You must sign up for Medicare at 65 unless you are still covered by an active employer health plan

If you turn 65 and do nothing, you will lose coverage on your 65th birthday unless your employer plan continues. Medicare does not start automatically—you have to take action during your enrollment window. The window opens three months before the month you turn 65 and closes three months after, giving you a seven-month span to sign up without penalty.

The one major exception: if you or your spouse are still working and covered by that employer's health plan, you can delay Medicare without penalty. Once that coverage ends, you then have eight months to sign up without a late-enrollment penalty. If you miss that window and do not have a may have access to reason, you will pay a permanent surcharge on your premiums for as long as you have Medicare.

Key Takeaways

  • Medicare enrollment happens during a seven-month window: three months before you turn 65, the month you turn 65, and three months after.
  • If you are still covered by an employer health plan at 65, you can delay Medicare without penalty, but you must sign up within eight months of losing that coverage.
  • Missing your enrollment window without a may have access to reason results in a permanent 10 percent monthly surcharge on Part B and a surcharge on Part D that lasts as long as you have Medicare.
  • You can sign up through Medicare.gov, by phone at 1-800-MEDICARE, or in person at your local Social Security office.

What happens if you do not sign up during your enrollment window

If you miss the seven-month window and do not have employer coverage or another may have access to reason, Medicare will charge you a late-enrollment penalty for the rest of your life. For Part B (doctor and outpatient care), you pay an extra 10 percent of the standard premium for each full year you were may be able to access but not enrolled. That surcharge is permanent—it does not go away once you finally sign up.

Part D (prescription drug coverage) carries a separate penalty: 1 percent of the national average premium for each month you were without creditable coverage. Like Part B, this penalty stays with you permanently. If you had a gap of three years without Part D coverage, for example, you would pay 3 percent more than the standard premium every month you have Part D.

A may have access to reason—such as losing employer coverage, moving out of the country and returning, or being a federal employee—can waive these penalties if you sign up within the correct timeframe. Social Security will ask about your circumstances when you enroll, so be ready to explain any delay.

When you can delay Medicare without a penalty

You do not have to sign up at 65 if you are covered by an active employer health plan through your job or your spouse's job. This applies whether you work full-time or part-time. The plan must be from a current employer—retiree plans do not count as active employer coverage for this purpose.

Once that employer coverage ends, you have eight months to sign up for Medicare without penalty. This eight-month window is separate from the initial seven-month enrollment window. If your employer coverage ends in the month after you turn 65, your eight-month clock starts then, not from your 65th birthday.

If you are not sure whether your plan qualifies as active employer coverage, contact your employer's benefits department or call 1-800-MEDICARE and describe your situation. Getting this wrong is expensive, so verify before you assume you can wait.

How to sign up for Medicare

You can enroll through three main routes: online at Medicare.gov, by phone at 1-800-MEDICARE (1-800-633-4227), or in person at your local Social Security office. Online enrollment through Medicare.gov is the fastest—you can complete it in about 15 minutes if you have your Social Security number and information about any current health coverage.

By phone, a representative will walk you through the same questions and can answer questions about which parts of Medicare you need. Wait times vary, but calling early in the week and before 10 a.m. is usually faster. At a Social Security office, you can bring documents if you have questions about your work history or coverage, though most people do not need to.

Whichever method you choose, have ready: your Social Security number, your date of birth, your citizenship or immigration status, and information about any current health coverage (employer plan, COBRA, or other insurance). If you are signing up for Part D (prescription drugs), have a list of your current medications or your pharmacy information.

The difference between signing up now and waiting

If you sign up during your initial seven-month window, your coverage starts the first day of the month you turn 65 (or the first of the following month if you sign up after the 15th of any month in your window). If you wait until after your window closes and you do not have a may have access to reason, you will have a gap in coverage and will owe the permanent late-enrollment penalty when you finally enroll.

Signing up early also gives you time to choose between Original Medicare (Parts A and B) and a Medicare Advantage plan, and to pick a Part D plan that covers your medications. If you enroll late, you still have to make these choices, but you will be doing it under time pressure and while owing penalties.

Part A, Part B, and Part D: which parts you need to sign up for

Medicare has four parts, but you do not sign up for all of them the same way. Part A (hospital insurance) is usually automatic—if you or your spouse paid Medicare taxes for at least 10 years, you get Part A at 65 with no premium. You do not have to sign up, but you should verify you are enrolled by checking your Social Security account or calling 1-800-MEDICARE.

Part B (doctor visits, outpatient care, lab tests) requires you to sign up unless you have active employer coverage. Part B has a monthly premium (the standard amount in 2024 is $164.90, but it varies by income). If you delay Part B past your window without employer coverage, you owe the late-enrollment penalty.

Part D (prescription drugs) is optional, but you should sign up during your initial window if you take any medications. If you go without Part D coverage for more than 63 days and then enroll later, you owe a permanent surcharge. Part C (Medicare Advantage) is an alternative to Parts A and B offered by private insurers—you do not sign up for both Original Medicare and Advantage; you choose one.

What to do if you missed your enrollment window

If you are past your seven-month window and do not have active employer coverage, contact Social Security or Medicare when ready. Explain your situation—whether you did not know about the important date, had a medical emergency, moved, or had another reason for the delay. Some reasons may have access to as exceptions and can waive or reduce the penalty.

Social Security will review your case and tell you whether you may have access to for an exception. Even if you do not, you can still enroll, and your coverage will start the first of the month after you sign up. You will owe the late-enrollment penalty, but delaying further only makes it larger.

If you are currently uninsured and over 65, do not wait. Call 1-800-MEDICARE or visit Medicare.gov to start the enrollment process. The penalty is based on how long you were without coverage, so enrolling now stops the clock.

Frequently Asked Questions

What if I am still working at 65 and do not need Medicare yet?

You can delay Medicare as long as you are covered by your employer's health plan. Once you retire or lose that coverage, you have eight months to sign up without penalty. If you wait longer than eight months, you will owe a permanent surcharge on Part B and Part D.

Do I have to sign up for Part D if I do not take any medications?

You do not have to sign up for Part D if you have no prescriptions. However, if you enroll in Part D later and go more than 63 days without any drug coverage, you will owe a permanent surcharge. If you think you might need medications in the future, signing up during your initial window protects you from that penalty.

Can I sign up for Medicare before I turn 65?

Yes. Your enrollment window opens three months before the month you turn 65. For example, if you turn 65 in June, you can sign up starting in March. Signing up early gives you time to choose a plan and ensures your coverage starts on your 65th birthday.

What if my birthday is on the first of the month?

Your enrollment window still opens three months before that month. If your birthday is June 1, you can sign up starting in March. Your coverage will start June 1 if you sign up by March 15, or July 1 if you sign up after March 15.

Is there a penalty if I sign up late but I have a good reason?

Some reasons—such as losing employer coverage, being a federal employee, or moving out of the country—may may have access to as exceptions. Social Security reviews each case individually. Contact them to explain your situation; they will tell you whether the penalty applies to you.