Medicare is available to people 65 and older, people under 65 with certain disabilities, and people of any age with end-stage renal disease or ALS

You do not need to be retired to have Medicare, and you do not need to have worked a certain number of years in every case. The program has four main entry points: age 65, a disability information from Social Security, end-stage renal disease (ESRD), or a diagnosis of amyotrophic lateral sclerosis (ALS). Each route has different rules about who qualifies and when coverage begins.

Medicare is federal health insurance run by the Centers for Medicare & Medicaid Services (CMS). It is not the same as Medicaid, which is a separate program run by states. The two programs have different income limits, different covered services, and different rules about who can join. This guide covers Medicare only.

Key Takeaways

  • You become may be able to access for Medicare automatically at 65 if you have worked and paid Medicare taxes for at least 10 years, or if your spouse has.
  • People under 65 can join Medicare if Social Security has determined they are disabled, or if they have end-stage renal disease or ALS, regardless of work history.
  • You must sign up during your initial enrollment window or face a permanent penalty on your premiums, even if you have other insurance.
  • Non-citizens can have Medicare if they are lawful permanent residents (green card holders) and meet the age or disability requirements.
  • Your work history is checked against Social Security records, not your tax returns, so you cannot claim credit for work you did not report to Social Security.

Medicare at age 65 and the 10-year work requirement

You are may be able to access for Medicare Part A (hospital insurance) at 65 if you or your spouse has worked and paid Medicare taxes for at least 10 years. The 10 years do not have to be consecutive, and they do not have to be recent. If you worked 10 years total across your lifetime and paid Medicare taxes during that time, you meet the requirement.

Social Security checks your work record when you turn 65 or when you contact them to sign up. They count "credits" based on your earnings history. You earn one credit for each quarter of the year you earned a certain amount (the threshold changes yearly). You need 40 credits total, which usually means 10 years of work, but the exact timeline depends on when you were born and how much you earned in each quarter.

If you do not have 10 years of work history yourself, you may be able to use your spouse's record. A spouse who is 62 or older can claim on the other spouse's record even if they did not work. A divorced person can claim on an ex-spouse's record if the marriage lasted at least 10 years and the ex-spouse is at least 62 (or has already claimed, regardless of age).

Disability before 65: Social Security's information

You can join Medicare before 65 if Social Security has determined that you are disabled. You do not need to have worked 10 years. You do need to have worked recently enough that Social Security considers you "insured" for disability benefits — usually meaning you worked and paid Medicare taxes in at least 5 of the last 10 years, though the exact rule depends on your age.

Social Security's definition of disability is strict: you must have a medical condition that prevents you from doing substantial work and is expected to last at least 12 months or result in death. You cannot straightforward be unable to find a job or be unable to do your old job. The condition must be severe enough that you cannot do any work that exists in the national economy, given your age, education, and work experience.

If Social Security approves you for disability benefits, Medicare coverage begins 24 months after your disability benefit payments start. You do not have to wait 24 months to explore for Medicare — you can sign up as soon as you are approved — but coverage does not begin until 24 months have passed. If you are already receiving Social Security retirement or survivor benefits, you may be able to switch to disability benefits, which can change your Medicare start date.

End-stage renal disease and ALS: when ready coverage

You are may be able to access for Medicare when ready if you have end-stage renal disease (ESRD) — kidney failure requiring dialysis or a transplant — regardless of age or work history. You do not need to have worked at all. Coverage begins the first day of the month in which you start dialysis, or the month of your transplant, whichever comes first.

You are also may be able to access for Medicare when ready if you have been diagnosed with amyotrophic lateral sclerosis (ALS), also called Lou Gehrig's disease. Unlike ESRD, you do not need to have worked or paid Medicare taxes. Coverage begins the first month you are diagnosed, with no waiting period.

If you have ESRD or ALS, you should contact Social Security or Medicare directly to sign up. Do not wait for an enrollment period. These conditions bypass the normal enrollment windows and allow you to join at any time.

Citizenship and residency requirements

You must be a U.S. citizen or a lawful permanent resident (green card holder) to have Medicare. If you are a citizen, you meet this requirement automatically. If you are a green card holder, you must have held the green card for at least 5 years and be a resident of the United States.

Undocumented immigrants are not may be able to access for Medicare, even if they have worked and paid Medicare taxes. If you are not sure about your immigration status or have questions about whether you may have access to, contact Social Security or Medicare directly. They can tell you whether your specific situation meets the residency requirement.

What happens if you miss your enrollment window

You have a specific window to sign up for Medicare without penalty. For most people, this is a 7-month period centered on the month you turn 65 — three months before, the month of, and three months after. If you miss this window and do not have other may have access to coverage, you will pay a permanent penalty on your Part B and Part D premiums for as long as you have Medicare.

The penalty is 10 percent of the standard Part B premium for each full 12 months you were may be able to access but did not sign up. If you were may be able to access for 2 years and did not sign up, your penalty is 20 percent, and it stays with you permanently. The same rule applies to Part D (prescription drug coverage).

There are exceptions: if you had employer coverage or other may have access to insurance while you were working, your enrollment window may be longer. If you were still working at 65 and your employer had 20 or more employees, you may have had a special enrollment period. Contact Medicare to ask whether an exception applies to you.

How to check your work record with Social Security

Social Security bases Medicare may be able to access on your earnings record, not on tax returns or pay stubs. You can view your record online at ssa.gov by creating a my Social Security account. The record shows the years you worked and how much you earned in each year, according to what your employer reported.

If your record is missing work or shows incorrect earnings, you can request a correction. You will need documents like W-2 forms, pay stubs, or a letter from your employer showing the dates you worked and what you earned. Social Security has a important date for corrections — generally three years, three months, and 15 days after the year in which you earned the money — so if you find an error, report it as soon as you can.

If you worked for a railroad, your record may be with the Railroad Retirement Board instead of Social Security. If you worked for the federal government before 1984, your record may be incomplete in Social Security's system. Contact the agency that employed you to verify your record before you turn 65.

Frequently Asked Questions

Can I have Medicare if I am still working at 65?

Yes. You become may be able to access for Medicare at 65 regardless of whether you are working. If your employer offers health insurance and has 20 or more employees, you may be able to delay signing up for Part B without penalty, but you should still sign up for Part A. Contact Medicare to understand your specific situation.

What if I worked outside the United States?

Work outside the U.S. generally does not count toward Medicare may be able to access unless you paid U.S. Social Security taxes on it. If you worked for a U.S. employer abroad or were self-employed and paid self-employment tax, that work counts. Check your Social Security record to see what years are credited.

Can my adult child claim Medicare on my record?

No. Medicare is for you, your spouse, and your ex-spouse (under certain conditions). Adult children cannot claim on a parent's record. Children under 19 (or 23 if in school full-time) may be able to receive survivor benefits if a parent dies, but that is a different program.

Do I lose Medicare if I move out of the United States?

You can keep Medicare Part A and Part B if you move abroad, but coverage is limited. Medicare generally does not pay for care outside the U.S., except in Canada and Mexico under specific circumstances. Part D (prescription drug coverage) does not work outside the U.S. at all. Contact Medicare before you move to understand what coverage you will have.

What if Social Security denies my disability claim?

You can request a reconsideration, a hearing before an administrative law judge, or an appeal to the Appeals Council. You have 60 days from the date of the denial letter to request reconsideration. Many people are denied initially and approved on appeal, so the process is worth pursuing if you believe you are disabled under Social Security's definition.