You can start Medicare at age 65, regardless of whether you have retired
Medicare may be able to access begins the month you turn 65, as long as you or your spouse paid Medicare taxes while working. You do not have to stop working to enroll. You do not have to be retired. The age requirement is the only requirement for most people — if you worked long enough to build up credits in the Social Security system, you are covered at 65.
There are two narrow exceptions. If you are under 65, you may be able to enroll if you have received Social Security disability benefits for 24 months, or if you have end-stage renal disease or ALS (amyotrophic lateral sclerosis). Otherwise, 65 is the standard entry point.
Your coverage can start as early as the first day of the month you turn 65, but only if you enroll during the right window. Missing that window costs you money in the form of late penalties that stay on your premiums for life.
Key Takeaways
- Medicare starts the month you turn 65 if you have enough work credits in the Social Security system, and you do not have to be retired to enroll.
- You must enroll during your Initial Enrollment Period, which runs three months before you turn 65, the month you turn 65, and three months after — a seven-month window.
- If you miss this window and do not have employer coverage, you pay a permanent 10 percent penalty on Part B premiums for each year you delayed.
- You can delay enrollment past 65 without penalty only if you or your spouse are still working and covered by an employer health plan.
- Part A (hospital insurance) is usually free at 65 if you paid Medicare taxes; Part B (medical insurance) costs a monthly premium that varies by income.
When your Initial Enrollment Period starts and ends
Your Initial Enrollment Period is a seven-month window: three months before the month you turn 65, the month you turn 65 itself, and three months after. If you turn 65 in June, your window opens in March and closes in September.
You must take action during this window to avoid penalties. Enrolling late — even by one month — triggers a permanent surcharge on your Part B premium. That penalty is 10 percent of the standard Part B premium for each 12 months you delayed, and it stays with you for life.
The only exception is if you or your spouse are still working and covered by an employer health plan. In that case, you can delay Part B enrollment without penalty as long as the employer coverage continues. Once that coverage ends, you have eight months to enroll in Medicare without triggering the late penalty. You must still enroll in Part A during your Initial Enrollment Period, even if you delay Part B.
How to enroll when you turn 65
You can enroll online through the Social Security website, by phone, or in person at a Social Security office. Online enrollment through Social Security is the fastest route — you can complete it from home without waiting for an appointment.
Call Social Security at 1-800-772-1213 if you prefer to enroll by phone. Have your Social Security number, birth date, and citizenship information ready. If you are enrolling in person, visit your local Social Security office; you can find the address on the Social Security website.
Medicare will send you a card in the mail after you enroll. It usually arrives within two to four weeks. Your coverage begins the first day of the month you turn 65, even if your card has not arrived yet.
Part A versus Part B and what each costs
Part A covers hospital stays, skilled nursing facility care, hospice, and home health services. Most people pay nothing for Part A at 65 because they or their spouse paid Medicare taxes for at least 40 quarters (10 years) while working. If you do not have 40 quarters of work history, you can buy Part A coverage, but the premium is higher.
Part B covers doctor visits, outpatient care, lab tests, and medical equipment. Part B requires a monthly premium. The standard premium in 2024 is $164.90 per month, but it is higher if your income is above certain thresholds. Higher-income beneficiaries pay an additional amount called an Income-Related Monthly Adjustment Amount (IRMAA).
You are not required to enroll in Part B at 65 if you have employer coverage through work. However, if you do not enroll when you first become may be able to access and you lose that employer coverage later, you will owe the late penalty unless you enroll within eight months of losing coverage.
What happens if you miss your enrollment window
If you do not enroll during your Initial Enrollment Period and you do not have employer coverage, you will pay a permanent penalty on Part B. The penalty is 10 percent of the standard Part B premium for each 12-month period you delayed. If you delayed for two years, your premium increases by 20 percent — permanently.
You can still enroll in Medicare after your Initial Enrollment Period ends, but the penalty applies when ready and never goes away. There is no way to remove it. The only way to avoid the penalty is to enroll during your seven-month window or to have employer coverage that qualifies you for a Special Enrollment Period.
If you realize you missed your window, contact Social Security as soon as possible. You can enroll during the General Enrollment Period, which runs January 1 through March 31 each year, with coverage starting July 1. This is slower than enrolling during your Initial Enrollment Period, and the penalty applies, but it stops the penalty from growing larger.
Special cases: disability, ESRD, and ALS
If you are under 65 and have received Social Security Disability Insurance (SSDI) benefits for 24 months, you become may be able to access for Medicare. Your coverage begins in the 25th month of receiving disability benefits. You do not have to wait until 65.
If you have end-stage renal disease (ESRD) — permanent kidney failure requiring dialysis or a transplant — you may be able to enroll in Medicare regardless of age. Coverage can begin as early as the first month of dialysis treatment or the month of a kidney transplant. You must enroll during your Initial Enrollment Period to avoid penalties, just as you would at 65.
If you have ALS (amyotrophic lateral sclerosis), you become may be able to access for Medicare when ready upon approval for Social Security Disability Insurance. You do not have to wait 24 months like other disability beneficiaries. Your coverage can begin the same month your disability benefits start.
Delaying Medicare past 65 if you are still working
If you or your spouse are still working and covered by an employer health plan, you can delay Part B enrollment past 65 without penalty. This is called a Special Enrollment Period. You must enroll in Part A during your Initial Enrollment Period, but you can wait on Part B.
Once your employer coverage ends — whether because you retire, leave the job, or the employer drops coverage — you have eight months to enroll in Part B without triggering the late penalty. After those eight months, the 10 percent permanent penalty applies for each year you delayed.
If you delay Part B, you should still enroll in Part A at 65. Part A is usually free, and it covers hospital care. Delaying Part A can also result in a penalty if you do not have employer coverage that qualifies as creditable coverage.
Frequently Asked Questions
Can I enroll in Medicare before I turn 65?
You can enroll up to three months before you turn 65, during your Initial Enrollment Period. You cannot enroll earlier than that unless you are under 65 and may have access to due to disability, ESRD, or ALS. If you are under 65 and do not may have access to under those conditions, you must wait until the month you turn 65 to begin the enrollment process.
What if I am still working at 65 and have health insurance through my job?
You can delay Part B enrollment without penalty as long as your employer coverage continues. You must still enroll in Part A during your Initial Enrollment Period. When your employer coverage ends, you have eight months to enroll in Part B without the late penalty. After eight months, a permanent 10 percent penalty applies for each year you delayed.
Do I have to enroll in both Part A and Part B?
Part A enrollment is automatic for most people at 65 if you have enough work credits. You can decline it, but you cannot re-enroll later without a penalty. Part B is optional, but if you do not enroll when first may be able to access and do not have employer coverage, you will pay a permanent penalty when you do enroll.
What if I turn 65 outside the United States?
You can still enroll in Medicare if you are a U.S. citizen or permanent resident, even if you are living abroad. Contact Social Security to enroll. Your coverage works in the U.S., but Medicare generally does not cover care received outside U.S. borders, except in limited cases near the border or on a cruise ship.
Can I change my mind after I enroll?
Yes, but only during certain windows. You have a limited time to disenroll from Part B if you enrolled during your Initial Enrollment Period. After that, you can only make changes during the Annual Enrollment Period (October 15 through December 7 each year), with changes taking effect January 1.