You must be 65 years old to get Medicare, with limited 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 automatically receive it on your 65th birthday — you must take a step to enroll. The enrollment window opens three months before the month you turn 65 and closes three months after, giving you a seven-month window. If you miss this window, you may face a permanent penalty on your premiums.
Some people under 65 can get Medicare if they have been receiving Social Security Disability Insurance (SSDI) for 24 months, or if they have end-stage renal disease (ESRD) or amyotrophic lateral sclerosis (ALS). These are the only pathways to Medicare before 65.
Key Takeaways
- Medicare starts at age 65, and you must enroll during a seven-month window centered on your birthday or face a permanent premium increase.
- If you are still working at 65 and have health coverage through your employer, you may delay Medicare Part B without penalty, but you must still enroll in Part A.
- People under 65 with SSDI, ESRD, or ALS can get Medicare, but the process and timing differ from age-based enrollment.
- Your Medicare coverage begins on the first day of the month you turn 65, or the first day of the month after you meet the disability requirement.
How the enrollment window works and what happens if you miss it
Your initial enrollment period (IEP) 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 window opens in March and closes in September. During this time, you can enroll in Medicare Part A (hospital insurance) and Part B (medical insurance) without penalty.
If you do not enroll during this window, you will pay a permanent surcharge on Part B premiums for as long as you have Medicare. The penalty is 10 percent of the standard Part B premium for each full 12 months you were may be able to access but not enrolled. This penalty does not go away, even if you enroll later. The only exception is if you had creditable coverage (health insurance through an employer or union) and enroll within eight months of losing that coverage.
Part A (hospital insurance) has a different penalty structure. If you do not enroll when first may be able to access and you do not have creditable coverage, you pay a 10 percent surcharge on your Part A premium for twice the number of years you were may be able to access but not enrolled. This penalty also lasts for life.
Working past 65 and delaying Medicare Part B
If you are still working at 65 and your employer has 20 or more employees, you can delay enrolling in Medicare Part B without penalty. You must still enroll in Part A, but you can put off Part B until you retire or lose your employer coverage. This is called the special enrollment period for people with group health plan coverage.
When you do enroll in Part B after leaving your job, you have eight months from the date your coverage ends to sign up without penalty. You must take this step yourself — Medicare does not automatically enroll you. If you wait longer than eight months, the permanent Part B penalty applies.
Part A has no such delay option. You must enroll in Part A during your initial enrollment period, even if you are working and covered by an employer plan. However, if your employer plan is primary and Medicare is secondary, you will not pay Part A premiums while you remain employed and covered.
Medicare for people under 65 with disabilities
If you receive SSDI benefits, you become may be able to access for Medicare after you have been receiving those benefits for 24 consecutive months. Your Medicare coverage begins in the 25th month of receiving SSDI. You do not need to be any particular age — the 24-month waiting period is the only requirement.
The Social Security Administration handles this automatically. You do not need to enroll separately. About three months before your 25th month of SSDI, Social Security will send you information about your Medicare coverage and your options for Part B enrollment. You can choose to enroll in Part B or decline it, though declining may result in a penalty if you enroll later.
People with end-stage renal disease can get Medicare regardless of age if they need dialysis or a kidney transplant. People with ALS (Lou Gehrig's disease) can get Medicare when ready upon approval for SSDI, without waiting the usual 24 months. In both cases, your local Social Security office or the Social Security Administration website will explain the enrollment process specific to your situation.
When your coverage actually starts
If you enroll during your initial enrollment period, your coverage begins on the first day of the month you turn 65. If you turn 65 on any day other than the first of the month, your coverage still begins on the first of that month — not on your birthday itself.
If you enroll after your initial enrollment period ends, your coverage begins on the first day of the month after you enroll, or the first day of the month after the month you enroll, depending on when in the month you sign up. The exact timing depends on which month you enroll and how Social Security processes your request. When you enroll, ask for a specific start date in writing so you have confirmation.
How to enroll in Medicare
You can enroll through three routes: online at Medicare.gov, by phone at 1-800-MEDICARE (1-800-633-4227), or in person at your local Social Security office. Online enrollment is fastest — you can complete it in about 10 minutes if you have your Social Security number and information about any current health coverage.
By phone, a representative will walk you through the same questions and can answer questions about your specific situation. Wait times vary, but calling early in the week and before noon generally means shorter holds. In person, you can bring documents if you have questions about your work history or coverage, though most people do not need to.
You will need your Social Security number, birth date, citizenship or immigration status, and information about any health coverage you currently have through an employer or union. If you are self-employed or have coverage through a spouse's employer, bring details about that coverage as well.
Frequently Asked Questions
What if I turn 65 but am not yet receiving Social Security?
You can still enroll in Medicare at 65 even if you have not claimed Social Security retirement benefits. In fact, many people enroll in Medicare at 65 but delay claiming Social Security until 70 to receive a higher monthly benefit. Enroll in Medicare during your seven-month window regardless of your Social Security claiming decision.
Can I enroll in Medicare before I turn 65?
No, you cannot enroll before your initial enrollment period begins, which is three months before the month you turn 65. If you try to enroll earlier, the process will be rejected. Your enrollment window opens automatically three months before your 65th birthday.
What happens if I miss my enrollment window by just a few days?
A few days past the end of your window still counts as missing the important date. The permanent penalty applies. Your only way to avoid it is if you had creditable coverage through an employer or union and enroll within eight months of losing that coverage. Otherwise, the 10 percent Part B surcharge is permanent.
Do I have to enroll in Part B if I am still working?
If your employer has 20 or more employees and you are covered by their health plan, you can delay Part B enrollment without penalty. You must still enroll in Part A. When you retire or lose your employer coverage, you have eight months to enroll in Part B penalty-free.
How long does it take to process a Medicare enrollment?
Processing typically takes one to two weeks. Your Medicare card will arrive in the mail within two to four weeks of approval. If you need coverage to start on a specific date, enroll at least four weeks before that date. You can check the status of your process online at Medicare.gov or by calling 1-800-MEDICARE.