You can sign up for Medicare at 65, or earlier if you have a disability or end-stage renal disease

Medicare may be able to access starts at age 65 for most people. If you are not yet 65, you may still be able to enroll if you have been receiving Social Security disability benefits for 24 months, or if you have end-stage renal disease (permanent kidney failure requiring dialysis or transplant) or ALS (amyotrophic lateral sclerosis). The enrollment window matters — sign up during the right period or you may face a permanent penalty on your premiums.

The month you turn 65, you enter your Initial Enrollment Period, which runs for seven months: three months before the month you turn 65, the month itself, and three months after. If you miss this window, you can still enroll, but you will pay more. For every 12 months you delay past 65 without coverage, your Part B premium increases by 10 percent for as long as you have Medicare.

Key Takeaways

  • You become may be able to access for Medicare the month you turn 65, and your enrollment window opens three months before that date.
  • If you are receiving Social Security disability benefits, you automatically move to Medicare at 65 with no action needed on your part.
  • People under 65 with end-stage renal disease or ALS can enroll in Medicare regardless of age.
  • Delaying enrollment past your Initial Enrollment Period costs you 10 percent more per year in Part B premiums for life.
  • You must be a U.S. citizen or permanent resident and have lived in the United States for at least five years to be may be able to access.

Automatic enrollment if you are already on Social Security

If you are receiving Social Security retirement or disability benefits when you turn 65, Medicare enrollment happens automatically. You do not need to do anything. Social Security will send you a Medicare card in the mail about three months before your 65th birthday. Check the card for accuracy — if your name, date of birth, or Social Security number is wrong, contact Social Security to correct it before you use it.

The same automatic process applies if you are receiving Railroad Retirement Board benefits. Your coverage begins on the first day of the month you turn 65, even if you have not yet received your Medicare card in the mail.

What to do if you are not yet on Social Security

If you are turning 65 but have not started Social Security, you must sign up for Medicare yourself. You can enroll online through Medicare.gov, by phone at 1-800-MEDICARE, or in person at your local Social Security office. The enrollment window is still seven months — three months before, the month of, and three months after your 65th birthday.

You will need your Social Security number and proof of citizenship or permanent residency (a birth certificate, passport, or naturalization papers work). Have this information ready before you call or visit. Enrollment takes about 15 minutes online or on the phone.

Medicare before 65: disability and kidney disease

You can enroll in Medicare before 65 if you have been receiving Social Security Disability Insurance (SSDI) for 24 months. The 24-month waiting period starts from the month Social Security approves your disability claim, not from when you applied. Once you have been on SSDI for two years, you move to Medicare automatically — no separate enrollment step is needed.

If you have end-stage renal disease, you can enroll in Medicare at any age. You must have permanent kidney failure that requires dialysis or a transplant, and a doctor must expect the condition to last at least 30 days. Contact Medicare directly at 1-800-MEDICARE to start the process, because this route does not go through Social Security.

People with ALS (Lou Gehrig's disease) can enroll in Medicare when ready upon diagnosis, without waiting for Social Security disability approval. You will need a letter from your doctor stating the diagnosis. This is the only condition that does not require a waiting period.

Citizenship and residency requirements

To be may be able to access for Medicare, you must be a U.S. citizen or a permanent resident (green card holder). If you are a permanent resident, you must have lived in the United States for at least five consecutive years. Time spent outside the country breaks the five-year clock — you have to start over.

Temporary visa holders, undocumented immigrants, and people who have not yet completed five years as a permanent resident cannot enroll in Medicare, even if they are 65 or older. If your residency status changes, contact Medicare to update your file.

What happens to your coverage when you turn 65

On the first day of the month you turn 65, your Medicare coverage begins — assuming you enrolled during your Initial Enrollment Period. If you were covered by an employer health plan, that coverage does not automatically end. You will need to notify your employer or your plan that you are now on Medicare and ask whether you should keep the employer coverage or drop it.

In most cases, you will drop employer coverage and use Medicare. However, if your employer has 20 or more employees, the employer plan may be primary (meaning it pays first), and Medicare pays second. Your employer's benefits office can tell you which applies to you. Do not assume — coordinating coverage incorrectly can leave you with unexpected bills.

Penalties for late enrollment

If you do not enroll during your seven-month Initial Enrollment Period, you will pay a permanent penalty. For Part B (doctor and outpatient care), the penalty is 10 percent of the standard premium for each 12-month period you were may be able to access but not enrolled. If you delay for three years, your premium goes up 30 percent — and that increase stays with you for life.

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. These penalties explore even if you eventually enroll, and they do not go away if you drop coverage and come back later.

There are narrow exceptions: if you were covered by an employer plan or union coverage when you turned 65, you may not owe a penalty if you enroll within eight months of losing that coverage. This is called a Special Enrollment Period. You must be able to prove you had that coverage. Keep your insurance cards and benefit statements as proof.

Frequently Asked Questions

What if I turn 65 but do not want Medicare yet?

You can delay enrollment if you are still working and covered by your employer's health plan. You will not face a penalty as long as your employer has 20 or more employees and you enroll within eight months of leaving that job or losing coverage. If your employer has fewer than 20 employees, you should enroll at 65 to avoid penalties.

Do I have to enroll in all parts of Medicare at 65?

No. Part A (hospital insurance) is usually free and most people enroll. Part B (doctor visits) costs a monthly premium and you can delay it if you have employer coverage. Part D (drug coverage) is optional but carries a penalty if you delay. Part C (Medicare Advantage) is an alternative to Parts A and B. Talk to your doctor or a Medicare counselor about which parts fit your situation.

Can I change my Medicare plan after I turn 65?

Yes, but only during specific windows. You have a seven-week window starting the day your Part B coverage begins. After that, you can make changes during the Annual Enrollment Period from October 15 to December 7 each year. Changes made during this period take effect January 1. Outside these windows, changes are limited to people with may have access to life events like moving or losing other coverage.

What if I am not a U.S. citizen but have a green card?

You can enroll in Medicare if you have been a permanent resident for at least five consecutive years. Time outside the United States breaks the five-year requirement. If you are unsure whether your time counts, contact Medicare at 1-800-MEDICARE with your green card and residency history.

Do I need to do anything if I am on disability and turning 65?

No. Your transition from disability benefits to Medicare happens automatically. You will receive a new Medicare card in the mail, but your coverage does not change and you do not need to take any action. Your benefits continue without interruption.