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

You become covered by Medicare automatically when you turn 65, as long as you or your spouse paid Medicare taxes while working. You do not have to do anything — the Social Security Administration enrolls you. 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 been diagnosed with ALS (amyotrophic lateral sclerosis, also called Lou Gehrig's disease).

Medicare is a federal insurance program, not a means-tested benefit. Your income and savings do not matter. What matters is your age, your work history (or your spouse's), or your medical condition. If you worked and paid into the system, or if you meet one of the disability or disease conditions, you have a path to coverage.

Key Takeaways

  • You are covered by Medicare at 65 if you or your spouse paid Medicare taxes for at least 10 years of work.
  • You can get Medicare before 65 if you have received Social Security disability for 24 months, have end-stage renal disease, or have been diagnosed with ALS.
  • Medicare enrollment happens automatically at 65 through Social Security; you do not need to sign up separately.
  • If you are not yet 65 and do not have a may have access to disability or disease, you may need to purchase coverage through the health insurance marketplace or your employer.

Coverage at age 65 and the work history requirement

At 65, you become covered by Medicare Part A (hospital insurance) and Part B (medical insurance) if you or your spouse worked and paid Medicare taxes for at least 10 years. The 10 years do not have to be consecutive. If you worked for 40 quarters (roughly 10 years) at any point in your life, you meet the requirement.

If you were born outside the United States, you may still be covered if you worked long enough in the U.S. and paid taxes. If you are a permanent resident or citizen, the same 10-year rule applies. If you are not a citizen or permanent resident, you generally cannot get Medicare, even at 65.

Social Security automatically enrolls you in Parts A and B three months before the month you turn 65. You will receive a Medicare card in the mail. If you are still working and have employer coverage, you can delay Part B without penalty, but Part A enrollment happens regardless.

Disability coverage before age 65

If you are under 65 and have been receiving Social Security Disability Insurance (SSDI) for 24 months, you become covered by Medicare. The 24 months starts from the month you began receiving disability payments, not from the month you applied. You do not have to wait until you turn 65.

You must have a medical condition that Social Security determined will prevent you from working for at least 12 months, or that is expected to result in death. The condition does not have to be visible or obvious. It can be a mental health condition, a chronic illness, a neurological disorder, or any condition that meets Social Security's definition of disability.

Once you have been on SSDI for 24 months, Medicare enrollment is automatic. You will receive a Medicare card. If you return to work and your benefits stop, your Medicare coverage continues for at least 93 months (about 7.5 years) after your benefits end, even if you are earning above the work limit.

End-stage renal disease and ALS coverage

If you have end-stage renal disease — meaning your kidneys no longer work and you need dialysis or a transplant to survive — you can get Medicare regardless of your age. You become covered the month your kidney failure is diagnosed, or the month you start dialysis, whichever comes first. If you receive a transplant, your coverage continues for 36 months after the transplant, even if the transplant fails.

If you have been diagnosed with ALS (amyotrophic lateral sclerosis), you can get Medicare when ready, without waiting for Social Security disability approval. You do not have to be unable to work yet. A diagnosis is enough. You will need medical documentation of the ALS diagnosis from your doctor to enroll.

For both conditions, you will need to contact Social Security or Medicare directly to enroll, since the enrollment does not happen automatically the way it does at 65. Your doctor can help you understand the process and provide the medical records Medicare will need.

Government employees and railroad workers

If you worked for the federal government and paid into the Civil Service Retirement System (CSRS), you may have different Medicare rules. Federal employees hired after 1983 pay Medicare taxes and are covered the same way as other workers. Those hired before 1983 may not have paid Medicare taxes and may not be covered at 65, depending on when they were hired and what system they were in.

If you worked for a railroad, you may have paid into the Railroad Retirement Board system instead of Social Security. You still become covered by Medicare at 65 if you paid Medicare taxes, but your benefits may be calculated differently. Contact the Railroad Retirement Board or Medicare directly to confirm your coverage.

Non-citizens and immigration status

To get Medicare at 65, you must be a U.S. citizen or a permanent resident (green card holder). If you are a citizen or permanent resident and worked long enough in the U.S., you are covered the same way as anyone else.

If you are in the U.S. on a visa, a temporary work permit, or without legal status, you cannot get Medicare, even if you have worked and paid taxes. Some states offer limited coverage to undocumented immigrants through Medicaid, but that is separate from Medicare. If you are unsure of your immigration status or how it affects your coverage, contact a legal aid organization or your state's health department.

What happens if you do not meet the requirements

If you are 65 or older but did not work long enough to may have access to for Medicare, you may be able to buy Medicare Part A by paying a monthly premium. The premium depends on how many quarters of work history you have. If you have 30 to 39 quarters, the premium is lower than if you have fewer than 30 quarters.

If you are under 65 and do not have a may have access to disability, end-stage renal disease, or ALS, you will need to find coverage another way. You can purchase a plan through the health insurance marketplace (Healthcare.gov or your state's marketplace), enroll in employer coverage if your job offers it, or look into Medicaid if your income is low enough. Each option has different rules and costs.

Frequently Asked Questions

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

You must be a U.S. citizen or permanent resident. If you are a permanent resident and worked long enough in the U.S., you are covered the same way as a citizen. If you are on a visa or do not have legal status, you cannot get Medicare.

What if I worked outside the United States?

Work outside the U.S. 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 work in those countries to count. Contact Social Security to learn about your work history qualifies.

Can my spouse's work history get me Medicare if I did not work?

Yes. If you are 65 and married, you can get Medicare based on your spouse's work history even if you never worked or did not work long enough yourself. Your spouse must be 62 or older and may be able to access for Social Security.

What if I delayed Social Security past 65?

You are still enrolled in Medicare at 65, even if you delay claiming Social Security benefits. Medicare enrollment and Social Security benefit claims are separate. You will get your Medicare card at 65 regardless of when you claim benefits.

Can I get Medicare if I am still working?

Yes. At 65, you are enrolled in Medicare whether you are still working or not. If you have employer coverage, you can delay Part B without penalty as long as you are actively employed and covered by your employer's plan. Part A enrollment still happens automatically.