The Main Routes to Medicare Coverage

You can get Medicare in three main ways: by reaching age 65, by receiving Social Security Disability Insurance (SSDI) for 24 months, or by having end-stage renal disease (ESRD) or ALS. Most people enter through age 65. If you are disabled or have one of the two specific conditions, you may may have access to before 65. You do not have to be retired to get Medicare at 65 — you just have to be 65.

Medicare is a federal health insurance program run by the Centers for Medicare & Medicaid Services (CMS). It is not means-tested, meaning your income and savings do not affect whether you can get it. Your citizenship or immigration status does matter: you must be a U.S. citizen or a permanent resident who has lived in the country for at least five years.

Enrollment happens through Social Security, not through Medicare directly. You can sign up online at ssa.gov, by phone at 1-800-772-1213, or in person at your local Social Security office. The process is free.

Key Takeaways

  • You become may be able to access for Medicare at age 65 regardless of your work history or income, as long as you are a U.S. citizen or permanent resident of five years or more.
  • You can get Medicare before 65 if you have received SSDI for 24 months, have end-stage renal disease, or have been diagnosed with ALS.
  • Enrollment happens through Social Security, and you should sign up in the three months before you turn 65 to avoid late penalties.
  • Medicare has four parts — A (hospital), B (doctor visits), D (prescriptions), and C (private alternative) — and you choose which ones you need based on your health and budget.

Reaching Age 65

The simplest path is turning 65. You do not need to have worked, paid taxes, or contributed to Social Security to get Medicare Part A (hospital insurance). Part A is free for most people at 65 because you or your spouse paid Medicare taxes while working.

If you did not work long enough to may have access to for free Part A, you can still buy it. The monthly premium in 2024 ranges from about $278 to $505 depending on how many quarters of coverage you have. A quarter of coverage means you worked and paid Medicare tax during that three-month period. You need 40 quarters (10 years of work) for free Part A; if you have fewer, you pay a higher premium.

Part B (doctor visits and outpatient care) is optional but most people take it. Part B costs a monthly premium — the standard amount in 2024 is $164.90, though it is higher if your income is above certain thresholds. You pay this premium even if you are still working.

Disability Before Age 65

If you receive SSDI, you become may be able to access for Medicare after you have been on disability for 24 months. The 24 months starts from the month Social Security approves your claim, not from the month you stopped working. So if Social Security approves you in June, you become may be able to access for Medicare in June of the following year.

You do not have to wait the full 24 months to enroll. You should enroll in the three months before your 24-month mark arrives, the same way you would at 65. If you miss that window, you can enroll later, but you may face a late penalty on Part B premiums.

If you are on Supplemental Security Income (SSI) instead of SSDI, the rules are different. SSI is a needs-based program for people with low income and assets. You may be on both SSDI and SSI at the same time. SSI does not lead to Medicare; only SSDI does.

End-Stage Renal Disease and ALS

You can get Medicare when ready if you have end-stage renal disease (ESRD) — kidney failure that requires dialysis or a transplant. You do not have to wait for age 65 or for any disability approval. You enroll through Social Security the same way, but the timeline is different: you become may be able to access the month your dialysis or transplant happens, or the month your doctor certifies that you need dialysis within 30 days.

Amyotrophic lateral sclerosis (ALS) also qualifies you for when ready Medicare. You do not have to wait 24 months on SSDI the way other disabled people do. Once Social Security approves your SSDI claim for ALS, you become may be able to access for Medicare right away. This is a rare exception to the 24-month rule.

What Happens If You Miss the Enrollment Window

If you turn 65 and do not enroll in Part B during your enrollment window, you will pay a penalty for as long as you have Medicare. The penalty is 10 percent of the Part B premium for each full 12 months you were may be able to access but not enrolled. If you wait three years to enroll, you pay 30 percent more than the standard premium forever.

The enrollment window is the three months before the month you turn 65, the month you turn 65, and the three months after. That is seven months total. If you are still working and have health insurance through your employer, you may be able to enroll in Part B later without penalty — but you have to meet specific conditions, and you should check with Social Security to be sure.

Part A does not have a late penalty, so if you miss the window, you can enroll later without extra cost. Part D (prescription drug coverage) does have a penalty, calculated the same way as Part B.

Immigrants and Non-Citizens

You must be a U.S. citizen or a lawful 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 years. Those five years do not have to be continuous, but they must add up to 60 months.

If you are on a visa, a temporary resident, or undocumented, you do not may have access to for Medicare. You may be able to get coverage through the Affordable Care Act marketplace or through Medicaid if your state offers it to your immigration status.

Working While on Medicare

You can work and have Medicare at the same time. Your age and your income do not affect your Medicare coverage. If you are working and have health insurance through your job, you can keep both that insurance and Medicare. Medicare will be your secondary payer, meaning your employer plan pays first.

If you are still working at 65 and do not enroll in Part B, you may be able to delay without penalty if your employer insurance meets certain size requirements. Your employer should tell you whether you can delay. If you are self-employed, the rules are different — you should contact Social Security to ask about your specific situation.

Frequently Asked Questions

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

No. Medicare is available to anyone who is 65 and a U.S. citizen or permanent resident of five years or more, whether you are working or retired. You can work full-time and have Medicare at the same time.

What if I worked outside the United States?

Work you did outside the U.S. does not count toward the 40 quarters needed for free Part A. Only work where you paid U.S. Medicare tax counts. If you do not have 40 quarters, you can still buy Part A, or you may be able to count work your spouse did if you are married.

Can I get Medicare if I am on a visa?

No. You must be a U.S. citizen or a lawful permanent resident who has lived in the country for at least five years. Visa holders, temporary residents, and undocumented immigrants do not may have access to for Medicare.

What if I am on disability but not SSDI?

SSDI is the only disability program that leads to Medicare. If you receive SSI, workers' compensation, or disability from the Veterans Administration, those programs do not make you may be able to access for Medicare. You become may be able to access when you turn 65 or if you have ESRD or ALS.

Do I have to enroll in all four parts of Medicare?

No. Part A and Part B are separate choices. Part D (prescriptions) is optional. Part C is an alternative to Parts A and B, not an addition to them. You choose which parts fit your health needs and budget. Many people take Part A and Part B but skip Part D if they do not take prescription drugs.