Who Is Eligible for Medicare? Age, Disability, ALS and ESRD (2026)

Most people become eligible for Medicare at 65, and some qualify earlier because of a disability, ALS (Lou Gehrig's disease) or End-Stage Renal Disease.1 When people ask who is eligible for Medicare, the rule that trips them up is the 40 work credits. Those credits decide whether Medicare Part A is premium-free, not whether you can get Medicare: a person 65 or older without them may still be able to buy Part A.2

In This Guide

• Key Takeaways
• The Four Ways to Qualify for Medicare
• Who Is Eligible for Medicare at 65
• Work Credits Decide Your Part A Premium, Not Your Eligibility
• Can You Get Medicare Before 65 With a Disability?
• Medicare Eligibility With ALS
• Medicare Eligibility With Kidney Failure (ESRD)
• Do Non-Citizens Qualify for Medicare?
• Is Medicare Eligibility Different in Your State?
• What to Do Once You Know You Qualify
• Frequently Asked Questions
• Learn More

The Four Ways to Qualify for Medicare

Medicare entitlement runs through four pathways in federal law: age 65, disability, ALS and End-Stage Renal Disease.2 Each one has its own start date and its own condition that people tend to miss. The table sorts them; the sections below explain each one and point to the full guide.

The start dates in the table come from federal law: 42 U.S.C. 426 for age and disability, 42 U.S.C. 426-1 for ESRD, and the matching CMS regulation.2,6

Who Is Eligible for Medicare at 65

At 65, you're entitled to premium-free Part A if you're entitled to, or eligible for, monthly Social Security benefits.2 Two further routes reach the same entitlement at 65: being a qualified railroad retirement beneficiary, and having worked in Medicare-qualified government employment.2

You don't need your own work record. Premium-free Part A can rest on a spouse's Medicare-covered work, and the Social Security Administration says you may also qualify through a current or former spouse's work.2 Each spouse route has its own bounds, set by the underlying Social Security benefit:

• Divorced spouse: you were married at least 10 years before the divorce and you're not currently married.2
• Surviving spouse: SSA's survivor rules generally require you to be 60 or older (50 to 59 with a disability), to have been married at least 9 months before your spouse died, and not to have remarried before 60 (50 with a disability). Premium-free Part A itself still begins at 65.2

Whether you have to do anything depends on whether you already draw Social Security. Federal regulation says a person who is entitled to monthly Social Security or railroad retirement benefits when they turn 65 need not file an application for hospital insurance.2 If you turn 65 without having claimed Social Security, you're not shut out: you file an application for Part A, and filing is the route rather than a forfeiture.2 The automatic enrollment guide covers who gets a card in the mail and who has to act.

Work Credits Decide Your Part A Premium, Not Your Eligibility

Most people get premium-free Part A because they or a spouse paid Medicare taxes for at least 40 quarters of Medicare-covered work, which medicare.gov describes as generally at least 10 years. About 99% of Medicare beneficiaries pay no Part A premium for that reason.3

Forty quarters is the figure SSA and medicare.gov state, but it's one route to "fully insured" status under federal law, not the definition of it. Someone whose working years were interrupted by a period of disability can be fully insured with fewer than 40 quarters, so a person who comes up short should have SSA check their record before concluding they don't qualify.2

If you don't qualify for premium-free Part A, you may be able to buy it. The 2026 monthly Part A premium depends on your Medicare-covered work, or your spouse's:4

The figures in the table are the 2026 amounts CMS announced, and they change every calendar year.3,2

Three things come with the buy-in. You must also sign up for Medicare Part B in order to buy Part A; you can't enroll in premium Part A by itself.4 Part B carries its own standard premium of $202.90 a month in 2026.3 And if you don't buy Part A when you're first eligible, your monthly Part A premium may go up 10%, a penalty you pay for twice the number of years you didn't sign up.4 The Part A premium guide and the work credits guide cover the counting in detail.

Can You Get Medicare Before 65 With a Disability?

Yes. A person under 65 who has been entitled to Social Security disability benefits for 24 calendar months is entitled to Medicare starting with the 25th month of that entitlement.2 CMS states that disabled individuals are automatically enrolled in Part A and Part B once they've received disability benefits from Social Security for 24 months.5

The 24-month clock isn't limited to Social Security Disability Insurance (SSDI) on your own work record. Federal law counts 24 months of entitlement to any of these:2

• SSDI on your own record
• Childhood disability benefits paid on a parent's record (the disabled adult child benefit)
• Disabled widow's or widower's benefits on a late spouse's record
• Disability benefits as a qualified railroad retirement beneficiary

For a first period of disability, the Medicare clock follows SSDI's own 5-month waiting period, so a first-time applicant typically waits five months for SSDI cash benefits and then 24 more months for Medicare.2 Months from an earlier period of disability benefits can count toward the 24-month Medicare waiting period, so someone returning to disability benefits may need fewer months, or none.2

Medicare.gov's page on getting Medicare before 65 lays out the official rules, and the Medicare under 65 guide walks through the timeline, returning to work, and why Medigap access under 65 varies by state.5

Medicare Eligibility With ALS

ALS is the one diagnosis that removes the wait. Federal law waives the 24-month Medicare waiting period for a person medically determined to have amyotrophic lateral sclerosis, so entitlement begins with the first month of disability benefit entitlement rather than the 25th.2 Medicare.gov states that with ALS you get Part A and Part B automatically the month your disability benefits start.2

The SSDI side moved too. The ALS Disability Insurance Access Act of 2019, as amended, eliminated the 5-month SSDI cash-benefit waiting period for people with ALS approved for SSDI benefits on or after July 23, 2020.5 Because Medicare with ALS starts with SSDI entitlement, the SSDI application is the step that starts Medicare.

