You can start Medicare at 65, but some people may have access to earlier

Medicare begins at age 65 for most people. If you were born on the first of the month, your coverage starts the month you turn 65. If you were born on any other day, coverage starts the first day of the month after you turn 65.

You do not have to wait until 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). People in these categories can start Medicare at any age.

If you are still working at 65 and have health coverage through your employer, you can delay Medicare without penalty. Your employer coverage remains primary, and you can enroll in Medicare later without facing higher premiums for waiting.

Key Takeaways

  • Medicare starts at age 65 for most people, with coverage beginning the month you turn 65 or the month after, depending on your birth date.
  • You can start Medicare before 65 if you have received SSDI for 24 months, have end-stage renal disease, or have been diagnosed with ALS.
  • If you have health coverage through your current employer at 65, you can delay Medicare enrollment without penalty as long as you are actively working.
  • You must enroll in Medicare during your initial enrollment period, which runs for seven months centered on your 65th birthday month, or face permanent premium increases.

What happens if you are under 65 and lose your job

If you lose employer coverage before 65, you have options. You can continue your employer plan through COBRA for up to 18 months, though you will pay the full premium yourself. You can also buy a plan on the health insurance marketplace, where you may receive subsidies based on your income.

You cannot start Medicare before 65 just because you are uninsured or unemployed. The only exceptions are the three categories listed above: 24 months on SSDI, ESRD, or ALS. If you do not fall into one of those groups, you will need to use COBRA, the marketplace, or Medicaid (if your state offers it and you meet income limits) until you reach 65.

Your initial enrollment period and why it matters

Your initial enrollment period is a seven-month window: three months before the month you turn 65, the month you turn 65, and three months after. If you enroll during this window, your coverage starts on the first day of your 65th birthday month (or the month after, depending on your birth date).

If you miss this window and do not have a valid reason to delay, you will pay a permanent penalty on your Part B premium for as long as you have Medicare. The penalty is 10 percent of the standard Part B premium for each full 12 months you were may be able to access but not enrolled. This penalty does not go away.

The main valid reason to delay without penalty is having health coverage through a current employer. If you are still working and covered by your employer's plan, you can enroll in Medicare after you retire or lose that coverage, as long as you enroll within eight months of losing the employer coverage.

How to enroll when you turn 65

You can enroll through Medicare.gov, by phone at 1-800-MEDICARE, or in person at your local Social Security office. You will need your Social Security number and information about any current health coverage.

If you are already receiving Social Security benefits, Medicare will contact you automatically about three months before you turn 65. You can accept the default enrollment or make changes during your initial enrollment period. If you are not yet receiving Social Security, you will need to contact Medicare directly to enroll.

Enrollment takes about 15 minutes online. You will choose between Original Medicare (Part A and Part B) and Medicare Advantage, and decide whether to add prescription drug coverage (Part D) and supplemental coverage. These choices do not have to be final — you can make changes during the annual enrollment period from October 15 to December 7.

What Medicare costs at 65

Part A (hospital insurance) is free for most people at 65 if you or your spouse paid Medicare taxes for at least 10 years. Part B (medical insurance) costs a monthly premium, which varies by income. In 2024, the standard Part B premium is $164.90 per month, but higher earners pay more.

If you choose Medicare Advantage instead of Original Medicare, you typically pay a lower or zero premium, but you will have a network of doctors and may pay more out of pocket when you use care. Prescription drug coverage (Part D) costs extra and varies by plan.

You can compare plans and costs on Medicare.gov before you enroll. The site shows you what each plan covers and what you would pay for the services you use most often.

Special situations: disability, ESRD, and ALS

If you have been receiving SSDI for 24 months, you become may be able to access for Medicare at any age. The 24 months do not have to be consecutive — they can be spread across your time on SSDI. Once you reach 65, you transition from SSDI to regular Social Security retirement benefits, but your Medicare coverage continues without change.

If you have end-stage renal disease (ESRD), you can start Medicare as soon as your condition is diagnosed and you begin dialysis or receive a transplant. You remain on Medicare for at least 36 months after a transplant, even if the transplant fails and you return to dialysis.

If you have been diagnosed with amyotrophic lateral sclerosis (ALS), you can start Medicare when ready without waiting for any other condition or time period. You do not need to be on SSDI first.

What to do before you turn 65

Start planning about three months before your 65th birthday. If you are still working, decide whether you will keep your employer coverage or switch to Medicare. If you are retiring, gather information about your current coverage and any prescriptions you take regularly.

Visit Medicare.gov and use the plan finder tool to see what Medicare Advantage and Original Medicare plans are available in your area. The tool shows you costs, coverage, and which doctors and pharmacies are in each plan's network.

If you have questions about your specific situation, call 1-800-MEDICARE. Representatives can answer questions about enrollment, costs, and coverage. You can also visit your local Social Security office in person.

Frequently Asked Questions

Can I delay Medicare past 65 if I am still working?

Yes, if you have health coverage through your current employer. You can delay Part B without penalty as long as you are actively working and covered by the employer plan. You must enroll within eight months of retiring or losing that coverage to avoid a permanent penalty.

What if I miss my initial enrollment period?

You can still enroll, but you will pay a permanent penalty on your Part B premium unless you have a valid reason for the delay, such as employer coverage. The penalty is 10 percent of the standard Part B premium for each full 12 months you were may be able to access but not enrolled.

Do I have to choose between Original Medicare and Medicare Advantage?

Yes, you choose one or the other when you enroll. You can switch between them during the annual enrollment period (October 15 to December 7) each year, so your choice at 65 is not permanent.

What if I am on disability but not yet 65?

If you have been receiving SSDI for 24 months, you can start Medicare at any age. The 24 months do not have to be consecutive. Once you turn 65, you move from SSDI to regular Social Security retirement benefits, but your Medicare coverage stays the same.

Can I enroll in Medicare before my 65th birthday month?

You can enroll starting three months before the month you turn 65. Your initial enrollment period runs for seven months total: three months before, the month you turn 65, and three months after. Enrolling early ensures your coverage starts on time.