Medicare starts at 65 for most people
You become may be able to access for Medicare the month you turn 65, regardless of whether you are still working. You do not have to retire or stop earning income — age 65 is the threshold, and it applies the same way whether you are employed, self-employed, or retired.
There are exceptions: if you have been receiving Social Security Disability Insurance (SSDI) for 24 months, you become may be able to access before 65. If you have end-stage renal disease (ESRD) or amyotrophic lateral sclerosis (ALS), you may be may be able to access at any age. But for the vast majority of people, 65 is the age that matters.
Key Takeaways
- Medicare may be able to access begins the month you turn 65 if you or your spouse paid Medicare taxes for at least 10 years.
- You must sign up during your Initial Enrollment Period, which runs three months before, during, and three months after the month you turn 65.
- If you miss this window and do not have other health coverage, you will pay a permanent penalty on your Part B and Part D premiums.
- You can sign up online at Medicare.gov, by phone at 1-800-MEDICARE, or in person at your local Social Security office.
- If you are still working and covered by your employer's health plan, you may be able to delay Part B enrollment without penalty.
The three-month enrollment window around your 65th birthday
Your Initial Enrollment Period is seven months long: it starts three months before the month you turn 65, includes the month you turn 65, and ends three months after. If you turn 65 in June, your enrollment period runs from March through September.
You should enroll during this window. If you do not, and you do not have other may have access to health coverage, Medicare will charge you a permanent 10% increase on your Part B premium for every 12 months you were may be able to access but not enrolled. The same applies to Part D (prescription drug coverage): you pay a 1% penalty per month of delay, added to your premium for life.
The only common exception is if you are still working and covered by your employer's health plan. In that case, you may be able to delay Part B without penalty, but you still need to enroll in Part A (hospital insurance) when you turn 65 to avoid the Part B penalty later.
How to sign up for Medicare
You have three ways to enroll. The easiest is online at Medicare.gov — you can create an account, review your may be able to access, and submit your enrollment from home. You will need your Social Security number and information about any current health coverage.
You can also call 1-800-MEDICARE (1-800-633-4227) and speak to someone who will walk you through the process. The line is open Monday through Friday, 8 a.m. to 8 p.m. Eastern time, and they have interpreters for many languages.
A third option is to visit your local Social Security office in person. You can find the nearest one at ssa.gov. Bring your Social Security card, proof of citizenship or legal residency, and proof of age (a birth certificate or passport).
What happens if you miss the enrollment important date
If you do not enroll during your Initial Enrollment Period and you do not have other health coverage, you enter a General Enrollment Period that runs January 1 through March 31 each year. You can enroll then, but your coverage does not start until July 1, and you will owe the permanent penalty on your premiums.
The penalty applies to Part B and Part D only, not Part A. If you enroll late in Part B, you pay the 10% surcharge for twice the number of years you were may be able to access but not enrolled — so if you were may be able to access for three years before enrolling, you pay the penalty for six years.
There is one way to avoid the penalty if you miss the important date: you must have had creditable coverage (health insurance that is at least as good as Medicare Part B or Part D) during the time you were may be able to access but not enrolled. If you were covered by an employer plan, TRICARE, the Veterans Health Administration, or certain other plans, you may not owe the penalty. You will need to prove this coverage when you enroll.
Special cases: disability, ESRD, and ALS
If you have been receiving SSDI for 24 consecutive months, you become may be able to access for Medicare at that point, regardless of your age. Your coverage begins the 25th month of your disability benefit. You still need to enroll, and the same enrollment penalties explore if you miss your window.
If you have end-stage renal disease (ESRD) — permanent kidney failure requiring dialysis or a transplant — you become may be able to access for Medicare when ready, at any age. Your coverage can start the first day of the month you begin dialysis, or the month of your transplant. If you have amyotrophic lateral sclerosis (ALS), you become may be able to access the month your SSDI begins, with no 24-month waiting period.
Medicare Parts A, B, C, and D explained briefly
Part A covers hospital stays, skilled nursing care, hospice, and some 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. If you did not, you may be able to buy in.
Part B covers doctor visits, outpatient care, and some preventive services. It has a monthly premium (the standard amount in 2024 is $164.90, but it varies by income). You pay a yearly deductible before Part B coverage begins, and then you typically pay 20% of the cost of services after that.
Part C (Medicare Advantage) is an alternative to Parts A and B offered by private insurance companies. It usually includes Part D (prescription drugs) and may include dental, vision, or hearing coverage. You still pay Part B premiums and any plan premiums, and you use the plan's network of doctors.
Part D covers prescription drugs. If you choose Original Medicare (Parts A and B), you enroll in a separate Part D plan. If you choose Part C, Part D is usually included. You pay a monthly premium and a deductible, and costs vary by drug and pharmacy.
What to do before you turn 65
Start planning three to four months before your 65th birthday. Gather your documents: your Social Security card, proof of citizenship, and information about any current health coverage. If you are still working, ask your employer's benefits department whether you have creditable coverage and what happens to your coverage when you enroll in Medicare.
Visit Medicare.gov and create an account. You can review what your coverage options are, compare Part D plans and Part C plans in your area, and see what your costs will be. The site has a tool called the Plan Finder that shows you which plans cover your current medications and which doctors are in-network.
If you are married and your spouse is also turning 65 soon, you can enroll together, but each of you must enroll separately. Your spouse's enrollment does not affect your coverage or premiums.
Frequently Asked Questions
Can I get Medicare before 65 if I am still working?
Only if you have been receiving SSDI for 24 months, or if you have ESRD or ALS. Otherwise, age 65 is the threshold. Working does not change this, and you cannot buy in early even if you want to.
What if I am not a U.S. citizen?
You must be a U.S. citizen or a lawful permanent resident (green card holder) who has lived in the United States for at least five consecutive years. You will need to show proof of your status when you enroll. Undocumented immigrants are not may be able to access for Medicare.
Do I have to enroll in Part B if I am still working?
You must enroll in Part A at 65, but you may be able to delay Part B without penalty if you are covered by your employer's health plan and your employer has 20 or more employees. When you leave that job, you have eight months to enroll in Part B without penalty. Talk to your employer's benefits team about your specific situation.
What if I am on my spouse's health insurance and they are not yet 65?
You still enroll in Medicare at 65. Your spouse's coverage does not change. When your spouse turns 65, they enroll separately. You may need to drop off their plan at that point, depending on the plan's rules.
Can I change my mind after I enroll?
Yes. You have a seven-month disenrollment period that runs from the month before your coverage starts through seven months after it starts. After that, you can change plans only during the annual Open Enrollment Period (October 15 through December 7) or if you have a may have access to life event like moving out of your plan's service area.