Medicare starts at age 65 for most people

You become may be able to access for Medicare the month you turn 65, regardless of whether you are still working. The program is federal health insurance run by the Centers for Medicare & Medicaid Services (CMS), and age 65 is the standard entry point for nearly all beneficiaries.

You do not have to retire to enroll. You do not have to stop working. You do not have to have paid a certain amount into Social Security. Reaching 65 is the main requirement — though a few exceptions exist for people under 65 who have specific conditions or circumstances.

Enrollment happens through Social Security, not through a hospital or doctor's office. You will need to contact Social Security directly or use their online portal to sign up during your enrollment window, which typically opens three months before the month you turn 65.

Key Takeaways

  • You become may be able to access for Medicare the month you turn 65, and you should enroll during the three-month window before that birthday.
  • Some people under 65 can enroll if they receive Social Security Disability Insurance (SSDI) for at least 24 months or have end-stage renal disease or ALS.
  • Delaying enrollment past your initial window can result in permanent premium penalties unless you have employer coverage or other may have access to circumstances.
  • Medicare has four parts — Part A (hospital), Part B (medical), Part D (prescription drugs), and Part C (Medicare Advantage) — and you choose which ones you need.

Who can enroll before age 65

Three groups of people under 65 may be may be able to access for Medicare. The largest group is people receiving Social Security Disability Insurance (SSDI) — if you have been on SSDI for 24 months, you automatically become may be able to access for Medicare, regardless of age. This can happen in your 30s, 40s, or 50s depending on when your disability was approved.

The second group includes people with end-stage renal disease (ESRD), which means permanent kidney failure requiring dialysis or a transplant. You can enroll in Medicare as soon as you start dialysis treatment or are scheduled for a kidney transplant, even if you are much younger than 65.

The third group is people with amyotrophic lateral sclerosis (ALS), also called Lou Gehrig's disease. You become may be able to access for Medicare when ready upon diagnosis, without waiting any length of time. This is the only condition with no waiting period.

How enrollment timing affects your costs

Your enrollment window opens three months before the month you turn 65 and closes three months after. If you enroll during this seven-month window, your coverage starts the month you turn 65 and you pay standard premiums with no penalty.

If you miss this window and do not have other health insurance through an employer or union, you will pay a late enrollment penalty for as long as you have Medicare. For Part B (medical insurance), the penalty is 10 percent of the standard premium for each full year you delayed. For Part D (prescription drugs), the penalty is 1 percent of the national average premium for each month you were late. These penalties do not go away — they stay on your account permanently.

The main exception is if you have creditable coverage through a current employer or union job. If you or your spouse is still working and covered by an employer plan, you can delay Medicare enrollment without penalty as long as you enroll within eight months of losing that coverage or retiring, whichever comes first.

Medicare Part A versus Part B and what you need to choose

Part A covers hospital stays, skilled nursing facility care, hospice, and home health services. Most people pay nothing for Part A premiums because they or their spouse paid Medicare taxes while working. Part A has a deductible you pay when you are admitted to the hospital, but no monthly premium for most beneficiaries.

Part B covers doctor visits, outpatient care, lab tests, and medical equipment. Part B has a monthly premium (the standard amount in 2024 is $164.90, though this changes yearly) and an annual deductible. You choose whether to enroll in Part B — it is not automatic. If you delay Part B without creditable coverage, you will owe the late penalty.

Most people enroll in both Part A and Part B. You can also choose Part C (Medicare Advantage), which is an alternative to Parts A and B offered by private insurance companies. Part C includes prescription drug coverage and often includes dental, vision, and hearing benefits that Original Medicare does not cover. If you choose Part C, you do not need separate Part D coverage.

What happens when you turn 65 while still employed

You can keep working past 65 and stay on your employer's health plan instead of enrolling in Medicare, as long as your employer has 20 or more employees. This is called creditable coverage, and it protects you from late enrollment penalties.

When you do retire or lose that employer coverage, you have eight months to enroll in Medicare without penalty. Tell your employer's benefits office that you are leaving, and they will tell you your coverage end date. Count eight months from that date and enroll in Medicare before that important date passes.

If your employer has fewer than 20 employees, Medicare becomes your primary insurance at 65, and your employer plan becomes secondary. You should still enroll in Medicare during your initial window to avoid penalties.

How to enroll and what documents you will need

You enroll through Social Security, not through Medicare directly. You can explore online at ssa.gov, call Social Security at 1-800-772-1213, or visit your local Social Security office in person. Have your Social Security number ready, along with your birth certificate or other proof of citizenship.

If you are already receiving Social Security benefits, you will be enrolled in Part A and Part B automatically the month you turn 65. You do not have to do anything. If you are not yet receiving Social Security, you must contact Social Security to enroll in Medicare — it does not happen automatically.

Enrollment takes about two weeks to process. Your Medicare card will arrive in the mail about two weeks after you enroll. Do not wait until your birthday month to explore — start the process three months before you turn 65 so your coverage is ready on your birthday.

Delaying Part B if you have employer coverage

If you are still working and covered by an employer plan at 65, you can delay Part B enrollment without penalty. You must enroll in Part A (hospital insurance) during your initial window, but you can skip Part B and enroll later when you retire.

When you do retire and lose employer coverage, you have eight months to enroll in Part B. Contact Social Security during this window to add Part B to your Medicare account. If you miss this eight-month important date, you will owe the late enrollment penalty for the rest of your life.

Part A has no late penalty, so you can delay it as well if you have creditable coverage. However, most people enroll in both Part A and Part B during their initial window to avoid any risk of missing important date.

Frequently Asked Questions

Can I enroll in Medicare before I turn 65?

Only if you receive SSDI for 24 months, have end-stage renal disease, or have ALS. Otherwise, you must wait until the month you turn 65. If you have one of these conditions, contact Social Security to see if you are may be able to access now.

What if I miss my enrollment window?

You can still enroll, but you will owe a late penalty on Part B and Part D for as long as you have Medicare. The penalty does not expire. The only way to avoid it is if you had creditable coverage through an employer or union job — then you have eight months after losing that coverage to enroll penalty-free.

Do I have to retire to enroll in Medicare?

No. You can enroll at 65 and keep working. If your employer has 20 or more employees and you stay on their health plan, you can delay Medicare enrollment without penalty as long as you enroll within eight months of retiring or losing that coverage.

Is Part B enrollment automatic at 65?

Only if you are already receiving Social Security benefits. If you are still working and not yet on Social Security, you must contact Social Security to enroll in Medicare — it will not happen automatically. You have a three-month window before and after your 65th birthday to avoid late penalties.

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

You can delay Part B if you have employer coverage, but you should still enroll in Part A during your initial window. When you retire, you have eight months to add Part B. If you miss that important date, you will owe the late penalty permanently.