You become may be able to access for Medicare at 65, or earlier if you have been on disability for 24 months or have end-stage renal disease
The most common path to Medicare is turning 65. You do not have to be retired, and you do not have to stop working — you straightforward become may be able to access when you reach that birthday. If you were born on the first of the month, your coverage starts the month before. If you were born on any other day, coverage starts the month you turn 65.
You can also become may be able to access before 65 in two situations: if you have been receiving Social Security Disability Insurance (SSDI) for 24 consecutive months, or if you have end-stage renal disease (ESRD) requiring dialysis or a transplant. A third group — people with amyotrophic lateral sclerosis (ALS) — becomes may be able to access when ready upon approval for SSDI, without the 24-month wait.
Key Takeaways
- Medicare may be able to access at 65 is automatic if you have worked and paid Medicare taxes for at least 10 years (40 quarters), or if your spouse or ex-spouse meets that requirement.
- You must sign up during your Initial Enrollment Period, which runs three months before you turn 65 through three months after, or face a permanent penalty on Part B premiums.
- If you are still working at 65 and have health insurance through your employer, you may delay Part B enrollment without penalty if your employer has 20 or more employees.
- People on SSDI become may be able to access at 65 automatically, but those under 65 on SSDI must wait 24 months unless they have ALS.
- You can enroll online through Medicare.gov, by phone at 1-800-MEDICARE, or in person at your local Social Security office.
Who qualifies based on age and work history
To get Medicare at 65 based on your own work record, you need to have worked and paid Medicare taxes for at least 10 years (40 quarters). A quarter is roughly three months, so 40 quarters equals about 10 years. You do not have to have worked those years consecutively — gaps are fine as long as the total adds up.
If you have not worked 10 years yourself, you may still be may be able to access through a spouse or ex-spouse. If your current spouse has 10 years of work history, you can get Medicare on their record at 65. If you are divorced and were married for at least 10 years, you can use an ex-spouse's record even if they have not yet signed up for Medicare themselves. Your ex does not need to agree or even know you are using their record.
The enrollment window and what happens if you miss it
Your Initial Enrollment Period is seven months long: it starts three months before the month you turn 65 and ends three months after. If your birthday is June 15, your period runs from March through September. You must enroll during this window to avoid a permanent penalty.
If you do not sign up for Part B (medical insurance) during your Initial Enrollment Period and you do not have a valid reason to delay, Medicare adds 10 percent to your Part B premium for each year you were may be able to access but not enrolled. That penalty stays with you for life. The only way to avoid it is to have had other health insurance that was considered "creditable coverage" — usually employer coverage or TRICARE — during the months you were not on Medicare.
You can enroll late if you have a may have access to reason, such as employer coverage that ended, but you must sign up within eight months of losing that coverage and provide proof. Do not wait and hope — contact Medicare as soon as your other coverage ends.
Staying on your employer plan while you are 65
If you are still working at 65 and your employer has 20 or more employees, you can delay Part B enrollment without penalty. Your employer plan becomes primary, and Medicare becomes secondary. You must enroll in Part B within eight months of retiring or losing the employer coverage, or you will face the late enrollment penalty.
This rule applies only to Part B. You still need to enroll in Part A (hospital insurance) at 65 even if you are working, because Part A has no premium for most people and delaying it can also trigger a penalty. Part A and Part B have separate enrollment rules.
Becoming may be able to access through disability before age 65
If you are approved for SSDI, you become may be able to access for Medicare after 24 months of receiving benefits. The 24 months starts from the month your SSDI payments begin, not from the month you applied. You do not have to do anything — once you hit 24 months, Medicare coverage starts automatically.
The exception is ALS. If you are approved for SSDI because of ALS, you become may be able to access for Medicare when ready, without waiting 24 months. You still need to enroll, but there is no waiting period.
If you are under 65 and on SSDI, you will receive a notice from Social Security about your Medicare may be able to access. Read it carefully, because you still have an enrollment period and can face penalties if you miss it.
End-stage renal disease and other medical conditions
If you have end-stage renal disease and need dialysis or a kidney transplant, you become may be able to access for Medicare regardless of age. You must enroll during your Initial Enrollment Period, which is the same seven-month window as for age-based may be able to access. Your coverage can start as early as the first day of the month you begin dialysis treatment.
If you receive a transplant, your Medicare coverage continues for 36 months after the transplant, even if the kidney fails. After 36 months, you lose Medicare coverage unless you are 65 or meet another may be able to access rule. Plan ahead with your transplant team about what coverage you will need after that period ends.
How to enroll when you become may be able to access
You can enroll online at Medicare.gov starting three months before you turn 65. The website walks you through the process and tells you which parts you need. You will need your Social Security number and information about any current health coverage.
You can also call 1-800-MEDICARE (1-800-633-4227) to enroll by phone. Representatives are available seven days a week. If you prefer in-person help, visit your local Social Security office — they can enroll you in Medicare at the same time you handle other business.
Enroll as soon as your Initial Enrollment Period opens. Do not wait until the last month. Processing takes time, and if there are questions about your work history or may be able to access, you want time to resolve them before your coverage date.
Frequently Asked Questions
What if I am still working and do not want Medicare yet?
You can delay Part B if your employer has 20 or more employees and you have health insurance through that job. You must still enroll in Part A at 65. When you retire or lose the employer coverage, you have eight months to enroll in Part B without penalty. After eight months, the late enrollment penalty applies.
Can I enroll in Medicare before I turn 65?
You can start the enrollment process three months before you turn 65, and your coverage will begin the month you turn 65 (or the month before if you were born on the first of the month). You cannot start coverage before the month you are may be able to access.
Do I lose Medicare if I go back to work after 65?
No. Once you are on Medicare, you keep it whether you work or not. Your earnings do not affect your Medicare coverage. If you are still working and have employer health insurance, that plan becomes primary and Medicare becomes secondary.
What happens if I miss my enrollment period?
You can enroll late, but you will owe a permanent penalty on Part B premiums unless you have proof of creditable coverage during the time you were not enrolled. The penalty is 10 percent per year. Enroll as soon as you realize you missed the window and bring documentation of any other insurance you had.
Does my spouse automatically get Medicare when I do?
No. Your spouse becomes may be able to access at 65 based on their own work history or yours, but they must enroll separately during their own Initial Enrollment Period. may be able to access is automatic; enrollment is not.