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. You do not have to wait until your birthday — you can sign up during the three months before you turn 65, the month you turn 65, or the three months after. If you miss that window, you may pay a penalty for as long as you have Medicare.

You can also sign up before 65 if you have been receiving Social Security Disability Insurance (SSDI) for 24 months, or if you have end-stage renal disease (ESRD) or amyotrophic lateral sclerosis (ALS). These routes have different timing rules and different enrollment windows.

If you are still working at 65 and have health coverage through your employer, you may be able to delay enrollment without penalty — but only if your employer has 20 or more employees. The rules are different for spouses and for people who worked for the federal government.

Key Takeaways

  • Most people become may be able to access for Medicare the month they turn 65, and you can enroll during the three months before or after that month.
  • If you have received SSDI for 24 months, you can sign up for Medicare before 65, and Medicare will begin the same month as your 25th month of disability payments.
  • People with end-stage renal disease or ALS can sign up for Medicare regardless of age, with enrollment windows that depend on when you start dialysis or receive your diagnosis.
  • Enrolling late without a valid reason usually means paying a higher premium for Part B for the rest of your life, so the enrollment window matters even if you do not need coverage right away.
  • If you have employer coverage and your employer has 20 or more employees, you can delay Medicare enrollment without penalty while you are still working.

Medicare at 65: The standard enrollment window

Your Initial Enrollment Period (IEP) is seven months long: the three months before the month you turn 65, the month itself, and the three months after. You can enroll in Part A (hospital insurance) and Part B (medical insurance) during any of those seven months. Enrollment is free and happens through Social Security, either online at ssa.gov, by phone at 1-800-772-1213, or in person at your local Social Security office.

If you turn 65 in March, for example, your window opens in December and closes in June. You do not have to enroll on your birthday — you can do it any time during those seven months. Coverage can start as early as the first day of the month you turn 65, depending on when you enroll.

If you miss your Initial Enrollment Period, you enter a General Enrollment Period that runs from January 1 to March 31 each year. Coverage would not start until July 1 of that year. You will also owe a penalty: Part B premiums increase by 10 percent for each full year you were may be able to access but not enrolled. That penalty stays with you permanently.

Signing up before 65 with a disability

If you receive SSDI, you become may be able to access for Medicare after you have been on disability for 24 months. You do not have to explore separately — Social Security will automatically enroll you in Part A and Part B. Your coverage begins the month after your 24th month of SSDI payments.

You can also sign up for Medicare if you receive Supplemental Security Income (SSI) and meet other conditions, though the timing is different. Contact Social Security to confirm your specific situation, since the rules depend on when your disability began and which program you are on.

If you are under 65 and on SSDI, you should receive a notice from Social Security about three months before your Medicare coverage starts. That notice will tell you what happens next and whether you need to take any action. Keep that notice — you will need it if you have questions later.

Medicare for end-stage renal disease and ALS

People with end-stage renal disease (ESRD) can sign up for Medicare at any age. If you start dialysis, your coverage can begin the first day of the month you start treatment, or the first day of the third month after you start, whichever comes first. If you receive a kidney transplant before starting dialysis, coverage can begin the first day of the month of your transplant.

People diagnosed with amyotrophic lateral sclerosis (ALS) can sign up for Medicare when ready upon diagnosis, regardless of age. Your coverage begins the first day of the month you are diagnosed. You do not have to wait for a waiting period the way SSDI recipients do.

For both ESRD and ALS, you should contact Social Security as soon as your condition is confirmed. Bring documentation from your doctor — a dialysis center report for ESRD, or a diagnosis letter for ALS. Social Security will walk you through enrollment.

Delaying Medicare if you have employer coverage

If you are still working at 65 and your employer has 20 or more employees, you can delay Part B enrollment without penalty. Your employer's health plan is considered primary, and Medicare is secondary. You can enroll in Part B later without paying the late-enrollment penalty.

Part A (hospital insurance) works differently. Even if you have employer coverage, you should enroll in Part A at 65 because it is usually free and covers hospital stays. Delaying Part A can result in a penalty.

When you leave your job or lose employer coverage, you have eight months to enroll in Part B without penalty. That eight-month window is called your Special Enrollment Period (SEP). You must enroll during this window or pay the penalty. Contact Social Security within that eight months to sign up.

Federal employees and railroad workers

If you worked for the federal government, your Medicare enrollment rules may be different. Federal employees are covered under the Federal Employees Health Benefits Program (FEHB), and some FEHB plans coordinate with Medicare differently than private employer plans do.

Railroad workers covered under the Railroad Retirement Act also have different rules. Contact the Railroad Retirement Board directly if this applies to you — do not assume standard Medicare rules will work the same way.

If you are unsure whether your employer coverage qualifies you to delay Part B, call Social Security at 1-800-772-1213 and ask. It is better to confirm before you miss your enrollment window.

What happens if you miss your enrollment window

If you do not enroll during your Initial Enrollment Period and you do not have a valid reason for the delay, you will pay a penalty. Your Part B premium increases by 10 percent for each full year you were may be able to access but not enrolled. That increase is permanent — it stays with you even after you finally enroll.

The only exceptions are if you had employer coverage with 20 or more employees, or if you were covered under TRICARE (military health coverage) or the Veterans Administration. These situations give you a Special Enrollment Period to enroll without penalty.

If you think you have a valid reason for enrolling late, contact Social Security and explain. They will review your situation, but the bar for avoiding the penalty is high. It is much simpler to enroll during your seven-month window.

Frequently Asked Questions

Can I sign up for Medicare before I turn 65?

Yes, if you have received SSDI for 24 months, or if you have end-stage renal disease or ALS. Otherwise, you must wait until the three months before you turn 65. Contact Social Security to confirm which category applies to you.

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

If your employer has 20 or more employees, you can delay Part B without penalty while you work. You should still enroll in Part A because it is usually free. When you leave your job, you have eight months to enroll in Part B.

Do I have to enroll on my 65th birthday?

No. Your enrollment window is seven months long — three months before, the month of, and three months after your 65th birthday. You can enroll any time during that window. Coverage can start as early as the first of the month you turn 65.

What is the penalty for enrolling late?

Your Part B premium increases by 10 percent for each full year you were may be able to access but did not enroll. That penalty is permanent. For example, if you were may be able to access at 65 but did not enroll until 67, you would pay 20 percent more for Part B for life.

How do I enroll in Medicare?

You can enroll through Social Security online at ssa.gov, by phone at 1-800-772-1213, or in person at your local Social Security office. Have your Social Security number and birth certificate ready. Enrollment is free.