The Main Groups Who Can Get Medicare

Medicare is available to people who are 65 or older, regardless of income or health history. You do not have to be retired or have worked a certain number of years — age 65 is the primary threshold. If you are under 65, you can still get Medicare if you have been receiving Social Security disability benefits for 24 months, if you have end-stage renal disease (permanent kidney failure requiring dialysis or transplant), or if you have ALS (amyotrophic lateral sclerosis, also called Lou Gehrig's disease).

There is one more path: if you are 65 or older and a U.S. citizen or permanent resident who has lived in the country for at least five years, you may be able to purchase Medicare coverage even if you do not have a work history. This option exists but comes with higher premiums than the standard program.

Key Takeaways

  • You become may be able to access for Medicare automatically at age 65 if you have worked and paid Medicare taxes for at least 10 years (or if your spouse has).
  • People under 65 can get Medicare if they have received Social Security disability for 24 months, have end-stage renal disease, or have ALS.
  • You do not have to be retired or poor to get Medicare — age and work history are what matter, not income.
  • Non-citizens and permanent residents may purchase Medicare at 65 if they have lived in the U.S. for at least five years, though premiums are higher.
  • You must enroll during your initial enrollment period or face potential penalties on your premiums.

The Work History Requirement

To get Medicare at 65 without paying extra premiums, you or your spouse must have worked and paid Medicare taxes for at least 10 years (40 quarters). This does not mean 10 consecutive years — the quarters can be spread across your entire working life. If you worked part-time or had gaps in employment, those quarters still count as long as you paid into the system.

If you do not have 10 years of work history yourself, you may still get Medicare based on your spouse's record. This applies whether your spouse is still living, retired, or deceased. You must be at least 62 years old to claim on a deceased spouse's record, and at least 62 for a living spouse (though you can claim at 65 regardless).

If neither you nor your spouse has 10 years of work history, you can still purchase Medicare at 65, but you will pay higher premiums for Part A (hospital insurance) than people with a work history. Part B (medical insurance) premiums are the same for everyone.

Disability Before Age 65

If you are under 65 and have been receiving Social Security Disability Insurance (SSDI) for 24 months, you become may be able to access for Medicare. The 24 months begins from the date your disability benefits started, not from when you first applied. During those first 24 months, you are covered by Medicaid instead (the rules vary by state).

You do not have to do anything to switch to Medicare after 24 months — it happens automatically. You will receive a new card in the mail, and your coverage changes on the first day of the month after your 24-month period ends. If you are working while receiving disability benefits under a work incentive program, your Medicare coverage continues even if your earnings increase.

End-Stage Renal Disease and ALS

People of any age with end-stage renal disease (ESRD) can get Medicare when ready, regardless of work history. ESRD means your kidneys no longer work well enough to survive without dialysis or a transplant. You become may be able to access the first day of the month you start dialysis or the month you have a kidney transplant, whichever comes first. If you receive a pre-emptive transplant (before you need dialysis), you become may be able to access the month of the transplant.

People with ALS become may be able to access for Medicare when ready upon approval for Social Security disability benefits, without waiting the usual 24 months. ALS is the only condition with this exception. You will receive your Medicare card along with your disability approval notice.

Citizenship and Residency Rules

You must be a U.S. citizen or permanent resident (green card holder) to get Medicare. If you are a permanent resident, you must have lived in the United States for at least five consecutive years before you turn 65. The five years must be continuous — extended trips outside the country can break the period, though short vacations do not.

If you are a citizen or permanent resident but do not meet the work history requirement, you can still purchase Medicare Part A and Part B at 65. Your premiums will be higher than standard rates. Some people in this situation may also be able to get help paying premiums through Medicaid, depending on their income and state rules.

What Happens If You Miss Your Enrollment Window

You have a seven-month initial enrollment period centered on the month you turn 65 (three months before, the month of, and three months after). If you do not enroll during this window and you do not have employer coverage, you will face a permanent penalty on your Part B and Part D premiums. The penalty is 10 percent of the standard Part B premium for each full year you were may be able to access but not enrolled.

There are exceptions: if you were covered by an employer health plan while you or your spouse was still working, you have eight months after that coverage ends to enroll without penalty. If you miss your window but fall into this category, keep your employer coverage documents to prove it when you do enroll.

Frequently Asked Questions

Do I have to be retired to get Medicare at 65?

No. You can be working full-time and still get Medicare at 65 if you meet the age or work history requirement. Your income and employment status do not affect your may be able to access. You can work and receive Medicare benefits at the same time.

Can I get Medicare if I never worked?

If you are 65 or older and a U.S. citizen or permanent resident who has lived here for at least five years, you can purchase Medicare even without a work history. Your Part A premiums will be higher than standard rates. Part B premiums are the same for everyone.

What if I worked in another country?

Work outside the United States generally does not count toward the 10-year requirement, even if you paid taxes. However, some countries have agreements with the U.S. that allow certain work to count. Contact Social Security to find out whether your international work history qualifies.

Can my adult child get Medicare based on my record?

No. Medicare is not available to dependents. Only spouses (current or former) and, in rare cases, parents can claim on your record. Your adult children would need their own work history or disability status to get Medicare.

If I have SSDI, do I automatically get Medicare after 24 months?

Yes. You do not need to do anything. After 24 months of receiving SSDI, Medicare begins automatically on the first day of the following month. You will receive your Medicare card in the mail before your coverage starts.