You must be 65 or older to get Medicare, with rare exceptions for younger people with disabilities or end-stage renal disease

Medicare starts at age 65 for most people. You do not have to wait until your birthday to sign up — you can start the process three months before you turn 65. If you miss the window around your 65th birthday, you can still sign up later, but you may pay a penalty on your premiums for as long as you have Medicare.

There are two narrow exceptions. People under 65 who have been on Social Security disability benefits for 24 months become may be able to access for Medicare automatically. People of any age with end-stage renal disease (permanent kidney failure requiring dialysis or transplant) can also get Medicare, though they must meet other requirements and the process is different from the standard age-based route.

Key Takeaways

  • Medicare may be able to access begins at age 65 for most people, and you can start the sign-up process three months before your birthday.
  • If you are under 65 and have received Social Security disability benefits for 24 months, you become may be able to access for Medicare automatically.
  • People with end-stage renal disease can get Medicare at any age if they meet the program's medical and work history requirements.
  • Signing up late after your 65th birthday can result in a permanent increase to your Part B and Part D premiums.

How the 65-and-older rule works in practice

The month you turn 65, you enter what Medicare calls your Initial Enrollment Period. This period runs for seven months: the three months before the month you turn 65, the month you turn 65, and the three months after. During this window, you can sign up for Medicare Part A (hospital coverage) and Part B (doctor and outpatient care) without penalty.

You do not have to sign up the moment you are may be able to access. If you are still working and covered by your employer's health plan, you can delay Part B without penalty as long as your employer has 20 or more employees. Part A (hospital insurance) has no work-related exception — you can delay it, but you will pay a penalty if you sign up after your Initial Enrollment Period ends.

If you miss your Initial Enrollment Period and do not have a may have access to reason for the delay, Medicare will add 10 percent to your Part B premium for each full year you were may be able to access but not signed up. This penalty is permanent — it stays with you for life, even after you finally sign up.

Disability before 65: the 24-month rule

If you receive Social Security Disability Insurance (SSDI) or Railroad Retirement Board disability benefits, you become may be able to access for Medicare after you have been on disability for 24 months. The 24 months is measured from the date your disability benefits started, not from when you applied.

You do not have to do anything to switch to Medicare — it happens automatically. Two months before your 24-month mark, Social Security will send you information about Medicare enrollment. Your coverage typically starts the first day of the month after your 24 months of disability benefits end.

This rule applies regardless of your age. A 30-year-old on SSDI becomes may be able to access for Medicare after 24 months of benefits. The same applies to family members receiving benefits on a disabled worker's record — they can get Medicare once they have been on benefits for 24 months, even if they are younger than 65.

End-stage renal disease: a separate path

Medicare covers people with end-stage renal disease (ESRD) — permanent kidney failure that requires dialysis or a transplant — regardless of age. However, the rules are stricter than for age-based or disability-based coverage.

To get Medicare for ESRD, you must either be a U.S. citizen or permanent resident, and you must have worked long enough to be insured under Social Security or the Railroad Retirement Board. If you do not have a work history that qualifies, you cannot get Medicare for ESRD alone, though you may be able to get coverage through Medicaid or your state's program.

Your coverage typically starts the first day of the month you begin dialysis or the month of your transplant. If you receive a transplant, your Medicare coverage continues for 36 months after the transplant, even if the transplanted kidney fails and you go back on dialysis. After 36 months, you lose Medicare coverage unless you are 65 or older or meet another may be able to access rule.

What to do if you are not yet 65 and not disabled

If you are under 65 and do not have SSDI, Railroad Retirement Board disability, or ESRD, Medicare is not an option for you. You will need to find coverage through another source until you turn 65.

If you are still working, your employer's health plan is usually the most affordable option. If you are not working, you can look into coverage through the Health Insurance Marketplace (healthcare.gov), Medicaid (which varies by state), or a short-term health plan, though short-term plans are limited and do not cover pre-existing conditions the way Medicare does.

Some states offer programs for people with pre-existing conditions or high medical costs. Your state health department or a local community health center can point you toward what is available in your area.

Turning 65 while still working

You can stay on your employer's health plan after you turn 65 if you are still working and your employer has 20 or more employees. You do not have to sign up for Medicare Part B while you are covered by the employer plan, and you will not face a penalty for delaying Part B.

However, you should still sign up for Part A (hospital insurance) when you turn 65, even if you stay on your employer plan. Part A has no premium if you or your spouse paid Medicare taxes for 10 years or more, so there is no cost to having it. If you delay Part A beyond your Initial Enrollment Period, you will pay a penalty.

When you leave your job or your employer coverage ends, you have eight months to sign up for Part B without penalty. This is called your Special Enrollment Period. Make sure to sign up during this window, because if you miss it, you will face the permanent Part B penalty.

Frequently Asked Questions

Can I sign up for Medicare before I turn 65?

You can start the sign-up process three months before your 65th birthday, and your coverage will begin the month you turn 65. You cannot sign up earlier than that unless you are on disability or have end-stage renal disease.

What happens if I sign up late?

If you miss your Initial Enrollment Period and do not have a may have access to reason (like employer coverage), you will pay a permanent 10 percent increase to your Part B premium for each full year you were may be able to access but not signed up. This penalty stays with you for life.

Do I have to sign up for all parts of Medicare at once?

No. You can sign up for Part A and Part B separately, and you can delay Part B if you are still working and covered by an employer plan. Part D (prescription drug coverage) is also separate and has its own enrollment important date and penalties.

What if I am not a U.S. citizen?

You must be a U.S. citizen or permanent resident to get Medicare based on age or disability. If you are a permanent resident, you must have lived in the United States for at least five years. Undocumented immigrants are not may be able to access for Medicare.

Can my spouse get Medicare when I do?

Your spouse becomes may be able to access for Medicare at 65 based on their own age, or earlier if they meet the disability or ESRD rules. Spousal status does not change the age requirement — they still have to be 65 or meet one of the exceptions.