Medicare starts at 65 for most people

You become may be able to access for Medicare at age 65, regardless of your work history or income. This is the standard age set by federal law. You do not have to be retired to sign up — you can still be working — but you must be a U.S. citizen or permanent resident who has lived in the country for at least five years.

The month you turn 65, you can enroll in Medicare Part A (hospital insurance) and Part B (medical insurance). If you miss the enrollment window around your 65th birthday, you may face a permanent penalty on your Part B premiums, so timing matters even if you do not plan to use the coverage right away.

Some people become may be able to access before 65 under specific circumstances. If you have received Social Security Disability Insurance (SSDI) for 24 months, you become may be able to access at any age. If you have end-stage renal disease (ESRD) or amyotrophic lateral sclerosis (ALS), you may be may be able to access regardless of age. These are the only exceptions to the 65-year rule.

Key Takeaways

  • The standard Medicare age is 65, and you can enroll in the three months before your birthday, the month of your birthday, or the three months after.
  • You do not have to be retired to sign up for Medicare at 65, but delaying enrollment past your initial window can result in permanent premium increases.
  • If you have been on SSDI for 24 months, you become may be able to access for Medicare before age 65.
  • Permanent residents and citizens who have lived in the U.S. for at least five years are the only non-citizens who can enroll.

What happens if you are still working at 65

Working past 65 does not delay your Medicare enrollment. You can sign up at 65 even if you are employed full-time and still receiving a paycheck. Your work status has no bearing on your may be able to access or your ability to enroll.

However, if your employer has 20 or more employees and offers group health insurance, you may want to delay enrolling in Medicare Part B (the medical insurance portion). If you stay on your employer's plan instead, you can enroll in Part B later without penalty — but you must enroll within eight months of leaving that job or losing the coverage. Part A (hospital insurance) has no such grace period, so most people enroll in Part A at 65 even if they skip Part B.

Enrollment important date and penalties for missing them

Your initial enrollment period runs for seven months: the three months before you turn 65, the month you turn 65, and the three months after. If you enroll during this window, your coverage typically begins on the first day of the month you turn 65 or the first day of the following month, depending on when you sign up.

If you miss this window and do not have may have access to coverage (such as an employer plan with 20+ employees), you will pay a permanent 10 percent increase on your Part B premium for each full year you were may be able to access but did not enroll. This penalty stays with you for life, even after you eventually sign up. Part A has a similar penalty: 10 percent for each year of delay.

The only way to avoid these penalties after missing your initial window is to have had creditable coverage — usually an employer plan or TRICARE — during the time you were may be able to access. If you did, you can enroll in a general enrollment period (January 1 through March 31 each year) without penalty.

How to sign up for Medicare

You can enroll through three routes: online at Medicare.gov, by phone at 1-800-MEDICARE, or in person at your local Social Security office. You will need your Social Security number, proof of citizenship or permanent residency, and information about any current health coverage you have.

If you are already receiving Social Security benefits, you may be enrolled automatically in Part A and Part B. Check your Social Security account or call Social Security to confirm. If you are not yet receiving benefits, you will need to enroll in Medicare separately.

The enrollment process itself takes about 15 minutes online or over the phone. Once you enroll, you will receive your Medicare card in the mail within two to three weeks. Your coverage can begin as early as the first day of the month you turn 65.

Medicare coverage types and what each covers

Part A covers hospital stays, skilled nursing facility care, hospice, and some home health services. Most people do not pay a monthly premium for Part A if they or their spouse paid Medicare taxes for at least 10 years. If you do not meet this requirement, you can still enroll and pay a monthly premium.

Part B covers doctor visits, outpatient care, medical equipment, and preventive services. Part B has a monthly premium that increases each year. In 2024, the standard premium is $164.90 per month, though higher earners pay more through an income-related adjustment.

Part D is prescription drug coverage. You can enroll in Part D when you turn 65, and it is offered through private insurance companies. If you do not enroll when you first become may be able to access and later sign up, you may pay a permanent penalty unless you had other creditable drug coverage.

Part C (Medicare Advantage) is an alternative to Original Medicare (Parts A and B). It is offered by private insurers and often includes prescription drug coverage and extra benefits like dental or vision. You can switch between Original Medicare and Part C during the annual enrollment period.

Special cases: disability and end-stage renal disease

If you have been receiving SSDI for 24 consecutive months, you become may be able to access for Medicare automatically at that point, regardless of your age. You do not need to turn 65. Your Medicare coverage begins the 25th month of your SSDI benefits.

If you have end-stage renal disease (ESRD) — permanent kidney failure requiring dialysis or transplant — you become may be able to access for Medicare when ready upon diagnosis or the start of treatment, regardless of age. The same applies if you have amyotrophic lateral sclerosis (ALS). These are the only medical conditions that override the age requirement.

If you fall into either of these categories, you will be contacted by Social Security or your healthcare provider about enrolling in Medicare. You should still verify your enrollment to may support your coverage begins on time.

Frequently Asked Questions

Can I enroll in Medicare before I turn 65?

No, unless you have SSDI for 24 months, ESRD, or ALS. For everyone else, enrollment begins three months before your 65th birthday. You can sign up during that three-month window, during the month you turn 65, or for three months after your birthday without penalty.

What if I am still working and have health insurance through my job?

You can enroll in Medicare Part A at 65 without affecting your employer coverage. For Part B, if your employer has 20 or more employees, you can delay enrollment and sign up later within eight months of leaving the job without penalty. Check with your employer's benefits office about how Medicare and your plan interact.

Do I have to enroll in all parts of Medicare?

Part A and Part B are separate decisions. You can enroll in Part A only and delay Part B if you have employer coverage. Part D (prescription drugs) and Part C (Medicare Advantage) are optional. However, delaying any of these past your initial window may result in permanent penalties.

What happens if I miss the enrollment important date?

You will pay a 10 percent permanent increase on your Part B and Part A premiums for each year you were may be able to access but did not enroll. This penalty applies for life. You can still enroll during the general enrollment period (January through March), but the penalty will remain unless you had creditable coverage during the time you were may be able to access.

Can non-citizens enroll in Medicare at 65?

Permanent residents and citizens who have lived in the U.S. for at least five years can enroll at 65. Temporary visa holders and undocumented immigrants are not may be able to access for Medicare, regardless of age.