When You Can Get Medicare: Age, Disability, and Other Routes

The main ways to get Medicare

You can get Medicare in three main ways: by reaching age 65, by receiving Social Security Disability Insurance (SSDI) for 24 months, or by having end-stage renal disease (ESRD) or ALS. Most people enter through age 65. If you are disabled and under 65, you become may be able to access after you have been on SSDI for two years. If you have ESRD or ALS, you may be may be able to access sooner, sometimes right away.

The age 65 route is automatic if you are already receiving Social Security retirement benefits — Medicare starts the month you turn 65. If you are not yet on Social Security, you have to sign up for Medicare yourself during your enrollment window, or you may face a penalty on your premiums later.

Timing matters because Medicare has specific enrollment periods. Missing your window can cost you money, even if you become may be able to access later. The rules are different depending on which route applies to you.

Key Takeaways

You become may be able to access for Medicare at age 65, or after 24 months on SSDI if you are disabled, or when ready if you have end-stage renal disease or ALS.
If you are already on Social Security retirement, Medicare starts automatically the month you turn 65 — you do not need to do anything.
If you are not on Social Security, you must sign up for Medicare during your initial enrollment window or face a permanent penalty on your premiums.
Your initial enrollment window is the three months before, the month of, and the three months after the month you turn 65.
If you have employer health insurance and are still working, you may be able to delay Medicare without penalty, but you must tell Medicare about your coverage.

Reaching age 65

Age 65 is the standard entry point for Medicare. You do not have to be retired — you can still be working and earning income. What matters is your age, not your employment status or income level.

If you are already receiving Social Security retirement benefits when you turn 65, Medicare Part A and Part B start automatically. You will receive your Medicare card in the mail about two weeks before your 65th birthday. You do not have to call anyone or fill out forms.

If you are not yet on Social Security retirement, you must sign up for Medicare yourself. You can do this online at Medicare.gov, by phone at 1-800-MEDICARE, or in person at your local Social Security office. Your initial enrollment window is seven months long: the three months before you turn 65, the month you turn 65, and the three months after. If you miss this window and do not have may have access to coverage, you will pay a higher premium for Part B for as long as you have Medicare.

Disability and the 24-month waiting period

If you are approved for SSDI before age 65, you become may be able to access for Medicare after you have been receiving SSDI for 24 months. The 24 months starts from the month your SSDI payments begin, not from the month you applied.

Once you have been on SSDI for 24 months, Medicare Part A and Part B start automatically. You will receive your Medicare card in the mail. You do not have to explore separately for Medicare — the Social Security Administration handles the transition.

During the 24-month waiting period, you may be able to purchase Medicaid or coverage through the health insurance marketplace, depending on your state and income. Some states also offer programs that help people with disabilities pay for health insurance while they wait for Medicare.

End-stage renal disease and ALS

If you have end-stage renal disease (ESRD) — kidney failure requiring dialysis or a transplant — you may become may be able to access for Medicare right away, regardless of age. You do not have to wait until age 65 or complete a 24-month waiting period. may be able to access usually begins the month your dialysis treatment starts, or the month of your kidney transplant.

If you have amyotrophic lateral sclerosis (ALS), you become may be able to access for Medicare when ready upon approval for SSDI. You do not have to wait 24 months like other people on disability. Your Medicare coverage starts the same month your SSDI payments begin.

Enrollment windows and what happens if you miss yours

Your initial enrollment window is seven months long and depends on when you turn 65 or become may be able to access through disability. For age 65, it runs from three months before your birthday through three months after. For SSDI, it runs from three months before your 24-month mark through three months after.

If you enroll during your initial window, your coverage starts on the first day of the month you turn 65 or become may be able to access. If you enroll after your initial window closes, your coverage starts the first day of the month after you sign up — and you will pay a higher premium for Part B for as long as you have Medicare. This penalty does not go away.

The one exception is if you have may have access to health insurance through an employer or union while you are still working. If you have that coverage, you can delay Medicare without penalty, but you must tell Medicare about your employer coverage when you do sign up. You have eight months after your employment or coverage ends to sign up without penalty.

Working past 65 and employer coverage

You can keep working past 65 and delay Medicare if you have health insurance through your current employer or your spouse's current employer. Your employer must have at least 20 employees. If you meet these conditions, you can skip Medicare during your initial enrollment window and sign up later without paying a penalty.

When you do leave your job or lose your employer coverage, you have eight months to sign up for Medicare without penalty. This is called your special enrollment period. You must sign up during this window or face the same permanent premium increase that applies to people who miss their initial window.

Tell Medicare about your employer coverage when you sign up. You will need your employer's name and the date your coverage started. This protects you from penalties and makes sure Medicare coordinates correctly with your employer plan.

Signing up for Medicare

You can sign up for Medicare online at Medicare.gov, by phone at 1-800-MEDICARE (1-800-633-4227), or in person at your local Social Security office. Online is usually the fastest — you can complete the process in about 10 minutes if you have your Social Security number and information about any current health insurance.

By phone, wait times vary but you can usually reach someone during business hours. In person, you will need to bring your Social Security card, proof of citizenship or legal residency, and proof of age (your birth certificate or passport). Bring any documents about employer coverage if you have it.

After you sign up, Medicare will mail you a card. If you signed up online or by phone, allow two to three weeks for delivery. If you need coverage to start sooner, you can print a temporary notice from your Medicare account online.

Frequently Asked Questions

What happens if I turn 65 but I am still working and do not want Medicare yet?

If you have health insurance through your current employer or your spouse's employer, you can delay Medicare without penalty. You have eight months after you leave your job or lose that coverage to sign up. If you do not have employer coverage, you should sign up during your initial enrollment window to avoid a permanent penalty.

Do I have to sign up for all parts of Medicare at once?

No. Part A (hospital insurance) and Part B (medical insurance) are separate. You can enroll in Part A and delay Part B if you have employer coverage. However, if you delay Part B without may have access to coverage, you will pay a higher premium when you do sign up. Part D (prescription drug coverage) has its own enrollment window and penalty rules.

What if I am on SSDI but I am not sure when my 24 months started?

Call Social Security at 1-800-772-1213 and ask when your SSDI entitlement began. That is the month your 24-month clock started. You can also check your Social Security statement online at ssa.gov if you have an account set up.

Can I get Medicare if I am not a U.S. citizen?

You must be a U.S. citizen or a lawful permanent resident (green card holder) who has lived in the United States for at least five years to be may be able to access for Medicare. If you are not sure about your status, call 1-800-MEDICARE and ask what documents you need to bring.

What if I miss my enrollment window?

You can still sign up for Medicare after your initial window closes, but you will pay a higher premium for Part B for as long as you have Medicare. The penalty is 10 percent of the standard Part B premium for each year you were may be able to access but did not enroll. There is no time limit on when you can sign up, but the penalty never goes away.

This guide is for general information only and is not medical, financial, legal, or other professional advice. For decisions specific to your situation, consult a qualified professional. See our Editorial Policy.