Medicare Eligibility in 2026: Age 65, Disability, ALS, and ESRD Rules

Qualifying at age 65

Turning 65 is the most common path to Medicare. You're generally eligible if you're a U.S. citizen, or a lawfully present permanent resident who has lived in the United States continuously for at least 5 years before applying.

Your Initial Enrollment Period (IEP) is a 7-month window: it starts 3 months before the month you turn 65, includes your birthday month, and ends 3 months after. Signing up during this window helps you avoid late-enrollment penalties on Part B and Part D.

Whether your Part A is premium-free depends on work history rather than age alone — see the work-credits section below.

Qualifying through disability before 65

If you receive Social Security Disability Insurance (SSDI) cash benefits, you become entitled to Medicare after a 24-month qualifying period. Coverage begins with the 25th month of disability benefit entitlement, and enrollment in Part A and Part B is automatic for most people.

Because of this timing, your Initial Enrollment Period around disability begins 3 months before the 25th month, includes the 25th month, and ends 3 months after — a 7-month window that mirrors the age-65 rule.

• The 24-month clock counts months you're entitled to SSDI cash benefits, not calendar time since diagnosis.
• If your SSDI benefits stop and later restart, prior months of entitlement can count toward the waiting period.
• Medicare based on disability is the same Medicare available at 65 — Parts A, B, C, and D all apply.

Faster pathways: ALS and ESRD

Two conditions bypass the standard 24-month wait. If your disability is Amyotrophic Lateral Sclerosis (ALS, or Lou Gehrig's disease), you get Medicare automatically the first month you're entitled to SSDI or Railroad Retirement Board disability cash benefits — there is no waiting period.

End-Stage Renal Disease (ESRD) — permanent kidney failure requiring regular dialysis or a transplant — has its own rules and is available at any age. You or a spouse generally must have earned at least 6 work credits within the last 3 years, or you must be receiving (or eligible for) Social Security or RRB benefits.

For ESRD, Medicare usually starts the fourth month of dialysis. It can start as early as the first month if you begin a home-dialysis training program in a Medicare-approved facility before your third month of dialysis. If you qualify only because of ESRD, coverage generally ends 36 months after a successful kidney transplant.

Work credits and your Part A premium

Eligibility to enroll is separate from whether Part A costs you anything. Premium-free Part A is based on Medicare-covered work — yours or a spouse's — measured in quarters of coverage.

About 99% of people pay no Part A premium because they have at least 40 quarters (roughly 10 years) of covered work. If you have fewer quarters, you can still buy into Part A at the 2026 rates below.

• 40+ quarters of covered employment: premium-free Part A.
• 30–39 quarters: $311 per month in 2026.
• Fewer than 30 quarters: $565 per month in 2026.
• Part B carries a standard premium of $202.90 per month in 2026 regardless of work history, with higher amounts for higher incomes (IRMAA).

Citizenship and residency rules

U.S. citizens who meet the age or disability rules qualify for Medicare. Lawfully present permanent residents can also qualify, but if you don't have enough work credits to get premium-free Part A, you generally must have been a permanent resident living in the U.S. continuously for at least 5 years before you can buy into Part A.

Part B is available to eligible citizens and qualifying lawfully present residents who pay the monthly premium. Because immigration and work-history situations vary widely, confirm your specific status with the Social Security Administration before assuming a start date.