Medicare · Guide
Medicare eligibility: who can get Medicare and when it starts
Last updated 2026-10-24 · Reviewed against official sources · Editorial standards
Key takeaways
- Medicare is for people 65 and older. Some younger people with disabilities, ALS or permanent kidney failure can also get it.
- Most people get Part A with no premium because they or a spouse paid Medicare taxes for at least 40 quarters, about 10 years.
- People under 65 get Medicare after 24 months of Social Security disability benefits. With ALS, it starts the month disability benefits start.
- With 30 to 39 quarters of work, Part A costs $311 a month in 2026. With fewer than 30 quarters, it costs $565.
- Without premium-free Part A, you can still buy Part B at 65 if you are a U.S. citizen, or a lawful permanent resident who has lived here for the last 5 years.
Who can get Medicare
Medicare is the federal health insurance program for people 65 and older. Social Security says that people under 65 with certain disabilities, permanent kidney failure or ALS may also be eligible. Medicare has four parts. Part A is hospital insurance. Part B covers doctors, outpatient care and medical equipment. Part C is Medicare Advantage, a private plan. Part D covers prescription drugs.
| Your situation | Medicare starts |
|---|---|
| Age 65 and already getting Social Security or railroad retirement benefits | The first day of the month you turn 65, on its own |
| Age 65 and not getting those benefits yet | Depends on when you sign up in your 7-month window |
| Under 65 with Social Security disability benefits (SSDI) | After 24 months of disability benefits, on its own |
| Under 65 with ALS (Lou Gehrig's disease) | The month disability benefits start, on its own |
| Any age with permanent kidney failure (ESRD) on dialysis | Usually the first day of the fourth month of dialysis, after you sign up |
| Any age with ESRD and a kidney transplant | The month you enter the hospital, if the transplant is that month or within 2 months |
Premium-free Part A: the 40-quarter rule
About 99 percent of people with Medicare pay no Part A premium. They have at least 40 quarters of work covered by Medicare, as Social Security counts it. That is generally 10 years of work. At 65, you can get premium-free Part A if any of these applies:
- You get, or can get, Social Security or railroad retirement benefits.
- Your spouse gets, or can get, those benefits. This includes a spouse who died and a divorced spouse.
- You or your spouse worked long enough in a government job that paid Medicare taxes.
- You are the dependent parent of a fully insured child who died.
If none applies, you can buy Part A. In 2026, it costs $311 a month with 30 to 39 quarters of work, by you or a spouse. With fewer than 30 quarters, it costs $565 a month. To buy Part A, you must also sign up for Part B.
Under 65: disability, ALS and kidney failure
If you get Social Security disability benefits, you get Part A and Part B on your own after 24 months of benefits. Some railroad disability benefits work the same way. With ALS, Medicare starts the month your disability benefits start. SSI does not qualify you for Medicare by itself.
Kidney failure works differently. You need regular dialysis or a kidney transplant. You, your spouse or a parent must have worked long enough under Social Security, the railroad system or a government job. Sign-up is not automatic. If you sign up late, coverage can go back up to 12 months.
Citizenship and residence
To buy Part A or Part B, you must live in the U.S. You must also be a citizen or a lawful permanent resident who has lived here for the 5 years in a row before you apply. To join a Medicare Advantage or drug plan, you must also live in the plan's service area.
Frequently asked questions
Can I get Medicare before 65?
Yes, in three cases. You have had Social Security disability benefits for 24 months. You have ALS and get disability benefits. Or you have permanent kidney failure and need dialysis or a transplant.
Do I need 40 work credits for Medicare?
Not to get Medicare. You need 40 quarters, by you or a spouse, for premium-free Part A. With fewer, you can still buy Part A and Part B.
Does SSI give me Medicare?
No. Social Security says SSI does not qualify you for Medicare on its own. You must meet one of the other rules, such as age 65 or 24 months of disability benefits.
Is the Part A premium for 2027 out yet?
Not as of Oct. 24, 2026. The amounts above are for 2026. In recent years the next year's amounts came out between late September and November.
Sources
- Social Security Administration, Medicare (Publication No. 05-10043, 2026): Who can get Medicare, the enrollment periods, the employer Special Enrollment Period with forms CMS-40B and CMS-L564, and phone hours. Read 2026-10-24.
- Social Security Administration, Sign up for Medicare: Signing up online, the information to have ready, ESRD and the phone lines. Read 2026-10-24.
- Medicare.gov, How do I sign up for Medicare?: Who gets Part A and Part B automatically, the welcome package and the rules for disability, ALS, ESRD and Puerto Rico. Read 2026-10-24.
- Medicare.gov, End-Stage Renal Disease (ESRD): Who can get Medicare with kidney failure and when coverage starts. Read 2026-10-24.
- CMS, 2026 Medicare Parts A and B Premiums and Deductibles (fact sheet): 2026 Part B premium and deductible, income-related amounts, Part A deductible, coinsurance and premiums. Read 2026-10-24.
- Medicare.gov, What does Medicare cost?: Premium-free Part A after about 10 years of work and the 2026 premiums. Read 2026-10-24.
- Medicare.gov, Joining a plan: Who can join a plan, Open Enrollment, the Medicare Advantage Open Enrollment Period, SHIP help and 3 ways to join. Read 2026-10-24.
- eCFR, 42 CFR 406.20, Premium hospital insurance: basic requirements: Citizens and lawful permanent residents with 5 years of U.S. residence. Read 2026-10-24.
- eCFR, 42 CFR 407.10, Eligibility to enroll in Part B: Age 65, U.S. residence, and citizenship or 5 years as a lawful permanent resident. Read 2026-10-24.
- Federal Register, Medicare Part B Monthly Actuarial Rates, Premium Rates, and Annual Deductible Beginning January 1, 2026 (2025-20251): The 2026 Part B notice, published Nov. 19, 2025. No 2027 notice found on Oct. 24, 2026. Read 2026-10-24.