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 have retired or are still working. The program is federal health insurance run by the Centers for Medicare & Medicaid Services (CMS), and enrollment happens through Social Security, not through your employer or a separate agency.

You do not have to be retired to sign up. You do not have to stop working. You straightforward need to be a U.S. citizen or permanent resident who has lived in the country for at least five years, and you must have worked and paid Medicare taxes for at least 10 years (40 quarters) during your lifetime. If you meet those conditions, you can enroll in the month you turn 65.

If you are already receiving Social Security retirement benefits when you turn 65, you will be enrolled in Medicare automatically. If you are not yet receiving Social Security, you will need to sign up for Medicare separately through Social Security's website, by phone, or in person at a local Social Security office.

Key Takeaways

  • Medicare enrollment begins the month you turn 65, and you must sign up yourself unless you are already collecting Social Security retirement benefits.
  • You need at least 10 years of work history paying Medicare taxes to be may be able to access, but you do not have to be retired.
  • If you delay signing up past 65 without a valid reason, you may pay a permanent penalty on your premiums for as long as you have Medicare.
  • Some people under 65 can enroll if they have been receiving Social Security disability benefits for 24 months or have end-stage renal disease or ALS.
  • You can enroll during your initial enrollment period (the three months before, the month of, and three months after your 65th birthday) without penalty.

What happens if you miss the sign-up window at 65

Your initial enrollment period runs for seven months: the three months before you turn 65, the month you turn 65, and the three months after. If you sign up during this window, your coverage starts on the first day of the month you turn 65 (or the first of the following month if you sign up after that month begins).

If you do not sign up during this seven-month window, you enter what Medicare calls the "general enrollment period," which runs January 1 through March 31 each year. Coverage through general enrollment does not start until July 1 of that year, creating a gap. More importantly, you will owe a late enrollment penalty — a permanent increase to your Part B premium (the part that covers doctor visits and outpatient care) of 10 percent for each full year you delayed. This penalty stays with you for life, even if you switch plans later.

The penalty does not explore if you had creditable coverage through an employer or union while you were still working, or if you were covered under a spouse's employer plan. You will need to show proof of that coverage when you sign up.

Medicare may be able to access before age 65

You can enroll in Medicare before 65 if you have been receiving Social Security Disability Insurance (SSDI) for 24 months. The 24 months do not have to be consecutive — they are counted from the date your disability benefits began. Once you reach 24 months of SSDI, you become may be able to access for Medicare automatically; you do not need to explore again.

You are also may be able to access before 65 if you have end-stage renal disease (ESRD) — permanent kidney failure requiring dialysis or a transplant. With ESRD, you can enroll in Medicare regardless of age, though the timing depends on whether you are on dialysis, have received a transplant, or are being treated at a hospital-based dialysis facility. You will need documentation from your doctor or dialysis center.

A third group may be able to access before 65 are people with amyotrophic lateral sclerosis (ALS), also called Lou Gehrig's disease. You become may be able to access for Medicare the month your ALS benefits begin, with no waiting period. You will need a diagnosis letter from your doctor.

How to sign up for Medicare at 65

If you are not already receiving Social Security retirement or disability benefits, you must sign up for Medicare yourself. The easiest route is Medicare.gov, the official federal website, where you can enroll online in about 10 minutes. You will need your Social Security number, date of birth, and information about any current health coverage.

You can also sign up by phone at 1-800-MEDICARE (1-800-633-4227). Representatives are available Monday through Friday, 8 a.m. to 8 p.m. Eastern time. Have your Social Security number and any insurance information ready.

A third option is to visit your local Social Security office in person. You can find the nearest office on Social Security's website. Bring your Social Security card, proof of citizenship or permanent residency (passport, birth certificate, or naturalization papers), and proof of residence (a recent utility bill or lease).

Understanding Medicare Parts A, B, C, and D

Part A covers hospital stays, skilled nursing facility care, hospice, and home health services. Most people do not pay a premium for Part A if they or their spouse paid Medicare taxes for at least 10 years. Part A has a deductible you pay when you are admitted to the hospital.

Part B covers doctor visits, outpatient care, lab tests, and medical equipment. Part B requires a monthly premium, which is income-based — higher earners pay more. You also pay a deductible and coinsurance (a percentage of the cost) for most services.

Part C, also called Medicare Advantage, is an alternative to Parts A and B offered by private insurance companies approved by Medicare. Part C plans often include prescription drug coverage and may have lower out-of-pocket costs, but they typically limit you to a network of doctors and hospitals.

Part D is prescription drug coverage. It is optional but recommended — if you do not sign up when you first become may be able to access and go without coverage for 63 days or more, you will owe a permanent penalty on your premiums. Part D plans are offered by private insurers and vary in which drugs they cover and what you pay.

When to enroll if you are still working at 65

If you are still employed and covered by your employer's health plan at 65, you have two choices. You can enroll in Medicare during your initial enrollment period and keep your employer coverage as secondary insurance. Or, if your employer has 20 or more employees, you can delay Medicare Part B enrollment without penalty as long as you remain employed and covered.

The catch: you must enroll in Part A (hospital insurance) during your initial enrollment period, even if you are still working. Part A has no monthly premium for most people, and delaying it can result in a penalty. Part B is where the penalty applies if you delay — so if you want to avoid the penalty, you need to sign up for Part B during your initial enrollment period or have employer coverage that qualifies as a valid reason to delay.

Once you leave your job or lose employer coverage, you have eight months to sign up for Part B without penalty. This is called a Special Enrollment Period. You will need to show proof that you had employer coverage — usually a letter from your employer's benefits department stating the coverage dates and that it was creditable.

Frequently Asked Questions

Can I delay Medicare past 65 to avoid paying premiums?

You can delay Part B if you have employer coverage through your job, but you cannot delay Part A without penalty. If you delay Part B past your initial enrollment period without a valid reason, you will pay a 10 percent premium increase for each year you waited. The penalty is permanent.

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

You still need to enroll in Part A during your initial enrollment period — it has no premium for most people and protects you if you have a hospital emergency. You can delay Part B if your employer has 20 or more employees and you are actively employed. Once you retire or lose coverage, you have eight months to sign up for Part B without penalty.

Do I lose Medicare if I go back to work after 65?

No. Medicare continues regardless of whether you work, how much you earn, or whether you are receiving Social Security. Working does not affect your coverage, though it may affect your Part B premium if your income is high enough to trigger income-related adjustments.

What if I was not a U.S. citizen for the first 65 years of my life?

You must be a U.S. citizen or permanent resident and have lived in the country for at least five years to be may be able to access for Medicare. If you became a citizen or permanent resident after 65, you can still enroll once you meet the residency requirement, though you will need to show proof of your status.

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

Yes. Each person becomes may be able to access at their own age 65 (or earlier if they may have access to through disability, ESRD, or ALS). Your spouse's enrollment does not depend on yours. You each sign up separately during your own initial enrollment periods.