When You Can Claim Medicare: Age, Work History, and Disability Rules

You can claim Medicare at 65, or earlier if you have been on disability for 24 months, or if you have end-stage renal disease or ALS

Medicare is not automatic at 65. You have to sign up during your enrollment window, which opens three months before the month you turn 65 and closes three months after. If you miss that window, you pay a penalty on your premiums for as long as you have Medicare — usually 10 percent more per year of delay. The one exception: if you are still working and covered by your employer's health plan, you can delay without penalty, but you must sign up within eight months of leaving that job.

If you are younger than 65, you may be able to claim Medicare if you have been receiving Social Security Disability Insurance (SSDI) for 24 months, or if you have end-stage renal disease (ESRD) or amyotrophic lateral sclerosis (ALS). These routes do not require you to wait until 65.

Key Takeaways

You become may be able to access for Medicare at 65, but you must sign up during your enrollment window or face a permanent penalty on your premiums.
If you are on SSDI, you can claim Medicare after 24 months of receiving disability payments, regardless of your age.
People diagnosed with end-stage renal disease or ALS can claim Medicare when ready, without waiting for age or work history requirements.
If you are still working at 65 and covered by your employer's health plan, you can delay Medicare without penalty, but you must enroll within eight months of leaving that job.

Claiming Medicare at 65 based on age and work history

To claim Medicare at 65 based on age, you need 40 work credits under Social Security. One credit is earned for each quarter of the year you work and pay Social Security taxes — so 40 credits takes roughly 10 years of work. If you have been working in the United States and paying into Social Security, you almost certainly have enough credits by 65.

Your spouse can also claim Medicare at 65 based on your work record, even if they have not worked 10 years themselves. They must be at least 62 years old. Your ex-spouse can claim on your record too, if you were married for at least 10 years and are now divorced.

You do not have to claim Social Security retirement benefits to claim Medicare. You can claim Medicare at 65 and delay your retirement benefits until 70 to get a larger monthly payment. These are two separate decisions.

Claiming Medicare before 65 through disability

If you are receiving SSDI, you automatically move to Medicare after you have been on disability for 24 months. You do not have to do anything — Social Security will enroll you. The 24-month clock starts the month your disability benefits begin, not the month you applied.

You can also claim Medicare before 65 if you have end-stage renal disease (ESRD), which means your kidneys function at less than 15 percent of normal capacity or you need dialysis. You become may be able to access the month your nephrologist certifies that you need dialysis or a transplant. If you are already on dialysis or have had a transplant, you can claim when ready.

People with ALS (Lou Gehrig's disease) can claim Medicare right away, without waiting for SSDI approval or any other requirement. You need a diagnosis from a physician, but there is no waiting period.

How to sign up during your enrollment window

Your initial enrollment window is seven months long: it starts three months before the month you turn 65 and ends three months after. For example, if you turn 65 in June, your window runs from March through September. You can sign up online through Medicare.gov, by phone at 1-800-MEDICARE, or in person at your local Social Security office.

If you miss your initial window, you can sign up during the General Enrollment Period, which runs January 1 through March 31 each year. Coverage begins the month after you sign up. However, you will pay a penalty on your Part B and Part D premiums for as long as you have Medicare — typically 10 percent more for each 12-month period you were not enrolled.

If you are still working at 65 and your employer offers health coverage, you can delay Medicare without penalty. You have eight months after you leave your job to sign up without penalty. Tell your employer's benefits office that you are declining Medicare because you have group health coverage — they will give you a notice you may need later.

What happens if you delay past your enrollment window

Delaying Medicare past your enrollment window costs you money. Your Part B premium (which covers doctor visits and outpatient care) increases by 10 percent for each year you were not enrolled. If you delay for three years, your premium goes up 30 percent permanently.

Part D (prescription drug coverage) has the same penalty structure. If you go without Part D coverage for 63 days or more in a row, you pay a penalty when you finally enroll — roughly 1 percent of the national average Part D premium for each month you were not covered.

The only way to avoid these penalties is to have creditable coverage — either through an employer, a spouse's employer, or a program like TRICARE or the VA. If you have creditable coverage, you can delay without penalty, but you must prove it when you sign up. Keep any paperwork your employer or plan sends you about your coverage.

Claiming Medicare as a spouse or ex-spouse

Your spouse can claim Medicare at 65 based on your work record if you are at least 62 years old and have 40 work credits. They do not need to have worked themselves. If your spouse is younger than 62, they cannot claim Medicare on your record until you reach 62.

An ex-spouse can claim on your record if you were married for at least 10 years, you are now divorced, and you are at least 62 years old. Your ex does not need your permission. If you remarry, your new spouse can also claim on your record.

A widow or widower can claim Medicare at 60 based on their deceased spouse's work record. If they are caring for a child under 16, they can claim at any age.

Special cases: ESRD and ALS

End-stage renal disease qualifies you for Medicare regardless of age or work history. You become may be able to access the month your doctor certifies that you need dialysis or a kidney transplant. If you are already on dialysis or have had a transplant, you can claim when ready. You sign up the same way as anyone else — through Medicare.gov, by phone, or at your local Social Security office.

ALS (amyotrophic lateral sclerosis) also qualifies you for Medicare without age or work requirements. You need a diagnosis from a physician, but there is no waiting period and no work history needed. This is one of the fastest routes to Medicare coverage.

Both ESRD and ALS beneficiaries can claim Medicare even if they are still working and have employer coverage. Medicare becomes your primary insurance once you are enrolled.

Frequently Asked Questions

What if I turn 65 but do not have 40 work credits?

You cannot claim Medicare based on age alone. However, you may be able to claim based on your spouse's or ex-spouse's work record if you meet the marriage requirements. If neither option works, you can still buy Medicare coverage if you are a U.S. citizen or permanent resident who has lived in the country for at least five years.

Can I claim Medicare while I am still working?

Yes. You can claim Medicare at 65 even if you are still working. If your employer offers health coverage, you can delay Medicare without penalty, but you must sign up within eight months of leaving your job. If your employer does not offer coverage, sign up at 65 to avoid penalties.

How long does it take to get Medicare after I sign up?

If you sign up during your initial enrollment window (three months before to three months after you turn 65), coverage usually begins the first day of the month you turn 65. If you sign up outside that window, coverage begins the month after you complete your process.

Do I have to claim Social Security retirement to claim Medicare?

No. Medicare and Social Security retirement are separate. You can claim Medicare at 65 and delay your retirement benefits until 70 to receive a larger monthly payment. You can also claim retirement benefits and delay Medicare, though you will face a penalty if you delay past your enrollment window.

What if I am on disability but not yet 24 months in?

You cannot claim Medicare until you have been on SSDI for 24 months. The 24-month clock starts the month your disability benefits begin. Once you reach 24 months, Social Security will enroll you automatically — you do not have to do anything.

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.