Not everyone over 65 is covered by Medicare automatically
You become may be able to access for Medicare at 65 if you are a U.S. citizen or permanent resident who has lived in the country for at least five consecutive years. But may be able to access and enrollment are different things. You must sign up during your enrollment window, or you may face penalties and gaps in coverage. If you do not meet the citizenship or residency requirement, you cannot get Medicare based on age alone, though other paths may exist.
Some people under 65 can get Medicare too — those with end-stage renal disease, amyotrophic lateral sclerosis (ALS), or certain disabilities. But the age-65 rule is the most common entry point, and it applies only to people who meet the residency and citizenship tests.
Key Takeaways
- You must be a U.S. citizen or permanent resident who has lived in the country for five consecutive years to get Medicare at 65.
- Turning 65 does not enroll you automatically — you must sign up during your initial enrollment window or face late penalties.
- If you are still working and have employer health insurance, you may delay Part B enrollment without penalty, but you must notify Social Security.
- Non-citizens and people who do not meet the five-year residency requirement cannot get Medicare based on age, though they may have other coverage options.
Citizenship and residency requirements for Medicare at 65
To get Medicare when you turn 65, you must be a U.S. citizen or a permanent resident (green card holder). Permanent residents must have held that status for at least five consecutive years. The five years do not have to be when ready before you turn 65 — they can be any five years since you became a permanent resident.
If you are a citizen, you do not need to prove residency. If you are a permanent resident, you must show that you have lived in the United States for those five years. You will provide this documentation when you sign up, usually through Social Security.
How to enroll when you turn 65
Your initial enrollment window is seven months long: three months before the month you turn 65, the month you turn 65, and three months after. If you sign up during this window, your coverage starts either the month you turn 65 or the month after, depending on when you enroll.
You can enroll through Social Security in person, by phone at 1-800-772-1213, or online at ssa.gov. You will need your birth certificate, proof of citizenship or permanent residency, and proof of income. If you miss your initial window, you can still sign up later, but you will owe a permanent penalty on your Part B and Part D premiums — 10 percent for each 12-month period you were late.
When you can delay enrollment without penalty
If you are still working at 65 and have health insurance through your employer or your spouse's employer, you may delay Part B enrollment without penalty. This is called creditable coverage. You must have a group health plan based on current employment — retiree coverage does not count.
To use this exception, you do not have to enroll in Part B when you turn 65. Instead, you can wait until you retire or lose the employer coverage. When you do enroll, you have eight months from the date you lose coverage to sign up without penalty. You must tell Social Security that you have employer coverage so they know not to charge you a late fee.
People who cannot get Medicare at 65
Non-citizens who are not permanent residents cannot get Medicare based on age. This includes people on temporary visas, undocumented immigrants, and people in the process of explore for permanent residency. Some states offer Medicaid coverage to older adults regardless of immigration status, but this varies widely by location.
Permanent residents who have not lived in the United States for five consecutive years also cannot enroll. If you are in this situation, you may be able to get coverage through your state's Medicaid program, the Affordable Care Act marketplace, or employer insurance if you are still working. Contact your state health department or visit healthcare.gov to explore what is available in your state.
What happens if you miss your enrollment window
If you do not sign up during your initial enrollment window and you do not have creditable coverage, you will pay a permanent penalty. Your Part B premium increases by 10 percent for each 12-month period you were late. If you were supposed to enroll in 2020 and did not sign up until 2023, you would pay 30 percent more than the standard premium for the rest of your life.
The same penalty applies to Part D (prescription drug coverage). You can still enroll after your window closes, but the penalty stays with you. The only way to avoid the penalty is to show that you had creditable coverage during the time you were not enrolled in Medicare.
Medicare Part A versus Part B enrollment
Part A (hospital insurance) and Part B (medical insurance) have different enrollment rules. Most people do not pay a premium for Part A if they or their spouse paid Medicare taxes while working. You are enrolled in Part A automatically when you turn 65 if you are already receiving Social Security benefits. If you are not yet receiving benefits, you must sign up for Part A separately.
Part B requires a monthly premium and has the late-enrollment penalty if you miss your window. You must sign up for Part B during your initial enrollment window unless you have creditable coverage through an employer. Even if you do not need Part B right away, signing up protects you from penalties later.
Frequently Asked Questions
Do I have to sign up for Medicare the month I turn 65?
No. Your enrollment window is seven months long — three months before, the month of, and three months after your 65th birthday. You can sign up anytime during this period. Coverage will start either the month you turn 65 or the month after, depending on when you enroll.
What if I am a permanent resident but have not lived here for five years yet?
You cannot get Medicare at 65 until you have completed five consecutive years as a permanent resident. Once you reach that milestone, you can enroll. In the meantime, check whether your state offers Medicaid to older adults or whether you can purchase coverage through the Affordable Care Act marketplace.
Can I delay Part B if I am retired but have retiree health insurance from my old job?
No. Retiree coverage does not count as creditable coverage for Medicare purposes. You must enroll in Part B during your initial window or pay a late penalty. The exception applies only to health insurance based on current employment — yours or your spouse's.
What is the penalty for signing up late, and does it ever go away?
Your Part B premium increases by 10 percent for each 12-month period you were late. This penalty is permanent — it does not decrease or disappear after a certain time. The only exception is if you can prove you had creditable coverage during the months you were not enrolled.
Where do I go to sign up for Medicare?
You can sign up through Social Security by calling 1-800-772-1213, visiting a local Social Security office, or going online to ssa.gov. You will need your birth certificate, proof of citizenship or permanent residency, and information about your income and any current health coverage.