The main age and citizenship rules for Medicare

You can enroll in Medicare when you turn 65, regardless of your health or income, as long as you are a U.S. citizen or permanent resident who has lived in the country for at least five consecutive years. Age 65 is the standard threshold — there is no way around it for most people. You do not have to be retired, and you do not have to stop working.

There are two exceptions to the age 65 rule. If you have received Social Security Disability Insurance (SSDI) for 24 months, you become may be able to access before 65 — usually around age 50 or whenever you have been on SSDI for two years. If you have end-stage renal disease (ESRD) — permanent kidney failure requiring dialysis or a transplant — you can enroll when ready, at any age, once your condition is diagnosed and documented by a doctor.

Permanent residents must have held that status for the full five years before they turn 65. If you are not yet a permanent resident, you cannot enroll in Medicare at 65, even if you have lived and worked in the United States for decades.

Key Takeaways

  • You become may be able to access for Medicare at age 65 if you are a U.S. citizen or have been a permanent resident for at least five consecutive years.
  • If you have received SSDI for 24 months, you can enroll in Medicare before age 65, typically in the 25th month of your SSDI benefits.
  • People with end-stage renal disease can enroll in Medicare at any age once the condition is medically documented.
  • You must enroll during your initial enrollment period, which begins three months before the month you turn 65 and ends three months after — a seven-month window.
  • Missing your initial enrollment period can result in permanent late-enrollment penalties added to your premiums for as long as you have Medicare.

How the enrollment window works when you turn 65

Your Initial Enrollment Period (IEP) is a seven-month window: it starts three months before the month you turn 65 and ends three months after. If you turn 65 in June, your window opens in March and closes in September. You can enroll any time during those seven months, and your coverage can start as early as the first day of the month you turn 65.

The Social Security Administration handles enrollment automatically for some people. If you are already receiving Social Security retirement or SSDI benefits, you will be enrolled in Medicare Parts A and B automatically about three months before you turn 65 — you do not have to do anything. You will receive a Medicare card in the mail.

If you are not yet receiving Social Security, you must contact Social Security yourself to enroll. You can do this online at ssa.gov, by phone at 1-800-772-1213, or in person at your local Social Security office. Enrollment takes about 15 minutes.

What happens if you miss your enrollment window

If you do not enroll during your Initial Enrollment Period and you do not have a valid reason for the delay, you will face a late-enrollment penalty. This penalty is a permanent increase to your Part B and Part D premiums — it does not go away, even after you eventually enroll.

The penalty for Part B is 10 percent of the standard premium for each full year you were may be able to access but not enrolled. If the standard Part B premium is $165 per month and you were late by two years, your penalty would be 20 percent — an extra $33 per month for life. Part D (prescription drug coverage) has a similar structure.

A few situations allow you to enroll late without penalty. If you were covered by a group health plan through your own job or your spouse's job when you turned 65, you have eight months after that coverage ends to enroll without penalty. If you are a federal employee, you may have different rules. Talk to your employer's benefits office before your coverage ends.

Special enrollment situations: SSDI and kidney disease

If you are on SSDI, your may be able to access date is automatic. You become may be able to access for Medicare in the 25th month of receiving SSDI benefits. You do not have to explore separately — Social Security will enroll you in Parts A and B automatically and send you a Medicare card. This happens whether you are 30 years old or 60.

If you have end-stage renal disease, you can enroll as soon as your nephrologist (kidney specialist) documents the diagnosis. You do not have to wait for dialysis to start or for a transplant to fail. Contact Social Security with your medical documentation, and they will process your enrollment. Your coverage can begin the first day of the month your condition is documented, or the first day of the following month if you enroll after the 15th.

People with ESRD have a different enrollment window than others. You have a 12-month period starting the month your condition is documented. After that window closes, you can still enroll during the general enrollment period (January 1 to March 31 each year), but you will face late-enrollment penalties if you wait.

Part A versus Part B: what you actually need to enroll in

Part A covers hospital stays, skilled nursing care, and hospice. Part B covers doctor visits, outpatient care, and some preventive services. Most people do not pay a premium for Part A if they or their spouse paid Medicare taxes for at least 10 years while working. Part B has a monthly premium that varies by income.

You must enroll in both Part A and Part B during your Initial Enrollment Period to avoid penalties. Even if you are still working and do not think you need coverage, enrolling protects you from late-enrollment penalties later. If you are still covered by your employer's health plan when you turn 65, you can delay Part B enrollment without penalty as long as you enroll within eight months of losing that coverage.

Part A has no such exception — if you are may be able to access, you should enroll in Part A even if you are still working, because there is no penalty for having it while you are covered elsewhere. Part B is the one where the eight-month grace period applies.

Income and assets do not affect Medicare may be able to access

Medicare is not means-tested. Your income, savings, home value, or investments have no bearing on whether you can enroll. A millionaire and someone living in poverty both become may be able to access at 65 if they meet the citizenship and residency requirements. Your income does affect how much you pay in premiums — higher earners pay more for Part B and Part D — but it does not determine whether you are may be able to access.

This is different from Medicaid, which is income-based and state-run. You can have both Medicare and Medicaid at the same time if your income is low enough to meet your state's Medicaid rules. But Medicaid may be able to access is separate from Medicare may be able to access.

Frequently Asked Questions

Can I enroll in Medicare before I turn 65 if I am still working?

Only if you have been on SSDI for 24 months or have end-stage renal disease. If you are working and healthy, you must wait until 65. You can enroll during your Initial Enrollment Period even while employed — working does not delay your may be able to access.

What if I was a permanent resident but lost my status?

You must be a permanent resident at the time you turn 65 to be may be able to access. If your permanent resident status was revoked or you did not renew it, you cannot enroll in Medicare. Consult an immigration attorney about your options.

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

No. Permanent residents who have held that status for at least five consecutive years are may be able to access. U.S. citizens are also may be able to access. Temporary visa holders, undocumented immigrants, and people on other visa types cannot enroll in Medicare.

What if I turn 65 but am not yet receiving Social Security?

You must contact Social Security to enroll in Medicare yourself. Even if you delay taking Social Security retirement benefits past 65, you should still enroll in Medicare at 65 to avoid late-enrollment penalties. You can enroll online, by phone, or at your local Social Security office.

Can I enroll in Medicare Part D without Part B?

You can enroll in Part D (prescription drug coverage) without Part B, but you cannot enroll in Part D without Part A. Most people enroll in all three parts — A, B, and D — during their Initial Enrollment Period to avoid penalties on any of them.