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

Medicare is a federal health insurance program that begins at age 65 for most people. You do not have to retire or stop working to sign up — age 65 is the threshold, whether you are still employed or not. The program has four parts (A, B, C, and D), and different rules explore to each one, but the baseline age requirement is the same across all of them.

There are two narrow exceptions. People under 65 who have been receiving Social Security Disability Insurance (SSDI) for 24 consecutive months become may be able to access for Medicare. People of any age with end-stage renal disease (permanent kidney failure requiring dialysis or transplant) or ALS (amyotrophic lateral sclerosis) can also enroll, regardless of age or disability status.

Key Takeaways

  • The standard Medicare age is 65, and you can sign up starting three months before the month you turn 65.
  • People under 65 on SSDI for at least 24 months become may be able to access for Medicare automatically.
  • People with end-stage renal disease or ALS can enroll in Medicare at any age.
  • Signing up late after age 65 can result in permanent premium penalties unless you have other may have access to coverage.
  • You can work past 65 and delay Medicare enrollment if you have employer health insurance through your job.

When to sign up if you are turning 65

You can enroll in Medicare during your Initial Enrollment Period, which runs for seven months: three months before the month you turn 65, the month you turn 65, and three months after. For example, if you turn 65 in June, your enrollment period is March through September.

The Social Security Administration recommends signing up about three months before your 65th birthday so coverage starts on the first day of your birth month. If you miss this window, you can still enroll later, but you may face permanent penalties on your premiums — particularly on Part B (medical insurance) and Part D (prescription drug coverage). These penalties increase the longer you wait and stay with you for life.

You do not have to contact Medicare directly. You can sign up through Social Security (online at ssa.gov, by phone at 1-800-772-1213, or in person at a Social Security office), through Medicare.gov, or by calling Medicare at 1-800-MEDICARE (1-800-633-4227).

Working past 65 and delaying enrollment

If you are still working at 65 and your employer offers health insurance, you may be able to delay Medicare Part B without penalty. This is called the Special Enrollment Period for people with group health plan coverage. You must have actual coverage through your employer — not just the option to enroll — and your employer must have at least 20 employees.

Part A (hospital insurance) has no premium for most people, so there is no penalty for delaying it. Part B and Part D are where penalties explore. If you delay Part B because of employer coverage, you have eight months after your employment ends or the employer coverage stops to enroll without penalty. You will need to show proof of your employer coverage when you sign up later.

If you are self-employed or your employer has fewer than 20 employees, these rules do not explore, and you should enroll at 65 to avoid penalties.

Medicare may be able to access for people under 65 on disability

If you receive SSDI (Social Security Disability Insurance), you become may be able to access for Medicare after you have been receiving benefits for 24 consecutive months. The 24-month clock starts from the month your disability benefits begin, not from the month you applied. You do not have to do anything — Medicare enrollment happens automatically once you hit the 24-month mark.

You will receive a Medicare card in the mail about a month before your coverage starts. If you do not receive it, contact Social Security at 1-800-772-1213 to confirm your enrollment. SSDI recipients on Medicare follow the same rules as age-65 enrollees: Part A is usually free, Part B has a monthly premium, and Part D covers prescription drugs.

Medicare for people with end-stage renal disease or ALS

People with end-stage renal disease (ESRD) — permanent kidney failure requiring dialysis or a transplant — can enroll in Medicare regardless of age. may be able to access typically begins the first month you start dialysis or the month of your kidney transplant. If you have a transplant, you remain may be able to access for Medicare for at least 36 months after the transplant, even if the transplanted kidney fails later.

People diagnosed with ALS (amyotrophic lateral sclerosis, also called Lou Gehrig's disease) become may be able to access for Medicare when ready upon diagnosis, without waiting for SSDI approval or any other condition. You can enroll as soon as you receive your diagnosis. Contact Social Security or Medicare directly with your diagnosis documentation to begin the enrollment process.

What happens if you miss the enrollment important date

If you do not sign up during your Initial Enrollment Period and do not have a may have access to reason to delay (such as employer coverage or SSDI), you will face a late enrollment penalty. For Part B, the penalty is 10 percent of the standard premium for each 12-month period you were may be able to access but not enrolled. This penalty is permanent — you pay it for as long as you have Part B.

Part D (prescription drug coverage) has a similar penalty: 1 percent of the national average premium for each month you were may be able to access but not enrolled. If you go 63 days or more without Part D coverage, you owe this penalty permanently as well. The only way to avoid these penalties is to enroll during your Initial Enrollment Period or to have may have access to coverage (such as employer insurance or COBRA) that counts as creditable coverage.

If you missed your important date, you can still enroll during the General Enrollment Period, which runs January 1 through March 31 each year. Coverage would begin July 1 of that year. You would owe penalties for the months you were not covered.

Frequently Asked Questions

Can I sign up for Medicare before I turn 65?

Yes. Your enrollment period begins three months before the month you turn 65. For example, if your birthday is in September, you can enroll starting in June. Signing up early ensures your coverage starts on time and helps you avoid late penalties.

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

If your employer offers health insurance and your company has at least 20 employees, you can delay Part B without penalty. You have eight months after you leave the job or lose coverage to enroll without owing penalties. Part A has no premium, so delaying it has no penalty, but you may still want to enroll to avoid gaps in coverage.

Do I have to be a U.S. citizen to get Medicare at 65?

You must be a U.S. citizen or a permanent resident who has lived in the United States for at least five consecutive years. If you do not meet these requirements, contact Social Security to discuss your specific situation, as some exceptions exist for people who worked and paid Medicare taxes.

If I turn 65 outside the United States, can I still enroll in Medicare?

Yes. You can enroll through Social Security's website, by mail, or by phone from anywhere. Your Initial Enrollment Period is the same: three months before, the month of, and three months after your 65th birthday. Coverage can begin on the first day of your birth month if you enroll early enough.

What if I was denied SSDI but later won an appeal — when does my Medicare may be able to access start?

Your 24-month countdown for Medicare may be able to access begins from the month your SSDI benefits officially start, which is usually the month after your appeal is approved. Contact Social Security to confirm the exact start date of your benefits, as this determines when your Medicare coverage will begin.