouse who has never worked can enroll in Medicare at 65 if the working spouse is at least 62 and has 40 quarters of coverage. The non-working spouse does not need their own work history. This also applies to divorced spouses if the marriage lasted at least 10 years.

What happens to my Medicare if I move outside the United States?

You can keep your Medicare Part A and Part B coverage while living abroad, but coverage is limited. Medicare generally does not pay for care received outside the U.S., with rare exceptions for emergency care in border areas or on ships. Many people living abroad drop Part B to reduce costs, since they cannot use it.