Key Takeaways

• Medicare eligibility isn’t just about turning 65—it also depends on your work history, residency status, and medical condition.

• There are multiple ways to qualify early, but each route comes with very specific rules you need to meet first.

So, Who Actually Gets Medicare?

If you think Medicare is something everyone gets the day they blow out 65 candles, think again. Yes, age is a big factor, but there’s more to it—like your job history, legal status, and even medical condition. It’s not just a birthday club. Here’s how it really works in 2025.

Age 65 Is Just the Starting Line

Most people become eligible for Medicare at age 65. But to actually qualify for premium-free Part A, you’ll need to have at least 10 years (40 quarters) of work history paying into Social Security or Railroad Retirement.

If you don’t meet that work requirement, you can still get Medicare—but you’ll have to pay a monthly premium for Part A. And yes, that can be a hefty cost in 2025.

Here’s what you need by age 65:

• U.S. citizenship or legal permanent residency for at least 5 continuous years.

• You or your spouse worked and paid Medicare taxes for 10 years.

You Can Get In Before 65, But It’s Complicated

Some people qualify for Medicare before they hit 65, but only under certain situations. The bar is set high, and there’s no skipping steps.

You’re eligible for early Medicare if:

• You’ve received Social Security Disability Insurance (SSDI) for 24 months.

• You have End-Stage Renal Disease (ESRD) and need dialysis or a kidney transplant.

• You’ve been diagnosed with Amyotrophic Lateral Sclerosis (ALS)—in that case, Medicare kicks in the first month you get SSDI.

So yeah, it’s possible. But each case is super specific.

Citizenship Rules: Not Just About Residency

Let’s talk about one of the biggest curveballs—immigration status. Being a lawful permanent resident (a green card holder) doesn’t mean you automatically qualify. You need to have lived in the U.S. for at least 5 continuous years.

And even if you meet that rule, you still need to pay premiums for Part A if you don’t have the 10-year work history. Dual hurdles, basically.

Spousal Benefits Count—But There’s a Catch

Don’t have your own 10-year work history? You might still be in luck if your spouse does. Medicare will let you qualify under your spouse’s record if:

• You’re currently married and your spouse qualifies for Medicare.

• You’re divorced but were married for at least 10 years, and you’re unmarried now.

• You’re widowed and were married at least 9 months before your spouse passed.

The rules are oddly specific, but they do open up the door for folks who didn’t have traditional careers.

Medicare and Disability: The 24-Month Rule

If you’ve been approved for SSDI, you’re automatically enrolled in Medicare after 24 months of benefits. This waiting period still applies in 2025, and it trips up a lot of people.

But again, if you have ALS, the waiting period is waived. And with ESRD, coverage begins after a certain number of dialysis treatments or right after a kidney transplant.

Timing matters—a lot.

Not All Disabilities Qualify

Just because you have a disability doesn’t mean you qualify for Medicare. You need to qualify for SSDI first, and the Social Security Administration has a strict list of impairments. Then you still wait 24 months before Medicare starts (unless you’re in one of the two special categories).

So unfortunately, being medically disabled doesn’t automatically translate to Medicare coverage.

What About People Who Keep Working Past 65?

Still working at 65? You can delay enrolling in Part B and Part D without penalty if you have credible employer coverage from a job with 20 or more employees.

Once that coverage ends or you retire, you get an 8-month Special Enrollment Period (SEP) to sign up for Part B.

But be careful—if your employer has fewer than 20 employees, Medicare becomes your primary insurance at 65, and you might get stuck with penalties if you delay.

Timing Your Enrollment Matters

Whether you qualify at 65 or earlier, the Initial Enrollment Period (IEP) is your main window. This lasts for 7 months:

• 3 months before your 65th birthday

• Your birthday month

• 3 months after

Miss it? You could face a lifetime late enrollment penalty for Part B or Part D unless you qualify for a Special Enrollment Period.

So don’t let that window close on you.

Green Card Holders and Expats—You’ve Got More to Think About

If you’re a green card holder, you must meet both the residency rule (5 continuous years in the U.S.) and the work history requirement to get premium-free Part A.

If you’re an expat returning to the U.S. at 65, you may qualify only if you’ve maintained your U.S. residency status and meet the other conditions. You’ll likely have to pay for Part A.

And don’t forget—you still need to enroll during your Initial Enrollment Period, even if you lived abroad.

Tribal Members and Medicare Eligibility

American Indians and Alaska Natives are eligible for Medicare under the same rules as other U.S. citizens. If you or your spouse worked the required 10 years and paid Medicare taxes, you’re in.

Tribal members may also qualify for special assistance programs, which can help with out-of-pocket costs once you’re enrolled.

If You Miss the Window: General Enrollment Isn’t Ideal

Did you miss your Initial Enrollment Period and don’t qualify for a Special Enrollment Period? You’ll have to wait until the General Enrollment Period (GEP) from January 1 to March 31.

Coverage won’t start until July 1, and you could owe late penalties—especially for Part B. That’s why most people try to enroll during their Initial Enrollment Period if they can.

Medicare and Incarcerated Individuals

If you’re incarcerated, you can still apply for Medicare, but your benefits won’t start until you’re released. Once you’re out, you should sign up within 63 days to avoid gaps and penalties.

Being in jail doesn’t erase your eligibility, but it can delay access.

Veterans and Military Retirees

If you qualify for Medicare, you can enroll even if you have VA benefits or TRICARE. In fact, it’s usually a good idea to enroll in at least Part A to avoid gaps in coverage.

Military retirees who want to keep TRICARE must enroll in Part B—no exceptions. If you skip it, you could lose TRICARE coverage altogether.

How Social Security Ties Into Medicare

You’re automatically enrolled in Parts A and B if you’re already receiving Social Security or Railroad Retirement benefits at least four months before you turn 65.

If you’re not taking Social Security yet, you’ll need to manually enroll in Medicare. That catches a lot of people off guard.

So, syncing your Social Security decision with Medicare matters more than people think.

Key Takeaway: Specifics Rule the Game

If there’s one thing to remember, it’s this: Medicare doesn’t operate on generalities. The rules are specific. Your eligibility hinges on details like work credits, residency, disability timing, and how you coordinate other types of insurance.

Ready to Check Your Eligibility?

It’s a lot to keep straight, but getting this right can save you from penalties and missed coverage. If you’re unsure where you stand, talk to a licensed agent listed on this website who can guide you through your specific situation.