Who Medicare Covers and Who It Doesn't

The Basic Rule: Age, Disability, or Kidney Disease

Medicare covers people in three main groups: anyone 65 or older, people under 65 with certain disabilities, and people of any age with end-stage renal disease (ESRD) or ALS. You do not have to be retired to get Medicare at 65—you just have to reach that birthday. If you are under 65, you must have been receiving Social Security Disability Insurance (SSDI) or Railroad Retirement Board (RRB) disability benefits for 24 months, or have ESRD or ALS, to be covered.

Citizenship or immigration status matters. You must be a U.S. citizen or a lawful permanent resident who has lived in the country for at least five consecutive years. If you are not yet a permanent resident, you cannot get Medicare, even if you work and pay taxes.

Key Takeaways

Medicare covers people 65 and older, people under 65 who have received SSDI or RRB disability benefits for 24 months, and people with end-stage renal disease or ALS at any age.
You must be a U.S. citizen or a lawful permanent resident with at least five years of continuous residence to be covered.
You do not have to be retired, working, or earning below a certain income to get Medicare at 65.
If you are under 65 and disabled, Medicare begins the 25th month after your disability benefits start, not on the first month.
Your spouse's age or work history does not automatically cover you—you must meet one of the three main coverage rules yourself.

People 65 and Older

Anyone who turns 65 can get Medicare if they are a U.S. citizen or lawful permanent resident with five years of continuous residence. You do not have to have worked, paid into Social Security, or earned any particular amount of money. If you have never worked in the United States, you can still get Medicare Part A (hospital insurance) at 65 by paying a monthly premium, though the premium is higher than it is for people who worked and paid Medicare taxes.

If you worked and paid Medicare taxes for at least 10 years (40 quarters), you get Part A for free. If you worked fewer than 10 years, you pay a premium. Your income does not matter, and there is no asset limit—Medicare is not means-tested for people 65 and older.

People Under 65 with Disabilities

If you are under 65 and have a disability, you can get Medicare after you have been receiving SSDI or RRB disability benefits for 24 months. This means you must first be approved for disability benefits through Social Security or the Railroad Retirement Board. Once you are approved, you wait 24 months, and then Medicare begins in your 25th month of receiving those benefits.

The disability itself does not have to be permanent. You can have a temporary condition that Social Security considers disabling, and you will still get Medicare after 24 months of benefits. The condition must be severe enough that Social Security determined you cannot work, but it does not have to be a lifelong diagnosis.

People with End-Stage Renal Disease or ALS

If you have end-stage renal disease (ESRD)—kidney failure requiring dialysis or a transplant—you can get Medicare regardless of age. You become covered the first month you start dialysis or the month you have a kidney transplant, whichever comes first. You do not have to wait 24 months like people with other disabilities.

If you have ALS (amyotrophic lateral sclerosis, also called Lou Gehrig's disease), you can get Medicare when ready upon Social Security approval. You do not have to wait 24 months. These two conditions are treated differently from other disabilities because of their severity and the when ready need for expensive medical care.

Who Is Not Covered

Medicare does not cover people under 65 who are unemployed, underemployed, or low-income unless they also have a disability, ESRD, or ALS. Working part-time or full-time at any wage does not make you covered if you are under 65 and not disabled. Income level—whether you are poor or wealthy—does not affect coverage for anyone.

Undocumented immigrants and people on temporary visas are not covered by Medicare, even if they work and pay taxes. Lawful permanent residents who have lived in the United States for fewer than five years are also not covered. If you are a permanent resident who has been in the country for five years or more, you are covered at 65 or if you meet the disability rules.

How to learn about You Are Covered

The clearest way to know your coverage status is to contact Social Security directly. Call 1-800-772-1213 (TTY 1-800-325-0778) or visit your local Social Security office. Have your Social Security number ready. If you are under 65, ask whether you are receiving or have been approved for SSDI or RRB disability benefits. If you are 65 or older, you are covered unless you are not a U.S. citizen or permanent resident.

If you have ESRD or ALS, your doctor or dialysis center can help you understand your Medicare coverage. They work with Medicare regularly and can walk you through the process. You can also call Medicare directly at 1-800-MEDICARE (1-800-633-4227) to ask about your specific situation.

Frequently Asked Questions

Does my spouse's Medicare coverage mean I am covered too?

No. Your spouse's age or Medicare coverage does not cover you. You must meet one of the three main rules yourself: be 65 or older, have received disability benefits for 24 months, or have ESRD or ALS. Your spouse's work history does not count toward your coverage.

If I am 64 and disabled, can I get Medicare before I turn 65?

Only if you have been receiving SSDI or RRB disability benefits for 24 months already. If you are approved for disability at age 64, you would get Medicare at age 65 (or in your 25th month of benefits, whichever comes later). You cannot skip ahead based on disability alone—the 24-month waiting period applies.

What if I worked outside the United States—does that count toward Medicare?

Work outside the U.S. does not count toward the 10 years of work needed for free Part A. Only work where you paid U.S. Medicare taxes counts. If you worked abroad for a U.S. employer and paid Medicare taxes, that counts. If you worked for a foreign employer, it does not.

Can I get Medicare if I am a permanent resident but have not lived here five years yet?

No. You must have been a lawful permanent resident for at least five consecutive years. If you have been here four years, you are not covered. Once you reach five years, you become covered at 65 or if you meet the disability rules.

If I have ESRD and am under 65, when does my Medicare start?

Medicare begins the first month you start dialysis or the month you have a kidney transplant, whichever comes first. You do not have to wait 24 months like people with other disabilities. If you are hospitalized for kidney failure before you start dialysis, Medicare may cover that hospital stay retroactively.

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.