When You Can Start Medicare: Age, Work History, and Other Paths

Medicare starts at 65 for most people, but you may may have access to earlier if you have a disability or end-stage renal disease

You become may be able to access for Medicare Part A (hospital insurance) at age 65 if you or your spouse worked and paid Medicare taxes for at least 10 years. You do not have to stop working to enroll. If you were born on the first of the month, Medicare considers your birthday to be the previous month for enrollment purposes.

You can enroll in Medicare starting three months before the month you turn 65. If you miss that window, you can still enroll, but you may face a permanent penalty on your premiums. The enrollment period runs from three months before your 65th birthday through three months after.

If you do not have 10 years of work history under your own name, you may still may have access to based on your spouse's or ex-spouse's work record. You must be at least 62 years old and married (or divorced for at least two years) to use a spouse's record.

Key Takeaways

You are may be able to access for Medicare at 65 if you or your spouse paid Medicare taxes for at least 10 years.
You can enroll starting three months before your 65th birthday, and the enrollment window stays open for three months after.
You may may have access to before 65 if you have been on Social Security disability for 24 months, have end-stage renal disease, or have ALS (amyotrophic lateral sclerosis).
Missing your initial enrollment window can result in a permanent increase to your monthly premiums.
If you lack sufficient work history, you may may have access to based on a spouse's or ex-spouse's record.

may have access to before age 65 through disability

If you receive Social Security Disability Insurance (SSDI), you become may be able to access for Medicare after you have been on disability for 24 months. The 24-month period starts from the month you were approved for SSDI, not from when you applied. You do not have to wait until age 65.

You can enroll in Medicare during the same months you are may be able to access for SSDI. Contact Social Security to confirm your may be able to access date, then enroll through Medicare.gov or by calling 1-800-MEDICARE. Some people on SSDI are automatically enrolled; others must enroll themselves.

End-stage renal disease and ALS may be able to access

You are may be able to access for Medicare when ready if you have end-stage renal disease (ESRD) — permanent kidney failure requiring dialysis or a transplant. You do not have to be 65 or have a work history. may be able to access begins the month your kidney disease is diagnosed, though you can enroll retroactively if you explore later.

You are also may be able to access at any age if you have been diagnosed with ALS (amyotrophic lateral sclerosis), also called Lou Gehrig's disease. Unlike SSDI, which requires a 24-month waiting period, ALS patients can enroll in Medicare when ready upon diagnosis. Your doctor must confirm the diagnosis, and you enroll through Medicare.gov or by phone.

What happens if you miss your enrollment window

If you turn 65 and do not enroll in Medicare Part A or Part B during your initial enrollment period, you may face a late enrollment penalty. For Part A, the penalty is 10 percent of the monthly premium for twice the number of years you were late. For Part B, the penalty is 10 percent of the monthly premium for each full year you were late, and it is permanent.

You can still enroll after your initial window closes, but only during the General Enrollment Period, which runs January 1 through March 31 each year. Coverage would not start until July 1 of that year. The exception is if you had creditable coverage (health insurance through an employer or union) when you turned 65 — in that case, you may enroll without penalty during an eight-month window after that coverage ends.

Using a spouse's or ex-spouse's work record

If you do not have 10 years of work history under your own name, you can use your spouse's record if you are at least 62 years old and currently married. You can also use an ex-spouse's record if you are at least 62, have been divorced for at least two years, and were married for at least 10 years. Your ex-spouse does not have to be enrolled in Medicare for you to use their record.

To enroll based on a spouse's or ex-spouse's record, contact Social Security before you enroll in Medicare. Social Security will verify the work history and provide documentation. Bring this to your Medicare enrollment, whether you enroll online, by phone, or in person at a Social Security office.

How to check your work history and enroll

Before you enroll, verify that you have enough work credits. Create an account on ssa.gov and view your Social Security Statement, which shows your earnings record and the number of credits you have earned. One credit is earned for each $1,770 of wages in 2023 (the amount changes yearly), and you need 40 credits total — roughly 10 years of work.

To enroll in Medicare, visit Medicare.gov, call 1-800-MEDICARE, or visit your local Social Security office. You will need your Social Security number, proof of citizenship or legal residency, and proof of age (birth certificate or passport). If you are enrolling based on disability or ESRD, have your diagnosis documentation ready. Enrollment takes about 15 minutes online or by phone.

Delaying Medicare and working past 65

You do not have to enroll in Medicare at 65 if you are still working and covered by your employer's health plan. However, you must enroll in Part A (hospital insurance) within eight months after your employment ends or your employer coverage stops, or you will face a late enrollment penalty.

If your employer has 20 or more employees, your employer's plan is primary and Medicare is secondary — meaning your employer plan pays first. If your employer has fewer than 20 employees, Medicare becomes primary. Either way, you should enroll in Medicare when your coverage ends to avoid gaps and penalties.

Frequently Asked Questions

Can I enroll in Medicare before I turn 65?

Yes, if you have been on Social Security disability for 24 months, have end-stage renal disease, or have ALS. Otherwise, you can enroll starting three months before your 65th birthday. You cannot enroll earlier than that window.

What if I worked outside the United States?

Work performed outside the U.S. counts toward Medicare may be able to access only if you paid U.S. Social Security taxes on those wages. Government employees hired before 1984 may have different rules. Contact Social Security to review your specific earnings record.

Do I lose Medicare if I go back to work?

No. Once you are enrolled in Medicare, you keep it regardless of whether you work. However, if you are under 65 and on SSDI, your benefits may change if your earnings exceed the limit. Contact Social Security about how work affects your SSDI before you return to work.

What if my spouse is not yet 65?

Your spouse can enroll in Medicare when they turn 65 or meet another may be able to access requirement (disability, ESRD, or ALS). You do not have to enroll together. Each person enrolls based on their own age or medical condition.

Can I change my mind after I enroll?

Yes, during the Initial Enrollment Period (three months before through three months after your 65th birthday), you can change your coverage choices. After that, you can make changes only during the Annual Enrollment Period (October 15 through December 7 each year) or if you have a may have access to life event.

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.