The Main Age and Work Requirements

Medicare is available to most people at age 65, regardless of income or work history. You do not have to be retired — you can still be working and sign up. The program is federal health insurance run by the Centers for Medicare & Medicaid Services (CMS), and it covers hospital stays, doctor visits, and prescription drugs through different parts.

Some people under 65 can also get Medicare if they have received Social Security Disability Insurance (SSDI) for 24 months, or if they have end-stage renal disease (ESRD) or amyotrophic lateral sclerosis (ALS). These are the only medical conditions that lower the age requirement.

You do not need a certain number of work credits to receive Medicare at 65 if you are a U.S. citizen or permanent resident who has lived in the country for at least five years. If you are not a citizen, you may still be able to enroll, but the rules are stricter and depend on your immigration status.

Key Takeaways

  • Most people become may be able to access for Medicare at age 65, and you can enroll even if you are still working.
  • People under 65 who have received SSDI for 24 months, or who have ESRD or ALS, can get Medicare before reaching 65.
  • You have a seven-month window to sign up that includes your 65th birthday month; signing up late can result in permanent premium penalties.
  • Medicare has four parts — A (hospital), B (doctor), D (drugs), and C (an alternative plan) — and you choose which ones you need based on your health and coverage.
  • Your spouse's work record can count toward your Medicare may be able to access if you have been married for at least one year.

How to Sign Up When You Turn 65

You should sign up during your Initial Enrollment Period, which runs for seven months: three months before your 65th birthday, the month you turn 65, and three months after. If you sign up during this window, your coverage can start as early as the first day of your birthday month.

You can sign up online at 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 permanent residency, and information about any current health coverage you have. If you are still working and have employer health insurance, tell Medicare — this affects which parts you should enroll in.

If you miss your Initial Enrollment Period, you can still sign up during the General Enrollment Period, which runs from January 1 to March 31 each year. However, coverage does not start until July 1, and you may face a permanent 10 percent increase to your Part B premium for each year you delayed enrollment without a valid reason.

Automatic Enrollment and When You Do Not Have to Sign Up

If you are already receiving Social Security benefits when you turn 65, Medicare will enroll you automatically in Parts A and B. You will receive your Medicare card in the mail about three months before your 65th birthday. You do not have to do anything, but you should still review the notice to make sure the information is correct.

If you are not yet receiving Social Security, you must sign up for Medicare yourself during your Initial Enrollment Period. Do not assume you will be enrolled automatically — you will not be unless you are already collecting Social Security payments.

Medicare for People Under 65 With Disabilities or Serious Illness

If you have been receiving SSDI for 24 consecutive months, you become may be able to access for Medicare at any age. The 24-month clock starts from the month you first received a disability payment, not from the month you applied. Once you have been on SSDI for two years, Medicare enrollment is automatic — you do not have to sign up.

If you have end-stage renal disease (ESRD) — permanent kidney failure requiring dialysis or a transplant — you can get Medicare regardless of age. You must enroll within three months of starting dialysis or having a transplant. If you miss this window, you can enroll during the General Enrollment Period, but your coverage will not start until July 1.

If you have been diagnosed with amyotrophic lateral sclerosis (ALS), you are may be able to access for Medicare when ready without waiting for SSDI approval. You must sign up yourself; enrollment is not automatic. Contact Social Security or Medicare to begin the process.

Using Your Spouse's Work Record

If you have been married for at least one year, you may be able to get Medicare based on your spouse's work record instead of your own. This is useful if your spouse worked long enough to may have access to but you did not. You do not have to be receiving spousal Social Security benefits to use their work record for Medicare.

If you are divorced, you can use your ex-spouse's work record if the marriage lasted at least 10 years and you are at least 65 years old. Your ex-spouse does not have to be receiving Social Security themselves — they just need to have worked long enough to may have access to.

What Happens If You Are Still Working at 65

You can enroll in Medicare and keep working. However, if you have health insurance through your employer, you should tell Medicare about it when you sign up. If your employer has 20 or more employees, your employer coverage is primary, meaning it pays first, and Medicare pays second. You may want to delay enrolling in Part B until your employment ends to avoid paying premiums for coverage you do not need yet.

If you delay Part B enrollment because you have employer coverage, you have eight months after your employment ends (or after your employer coverage stops, whichever comes first) to sign up without a penalty. This is called the Special Enrollment Period. You must request it — it is not automatic.

Part A, Part B, Part C, and Part D: Which Ones You Need

Part A covers hospital stays, skilled nursing facilities, hospice, and some home health care. Most people do not pay a monthly premium for Part A if they or their spouse worked long enough. Part B covers doctor visits, outpatient care, and preventive services. Part B has a monthly premium that changes each year.

Part D is prescription drug coverage. You should enroll in Part D when you first become may be able to access for Medicare, or during the annual enrollment period (October 15 to December 7). If you delay Part D without a valid reason, you may pay a permanent penalty.

Part C, also called Medicare Advantage, is an alternative to Original Medicare (Parts A and B). It is offered by private insurance companies and often includes Part D drug coverage. If you choose Part C, you are still in Medicare, but the private plan handles your benefits instead of the federal program.

Frequently Asked Questions

What if I turn 65 but do not want Medicare yet?

You can delay enrollment if you have health insurance through your employer or your spouse's employer and the company has 20 or more employees. You must sign up within eight months after that coverage ends. If you delay without this valid reason, you will face permanent premium penalties.

Can I change my mind after I sign up for Medicare?

Yes. You have a seven-month Initial Enrollment Period, and you can change your choices during the annual enrollment period from October 15 to December 7 each year. Changes made during annual enrollment take effect January 1 of the following year.

Do I need to have worked to get Medicare at 65?

No. If you are a U.S. citizen or permanent resident who has lived in the country for at least five years, you can get Medicare at 65 even if you never worked. You can also use your spouse's or ex-spouse's work record if you meet the marriage length requirements.

What if I am not a U.S. citizen?

Permanent residents can get Medicare at 65 if they have lived in the United States for at least five years. Other visa holders may be able to enroll, but the rules are complex and depend on your specific immigration status. Contact Social Security or Medicare directly to find out whether you are may be able to access.

Will I lose my current health insurance if I sign up for Medicare?

Not automatically. If you have employer coverage, you can keep it and let Medicare be secondary. If you have individual health insurance through the marketplace, you should contact your plan to let them know you are enrolling in Medicare, as you may no longer need the marketplace plan.