Medicare starts at 65 for most people

You can sign up for Medicare the month you turn 65, regardless of whether you are still working. The program does not require you to be retired. If your birthday falls on the first of the month, your coverage begins the month before. If your birthday is any other day, coverage starts the month of your birthday.

You have a window to sign up without penalty: you can enroll starting three months before the month you turn 65 and ending three months after. If you miss this window and do not have other health coverage, you will pay a permanent surcharge on your premiums for as long as you have Medicare.

Key Takeaways

  • You become may be able to access for Medicare at 65, and you can sign up during the seven-month window that starts three months before your 65th birthday.
  • If you are still working and have employer health insurance, you may be able to delay enrollment without penalty under certain conditions.
  • Some people under 65 can sign up if they have been receiving Social Security disability benefits for 24 months or have end-stage renal disease or ALS.
  • Signing up late without a valid reason results in a permanent 10 percent monthly increase to your Part B and Part D premiums.
  • You sign up through Medicare.gov, by phone at 1-800-MEDICARE, or in person at your local Social Security office.

Who can sign up before 65

Three groups of people under 65 can enroll in Medicare. The first group includes anyone who has been receiving Social Security Disability Insurance (SSDI) for at least 24 months. You do not need to wait until 65; you become may be able to access automatically after the 24-month waiting period ends.

The second group consists of people with end-stage renal disease (ESRD), which means permanent kidney failure requiring dialysis or a transplant. You can sign up when ready upon diagnosis, regardless of age. The third group includes people with amyotrophic lateral sclerosis (ALS). You become may be able to access the month your ALS diagnosis is made, with no waiting period.

How the enrollment window works and what happens if you miss it

Your Initial Enrollment Period (IEP) lasts seven months: three months before the month you turn 65, the month you turn 65, and three months after. You can sign up anytime during this window without penalty. If you enroll late—after those three months have passed—you will pay a permanent surcharge on Part B premiums of 10 percent for each full year you delayed.

The surcharge applies for as long as you have Medicare Part B. For example, if you were may be able to access at 65 but did not sign up until age 68, you would pay an extra 30 percent on your Part B premium forever. Part D (prescription drug coverage) carries a similar penalty: 1 percent of the national base premium for each month you delayed, also permanent.

The only way to avoid this penalty is to have had creditable coverage—health insurance through an employer, a spouse's employer, or certain other sources—during the time you were not enrolled in Medicare. If you had such coverage, you have an eight-month Special Enrollment Period after your coverage ends to sign up without penalty.

Delaying enrollment if you are still working

If you are still employed and covered by your employer's health plan, you may be able to delay Medicare Part B enrollment without penalty. This applies only if your employer has 20 or more employees. You must be actively working, not just receiving benefits from a former employer.

When you eventually leave your job or lose that coverage, you have eight months to sign up for Part B without penalty. You must sign up during this window; waiting longer will trigger the late-enrollment surcharge. Part A (hospital insurance) has different rules: if you are covered by an employer plan, you can usually delay Part A as well, but you should verify this with your employer's benefits office.

How to sign up for Medicare

You can sign up online at Medicare.gov, by calling 1-800-MEDICARE (1-800-633-4227), or by visiting your local Social Security office in person. Online enrollment through Medicare.gov is the fastest method and allows you to complete the process from home. The phone line has wait times, especially during peak enrollment periods, but representatives can answer questions and walk you through the process.

Social Security offices handle Medicare enrollment in person. Bring your Social Security card, proof of citizenship or legal residency, and proof of age. If you are signing up based on disability or ESRD, bring documentation of your condition. Processing typically takes two to four weeks after you submit your process.

What happens on your 65th birthday if you do nothing

If you are receiving Social Security benefits when you turn 65, you are automatically enrolled in Medicare Part A and Part B. You do not need to do anything; your coverage begins the month you turn 65. If you are not yet receiving Social Security, you must sign up yourself during your enrollment window, or you will face the late-enrollment penalty.

Automatic enrollment applies only to people already collecting Social Security. If you are still working and have not claimed benefits, you must actively enroll in Medicare to avoid penalties. Check your Social Security account online at ssa.gov to see whether you are receiving benefits.

Medicare Part A versus Part B and when each starts

Part A covers hospital stays, skilled nursing facility care, hospice, and some home health services. Part B covers doctor visits, outpatient care, and preventive services. You can enroll in Part A without Part B if you are still working and covered by an employer plan, but most people enroll in both at the same time.

Coverage for both parts begins on the first day of the month you turn 65 (or the first day of the month before, if your birthday is the first of the month). If you delay enrollment and later sign up, your coverage start date depends on when you enroll. Enrolling in January means coverage starts in March; enrolling in March means coverage starts in May. There is always a two-month lag between enrollment and coverage start.

Frequently Asked Questions

What if I turn 65 on the first day of the month?

Your Medicare coverage begins the month before your birthday. If you turn 65 on January 1, your coverage starts December 1. You should still enroll during your standard enrollment window (three months before through three months after your birthday) to may support there are no gaps.

Can I delay Medicare if I have a health savings account?

No. Once you turn 65, you cannot contribute to a Health Savings Account (HSA) anymore. If you are still working and covered by a high-deductible health plan with an HSA, you must choose: keep the HSA and delay Medicare, or enroll in Medicare and stop HSA contributions. Consult your employer's benefits office about the timing that works best for your situation.

What if I miss my enrollment window by a few months?

You can still sign up, but you will owe the late-enrollment penalty on Part B and Part D premiums. The penalty is permanent and applies for as long as you have Medicare. The only exception is if you had creditable coverage through an employer or other source during the time you were not enrolled.

Do I have to sign up for Part D when I turn 65?

You do not have to, but if you go without prescription drug coverage and later sign up, you will pay a penalty. If you do not take prescription medications, you may skip Part D enrollment, but you can sign up later during the annual enrollment period (October 15 to December 7) without penalty, as long as you do not go more than 63 days without coverage.

Can my spouse sign up for Medicare at a different age than me?

Yes. Each person signs up based on their own age. Your spouse becomes may be able to access at 65 regardless of your age. If your spouse is younger, they can stay on your employer plan or purchase individual coverage until they turn 65.