Medicare starts at 65 for most people, but some younger people can get it too

You can enroll in Medicare when you turn 65, regardless of your work history or income. If you are already receiving Social Security retirement benefits, Medicare enrollment happens automatically. If you are not yet receiving Social Security, you will need to sign up for Medicare separately during your enrollment period.

Some people under 65 can also get Medicare. You may be covered if you have received Social Security Disability Insurance (SSDI) for 24 months, if you have end-stage renal disease (ESRD), or if you have been diagnosed with amyotrophic lateral sclerosis (ALS). These three groups do not have to wait until 65.

Key Takeaways

  • You become may be able to access for Medicare at age 65, and enrollment is automatic if you are already receiving Social Security retirement benefits.
  • If you are under 65 and receiving SSDI benefits, you become may be able to access for Medicare after 24 months on SSDI, regardless of your age.
  • People diagnosed with end-stage renal disease or ALS can get Medicare at any age without waiting for disability benefits to begin.
  • Your initial enrollment period lasts seven months and starts three months before the month you turn 65; missing it can result in permanent premium penalties.

How the 65-year-old age requirement works

Turning 65 is the standard threshold for Medicare. You do not need to have worked a certain number of years, and your income does not matter. If you are a U.S. citizen or permanent resident who has lived in the country for at least five consecutive years, you can enroll.

Your enrollment period begins three months before the month you turn 65 and ends three months after. For example, if you turn 65 in June, your enrollment period runs from March through September. During this time, you can sign up for Medicare Part A (hospital insurance) and Part B (medical insurance) without penalty.

If you miss your initial enrollment period, you can still enroll later, but you may face a permanent increase to your Part B premium. The penalty is 10 percent of the standard premium for each full year you delayed enrollment. This penalty stays with you for life, so enrolling on time matters.

Medicare for people under 65 with disabilities

If you have been receiving SSDI for 24 consecutive months, you become may be able to access for Medicare regardless of your age. The 24-month waiting period starts from the month you began receiving SSDI payments, not from the month you applied. Once those 24 months pass, Medicare enrollment is automatic.

You do not need to do anything to enroll—Social Security will transfer you to Medicare automatically in the month after your 24-month period ends. Your Medicare coverage will begin on the first day of that month. You will receive a Medicare card in the mail before your coverage starts.

Medicare for people with end-stage renal disease or ALS

Two medical conditions bypass the age and disability waiting period entirely. If you have end-stage renal disease (ESRD)—permanent kidney failure requiring dialysis or a transplant—you can get Medicare when ready, even if you are under 65 and not receiving disability benefits.

If you have been diagnosed with amyotrophic lateral sclerosis (ALS), commonly called Lou Gehrig's disease, you also become may be able to access for Medicare right away. Unlike ESRD, you do not have to wait for treatment to begin. A diagnosis alone qualifies you. You will need to provide medical documentation of your diagnosis when you enroll.

For both conditions, you will need to contact Social Security or Medicare directly to start the enrollment process. These are not automatic like SSDI-based coverage, so you have to take the first step yourself.

What happens if you are still working at 65

You can enroll in Medicare at 65 even if you are still working and covered by your employer's health plan. However, the timing of your enrollment affects your coverage and any penalties you might face later.

If your employer has 20 or more employees, your employer coverage is considered primary, and Medicare is secondary. You can delay enrolling in Part B without penalty as long as you remain covered by the employer plan. Once you leave that job or lose the coverage, you have eight months to enroll in Part B without penalty.

If your employer has fewer than 20 employees, Medicare becomes primary when ready at 65. In this case, you should enroll during your initial enrollment period to avoid penalties, even if you have other coverage.

Enrollment periods and important date

Your initial enrollment period is the seven-month window centered on your 65th birthday. It starts three months before and ends three months after the month you turn 65. This is the easiest time to enroll because there are no penalties for late enrollment during this window.

If you miss your initial enrollment period, you can enroll during the general enrollment period, which runs from January 1 through March 31 each year. Coverage begins July 1 of that year. However, you will pay a permanent 10 percent penalty on your Part B premium for each full year you delayed.

Some people may have access to for a special enrollment period, which allows enrollment outside the standard windows without penalty. You may may have access to if you lose employer coverage, move out of your plan's service area, or experience other may have access to life events. You have 63 days from the may have access to event to enroll.

How to enroll in Medicare

You can enroll online through Medicare.gov, by phone at 1-800-MEDICARE (1-800-633-4227), or in person at your local Social Security office. Online enrollment is the fastest option and takes about 10 minutes.

When you enroll, have your Social Security number, birth date, and citizenship information ready. If you are enrolling in Part B, you will also need information about any current health coverage you have, such as an employer plan or COBRA coverage.

If you are already receiving Social Security retirement or disability benefits, you do not need to do anything—Social Security will enroll you automatically. You will receive your Medicare card in the mail about two weeks before your coverage begins.

Frequently Asked Questions

Can I get Medicare before 65 if I am not disabled?

No, unless you have end-stage renal disease or ALS. These are the only conditions that allow Medicare coverage before 65 without a disability information. If you are under 65 and not disabled, you will need to wait until you turn 65 or until you have received SSDI for 24 months.

What if I turn 65 but am still working and do not want Medicare yet?

You can delay enrolling in Part B if your employer has 20 or more employees and you are covered by their health plan. You have eight months after you leave that job to enroll without penalty. However, you should still enroll in Part A (hospital insurance) at 65, as it has no premium and covers hospital stays.

Do I lose my employer coverage when I turn 65?

No. You can keep your employer coverage and Medicare at the same time. Your employer plan may be primary or secondary depending on the size of your employer. Contact your employer's benefits department to understand how your coverage will coordinate with Medicare.

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

You can still enroll during the general enrollment period (January 1 through March 31), but your coverage will not begin until July 1, and you will pay a permanent 10 percent penalty on your Part B premium. It is worth enrolling as soon as you realize you missed the important date rather than waiting longer.

How do I know if my SSDI 24-month period has ended?

Social Security will notify you by mail when you become may be able to access for Medicare. You do not need to track the months yourself. The notification will arrive before your coverage begins, and your Medicare card will follow shortly after.