The Basic Rule: Age 65 or Disability

You can get Medicare if you are 65 or older, or if you are under 65 and have been receiving Social Security disability benefits for 24 months, or if you have end-stage renal disease (permanent kidney failure requiring dialysis or transplant) or ALS (amyotrophic lateral sclerosis, also called Lou Gehrig's disease). Most people fall into the first group—those who reach 65.

Age alone is not quite enough, though. You also need a work history. You or your spouse must have paid Medicare taxes for at least 10 years (40 quarters of coverage). If you do not have that work history yourself, you may still be covered based on your spouse's record, or your ex-spouse's record if you were married for at least 10 years.

If you do not meet the work history requirement, you can still buy Medicare coverage at age 65, but the monthly premium will be higher than the standard rate. This option exists so that people who immigrated later in life or worked outside the U.S. system are not locked out entirely.

Key Takeaways

  • You become may be able to access for Medicare at 65 if you or your spouse paid Medicare taxes for at least 10 years (40 quarters).
  • You can get Medicare before 65 if you have received Social Security disability benefits for 24 months, or if you have end-stage renal disease or ALS.
  • If you do not have 10 years of work history, you can still buy Medicare at 65, but your monthly premium will be higher.
  • You can claim Medicare based on your spouse's or ex-spouse's work record if you were married at least 10 years and are at least 62.
  • You must sign up during your enrollment window or face a permanent penalty on your premiums.

Work History: The 10-Year Rule and How It Works

Medicare uses a system called quarters of coverage to measure your work history. You earn one quarter for each three-month period in which you earned at least a certain amount of income and paid Medicare taxes. In 2024, you need to earn $1,680 in a quarter to get credit for that quarter, though this amount changes yearly. You need 40 quarters total—which works out to 10 years of work, though not necessarily consecutive.

The work does not have to be recent. If you worked 15 years ago and then stopped, those quarters still count. Self-employed people, W-2 employees, and farm workers all build quarters the same way. The Social Security Administration keeps a record of your quarters, and you can check your record online through your Social Security account or by calling 1-800-772-1213.

If you are close to 40 quarters but not quite there, you may want to check your record before you turn 65. Sometimes earnings are missing or miscredited, and you can request a correction. The important date to correct earnings from a specific year is generally three years, three months, and 15 days after that year ends.

Getting Medicare Before 65: Disability and Medical Conditions

If you are under 65, you can get Medicare if you have been receiving Social Security Disability Insurance (SSDI) for 24 months. The 24 months starts from the month you first became may have access to to benefits, not from the month you applied. So if you were approved for disability in January, you become may be able to access for Medicare in January of the second year after that.

You do not need to wait 24 months if you have end-stage renal disease (ESRD)—permanent kidney failure that requires dialysis or a transplant. You can get Medicare as soon as your doctor determines you have ESRD, even if you have not yet started dialysis. You also do not need to wait if you have ALS. People with ALS become may be able to access for Medicare when ready upon approval for Social Security disability benefits, without the 24-month waiting period.

If you are under 65 and do not fall into these categories, you cannot get Medicare. You would need to look at other coverage options, such as the Affordable Care Act marketplace or Medicaid (which has different rules and is run by your state).

Spousal and Ex-Spousal Coverage

If your spouse is 65 or older and has 40 quarters of work history, you can get Medicare at 62 based on their record, even if you have no work history yourself. You must have been married for at least two years at the time you sign up. If your spouse is younger than 65 but already on Medicare due to disability, you can still claim at 62 based on their record.

You can also claim based on an ex-spouse's record if you were married for at least 10 years, are at least 62, and have been divorced for at least two years. You do not need your ex-spouse's permission, and claiming on their record does not reduce their Medicare benefits. Your ex-spouse does not even need to know you claimed.

If you claim spousal or ex-spousal Medicare before 65, your coverage will be the same as it would be at 65—you get the same Parts A and B. The age requirement is the only difference.

Non-Citizens and Work History

Non-citizens can get Medicare if they meet the age and work history requirements, just like citizens. You do not need to be a U.S. citizen to earn quarters of coverage or to claim Medicare at 65. However, you do need to be a lawful permanent resident (green card holder) or have a valid visa to sign up for Medicare Parts B and D (medical insurance and prescription drug coverage). Part A (hospital insurance) has slightly different rules and may be available to some non-citizens without a green card.

If you are not yet a permanent resident but are working and paying Medicare taxes, those quarters still count toward your 40-quarter requirement. When you become a permanent resident or reach 65, you can claim the coverage you have earned.

When You Must Sign Up: Enrollment Windows and Penalties

You must sign up for Medicare during your Initial Enrollment Period, which is the seven-month window that includes the month you turn 65, the three months before, and the three months after. If you sign up late—after this window closes—you will pay a permanent penalty on your Part B and Part D premiums for as long as you have Medicare.

The Part B penalty is 10 percent of the standard premium for each full year you delayed. The Part D penalty is 1 percent of the national average premium for each month you delayed. These penalties do not go away, even if you sign up years later. The only exception is if you had other health coverage (such as through an employer) during the time you were not signed up; in that case, you may not owe a penalty.

If you are still working at 65 and have health insurance through your job, you may be able to delay Medicare without penalty, but you must sign up within eight months of losing that coverage. Do not assume you can wait—the rules are specific, and missing the window costs you permanently.

How to Check Your Work History and Start the Process

Before you turn 65, create a my Social Security account at ssa.gov. Log in and view your earnings record. This shows all the quarters you have earned and whether you have reached 40. If something looks wrong—missing years, incorrect amounts, or a name change that was not processed—you can request a correction through your account or by calling 1-800-772-1213.

About three months before you turn 65, you will receive a notice in the mail from Social Security telling you that you are approaching Medicare age. The notice will explain your options and how to sign up. You can sign up online through Medicare.gov, by phone at 1-800-MEDICARE, or in person at your local Social Security office. You do not have to wait for the notice—you can sign up anytime during your Initial Enrollment Period.

When you sign up, have your Social Security number ready, along with information about any health coverage you currently have. If you are claiming based on a spouse's or ex-spouse's record, you will need their Social Security number and proof of marriage or divorce.

Frequently Asked Questions

What if I worked outside the United States?

Work done outside the U.S. does not count toward your 40 quarters unless you were working for a U.S. employer or the U.S. government. Some countries have agreements with the U.S. Social Security Administration that allow work in those countries to count, but this varies by country. Contact Social Security at 1-800-772-1213 to find out whether your foreign work can be credited.

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

Yes. Working does not affect your may be able to access for Medicare at 65. You can work as long as you want and still claim Medicare. However, if you have health insurance through your employer, you may want to delay Part B to avoid paying for duplicate coverage—but you must still sign up for Part A (hospital insurance) to avoid penalties.

What happens if I do not have 40 quarters but I am 65?

You can still buy Medicare Part A at age 65 if you are a U.S. citizen or permanent resident, but you will pay a higher monthly premium (about $278 to $505 per month in 2024, depending on how many quarters you have). You can also claim based on a spouse's or ex-spouse's record if you meet those requirements.

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

You can keep Medicare Part A (hospital insurance) if you move abroad, but Part B (medical insurance) coverage ends if you are outside the U.S. for more than six months in a row. You can restart Part B when you return, but you may owe a penalty if you delayed it originally. Part D (prescription drug coverage) does not work outside the U.S.

Can I claim Medicare based on my child's work record?

No. You can only claim based on your own work record, your spouse's record, or your ex-spouse's record. Your children's work history does not help you become may be able to access for Medicare.