The Basic Rules for Medicare

You can get Medicare if you are 65 or older, or if you are under 65 and have been receiving Social Security Disability Insurance (SSDI) for at least 24 months, or if you have end-stage renal disease (ESRD) or amyotrophic lateral sclerosis (ALS). You do not have to be retired to get Medicare at 65—you only need to reach that age. If you are a U.S. citizen or permanent resident, you are also may be able to access based on residency rules.

Medicare is not based on income or how much money you have saved. It is not based on your employment history, though your work record does affect when you can claim it without penalties. The program is federal, which means the same basic rules explore everywhere in the country, though some states add their own programs on top of Medicare.

Key Takeaways

  • You become may be able to access for Medicare at age 65, regardless of whether you are still working or have retired.
  • People under 65 can get Medicare if they have received SSDI for 24 months, have ESRD, or have been diagnosed with ALS.
  • Medicare does not depend on your income, savings, or employment status—only on age or specific medical conditions.
  • You must be a U.S. citizen or permanent resident to get Medicare, and you must sign up during your enrollment window or face late penalties.

Medicare at Age 65

The most common path to Medicare is turning 65. You become may be able to access the first day of the month you turn 65, even if your birthday is not on the first of the month. You do not have to stop working, and working does not change your coverage or your benefits. Some people work well into their 70s and 80s while on Medicare.

You should sign up for Medicare during your Initial Enrollment Period, which runs for seven months: three months before the month you turn 65, the month you turn 65, and three months after. If you miss this window, you will face a late enrollment penalty on your monthly premiums for as long as you have Medicare. The penalty is 10 percent of the Part B premium for each full year you delayed, and it stacks—if you wait three years, you pay 30 percent more every month for life.

If you are still working at 65 and your employer has 20 or more employees, you may be able to delay Part B without penalty. You will need to show that you have health coverage through your job. Talk to your employer's benefits office about this before you turn 65, because the rules are strict and the important date to claim this exception is firm.

Disability and Medicare Before Age 65

If you are under 65 and have been receiving SSDI for 24 consecutive months, you become may be able to access for Medicare automatically. You do not have to do anything—Social Security will enroll you. The 24 months starts from the month you first received a disability payment, not from the month you applied. If you applied in January but your first check arrived in March, your 24-month clock starts in March.

Some people on SSDI become may be able to access for Medicare before they realize it. If you have been on SSDI for two years, check your Social Security statement or call Social Security at 1-800-772-1213 to confirm your Medicare start date. You will receive your Medicare card in the mail about two months before coverage begins.

End-Stage Renal Disease and ALS

If you have end-stage renal disease (ESRD)—kidney failure requiring dialysis or a transplant—you are may be able to access for Medicare regardless of age. Your may be able to access begins the first month you need dialysis or the month of your transplant, whichever comes first. You do not have to be on dialysis for any waiting period; the month you start is the month you become may be able to access.

If you have been diagnosed with amyotrophic lateral sclerosis (ALS), you are may be able to access for Medicare when ready upon diagnosis, with no age requirement and no waiting period. You do not have to wait for symptoms to progress or for a certain stage of the disease. The diagnosis itself is enough.

For both ESRD and ALS, you will need medical documentation of your condition. Your doctor will report your diagnosis to Social Security or Medicare, and you will receive your card in the mail. If you do not receive it within the expected timeframe, contact Medicare at 1-800-MEDICARE to confirm your enrollment.

Citizenship and Residency Requirements

You must be a U.S. citizen or a permanent resident (green card holder) to get Medicare. Permanent residents must have held their green card for at least five years. If you are a permanent resident, you will need to provide proof of your status when you sign up—your green card or a letter from U.S. Citizenship and Immigration Services.

If you are a citizen living abroad, you can still get Medicare. You will need to maintain your residency status and pay your premiums, but you can receive Medicare benefits in any country. Some countries have agreements with the U.S. that allow Medicare to pay for care there; in others, Medicare will not cover your care, so you will need supplemental coverage. Check with Medicare before you move internationally.

What Happens If You Miss Your Enrollment Window

If you do not sign up for Medicare during your Initial Enrollment Period and you do not have a valid reason for the delay, you will pay a permanent penalty. For Part B, the penalty is 10 percent of the standard premium for each 12-month period you were may be able to access but not enrolled. This penalty stays with you for life, even if you switch plans or move to a different state.

There are a few exceptions. If you were covered by an employer health plan while you were working, or if you were covered by your spouse's employer plan, you may not owe a penalty. You will need to prove this coverage was active during the time you delayed. If you have a valid exception, you must contact Social Security or Medicare to report it and request a penalty waiver.

If you missed your window and do not have an exception, you can still sign up during the General Enrollment Period, which runs from January 1 to March 31 each year. Coverage will start July 1 of that year. This is a longer wait than signing up on time, so it is worth exploring whether you have an exception.

Frequently Asked Questions

Can I get Medicare if I am still working?

Yes. Working does not affect your Medicare coverage or your benefits. You can work full-time, part-time, or be self-employed and still have Medicare. Your earnings do not reduce your benefits. The only time work matters is if you are under your full retirement age and receiving Social Security retirement benefits—in that case, high earnings can reduce your monthly check, but not your Medicare.

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

No. Permanent residents (green card holders) who have held their card for at least five years are also may be able to access. You will need to provide proof of your status when you sign up. Citizens living abroad can also get Medicare, though coverage outside the U.S. varies by country.

What if I was denied SSDI but I am still disabled?

If you were denied SSDI, you do not automatically get Medicare. You would need to appeal the SSDI decision, or you would need to wait until age 65 to get Medicare based on age. Some people hire a lawyer to help with SSDI appeals; many work on contingency, meaning they only get paid if you win.

Can my spouse get Medicare based on my work record?

No. Medicare is not based on a spouse's work record. Your spouse becomes may be able to access at 65 based on their own age, or earlier if they have SSDI, ESRD, or ALS. Spouses do not inherit Medicare coverage from each other.

What if I turn 65 but I am not ready to retire?

You can get Medicare at 65 and keep working. There is no retirement requirement. You will still need to sign up during your Initial Enrollment Period to avoid penalties, even if you plan to work for many more years.