Medicare Eligibility With Kidney Failure (ESRD)

End-Stage Renal Disease is permanent kidney failure that requires a regular course of dialysis or a kidney transplant.6 Medicare.gov says you can get Medicare with ESRD no matter how old you are, but only if all of these apply:1

• Your kidneys no longer work.
• You need regular dialysis or have had a kidney transplant.
• You've worked the required amount of time under Social Security, the railroad retirement system or as a government employee; or you're already getting or are eligible for Social Security or railroad retirement benefits; or you're the spouse or dependent child of a person who meets either of those requirements.

An ESRD diagnosis alone doesn't qualify you for Medicare; the work-record or family condition has to be met too.5 ESRD Medicare is also not automatic: signing up is your choice, and you contact Social Security to do it.2 For someone on dialysis, coverage usually starts on the first day of the fourth month of dialysis, and it can start as early as the first month if you take part in a home dialysis training program and meet Medicare's other conditions.6 A late application doesn't automatically cost you that coverage: if you're eligible based on ESRD and don't sign up right away, your coverage could start up to 12 months before the month you apply.2

The ESRD guide covers transplant start dates, when ESRD-based coverage ends, and how Medicare works alongside an employer plan during the 30-month coordination period.

Do Non-Citizens Qualify for Medicare?

Some do. Section 1899C of the Social Security Act limits Medicare entitlement and enrollment to four groups:7

• U.S. citizens and nationals
• Lawful permanent residents (green-card holders)
• Cuban and Haitian entrants
• People lawfully residing in the United States under a Compact of Free Association (COFA)

Under Section 1899C, lawfully present immigrants who are not citizens, nationals, green-card holders, Cuban or Haitian entrants or COFA residents can no longer newly enroll in Medicare, and those already entitled or enrolled as of July 4, 2025 lose Medicare entitlement on January 4, 2027.7

A green-card holder 65 or older who has enough work history qualifies for premium-free Part A on the same basis as a citizen.7 A green-card holder 65 or older without enough work history must have lived in the United States continuously for the 5 years before the month they apply in order to buy Medicare Part A, so the residence clock, not the work record, is what governs for a recent arrival.2 The Medicare guide for immigrants covers the categories and the 2027 change in full.

Is Medicare Eligibility Different in Your State?

No. Medicare entitlement is set by federal statute (42 U.S.C. 426, and 42 U.S.C. 426-1 for ESRD) and the matching CMS regulation, so the four routes above apply the same way in Tennessee, Georgia, California or any other state.2

What your state can affect is help paying for Medicare. People with limited income and resources may be able to get help from their state paying Medicare premiums and other costs.4 That help runs through Medicaid and the Medicare Savings Programs (QMB, SLMB, QI and QDWI), and a person who has both Medicare and Medicaid is called dually eligible.8 The Medicare vs. Medicaid guide explains how the two programs differ and how they work together.

What to Do Once You Know You Qualify

1. Confirm your work record with SSA. If you're near 40 quarters, or counting on a spouse's, former spouse's or late spouse's record, ask Social Security to check it before you decide you don't qualify.2
2. Find out whether you'll be enrolled automatically. If you already draw Social Security at 65, Part A comes without an application; if you don't, you file.2 Social Security's sign up for Medicare page is where you apply; see how to sign up for Medicare and when to sign up to avoid late penalties.
3. If you have a Marketplace plan, plan the switch. Once you're eligible for premium-free Part A, you no longer qualify for the premium tax credit and cost-sharing reductions that lower a Marketplace plan's costs, even if you haven't enrolled in Medicare.9 The Marketplace-to-Medicare guide covers the timing.
4. If you're a veteran, don't skip Medicare. VA recommends that veterans with VA health care sign up for Medicare as soon as they can, and warns that delaying Part B and signing up later brings a penalty you pay for the rest of your life.10 See VA benefits and Medicare.
5. If money is tight, ask about help. Your state may help pay Medicare premiums and costs for people with limited income and resources.4 Start with the Medicare Savings Programs guide.

Learn More

Find personalized help working out whether you or a parent qualifies for Medicare at brevy.com.

The information on Brevy.com is for educational purposes only and is not a substitute for professional legal, financial, or medical advice. Rules vary by state and program and change frequently. Always verify with the relevant agency or a qualified professional. Brevy is not a law firm, financial advisor, or healthcare provider.