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 are still working. The federal government enrolls you automatically if you are already receiving Social Security benefits. If you are not yet taking Social Security, you will need to sign up for Medicare yourself during your enrollment window, or you may face a penalty on your premiums later.
The enrollment process begins three months before the month you turn 65 and stays open for three months after. This seven-month window is called your Initial Enrollment Period. Missing this window does not prevent you from getting Medicare, but it can cost you more money each month for the rest of your life.
Key Takeaways
- Medicare may be able to access begins the month you turn 65, and you can enroll starting three months before that birthday.
- If you receive Social Security, Medicare enrollment happens automatically; if you do not, you must sign up yourself during your Initial Enrollment Period.
- Signing up late outside your Initial Enrollment Period triggers a permanent penalty added to your Part B and Part D premiums.
- Some people under 65 may be covered through Medicare if they receive Social Security Disability Insurance or have end-stage renal disease.
How the Initial Enrollment Period works
Your Initial Enrollment Period is a seven-month window centered on your 65th birthday month. It opens three months before you turn 65 and closes three months after. For example, if you turn 65 in June, you can enroll from March through September.
During this window, you can sign up for Medicare Part A (hospital insurance) and Part B (medical insurance) without penalty. You can also choose a Medicare Advantage plan or a Medigap supplemental plan if you want coverage beyond what Original Medicare provides. The coverage you choose during this period takes effect on the first day of the month you turn 65.
If you are still working and have health insurance through your employer, you may be able to delay Part B enrollment without penalty, but you must meet specific conditions. Talk to your employer's benefits office or call Medicare directly at 1-800-MEDICARE to understand whether your situation qualifies for a delay.
What happens if you miss your enrollment window
If you do not sign up for Part B during your Initial Enrollment Period, you will pay a late enrollment penalty for as long as you have Medicare. The penalty is 10 percent of the standard Part B premium for each full 12-month period you were not enrolled. If you wait two years to sign up, your premium goes up 20 percent permanently.
The same penalty applies to Part D (prescription drug coverage). If you go 63 days or longer without drug coverage and later sign up, you pay an extra amount each month based on how long you went without it. These penalties do not expire — they stay on your bill for life.
You can still sign up for Medicare after your Initial Enrollment Period ends, but only during the General Enrollment Period, which runs January 1 through March 31 each year. Coverage would not start until July 1 of that year, creating a gap in your protection.
Medicare before age 65: disability and kidney disease
You may be covered by Medicare before 65 if you receive Social Security Disability Insurance (SSDI) for at least 24 months. Once you have been on SSDI for two years, Medicare coverage begins automatically, even though you are under 65.
You are also covered by Medicare at any age if you have end-stage renal disease (permanent kidney failure requiring dialysis or a transplant) or ALS (amyotrophic lateral sclerosis, also called Lou Gehrig's disease). For kidney disease, coverage begins the month your dialysis treatments start or the month of your transplant. For ALS, coverage begins the month you are approved for SSDI.
If you fall into either of these categories, you still have an Initial Enrollment Period and the same late enrollment penalties explore. Contact Social Security or Medicare to confirm your enrollment status and avoid gaps in coverage.
Automatic enrollment through Social Security
If you are already receiving Social Security retirement or disability benefits when you turn 65, Medicare enrolls you automatically. You do not have to do anything. Your Medicare card will arrive in the mail about two weeks before your coverage starts.
Automatic enrollment covers Part A and Part B. You will receive Original Medicare unless you choose a different plan. If you want a Medicare Advantage plan or Medigap coverage instead, you must contact Medicare or an insurance company to switch during your Initial Enrollment Period.
Check your mail carefully when your Medicare card arrives. If you do not receive it within two weeks of your 65th birthday, call 1-800-MEDICARE to confirm your enrollment and request a replacement card.
How to sign up if you are not on Social Security
If you are not receiving Social Security benefits, you must sign up for Medicare yourself. You can enroll online at 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 proof of citizenship or legal residency.
Start the process at least one month before your 65th birthday to make sure your coverage begins on time. If you wait until the last day of your Initial Enrollment Period, there is a risk your process will not process in time, and your coverage will be delayed.
When you sign up, you will choose between Original Medicare (Part A and Part B) or a Medicare Advantage plan. You will also decide whether to add Part D prescription drug coverage. These choices affect your monthly costs and which doctors and pharmacies you can use, so review your options carefully before enrolling.
Working past 65 and Medicare enrollment
You can keep working after 65 and delay Medicare enrollment if you have health insurance through your current employer. This is called creditable coverage. If your employer has 20 or more employees, you can usually delay Part B without penalty.
However, you must still enroll in Part A (hospital insurance) at 65, even if you are working and have employer coverage. Part A is free for most people, and delaying it can result in a penalty. Part B is where the penalty applies if you delay without creditable coverage.
When you leave your job or your employer coverage ends, you have eight months to sign up for Part B without penalty. This is called a Special Enrollment Period. Keep documentation of your employer coverage dates so you can prove you were covered when you explore.
Frequently Asked Questions
Can I sign up for Medicare before I turn 65?
You can begin the enrollment process three months before your 65th birthday, but coverage does not start until the month you turn 65. Signing up early ensures your coverage begins on time and avoids gaps in protection.
What if I am still working at 65 and do not want Medicare yet?
If you have health insurance through your employer with 20 or more employees, you can delay Part B without penalty. You must still enroll in Part A at 65. When your employment ends, you have eight months to enroll in Part B without a late penalty.
Do I lose my current health insurance when Medicare starts?
You do not automatically lose employer coverage when you turn 65, but you should review both plans to see which works better for you. Some people keep employer coverage and delay Medicare; others switch to Medicare. Your employer's benefits office can explain your options.
What is the penalty for signing up late for Medicare?
For Part B, the penalty is 10 percent of the standard premium for each 12-month period you were not enrolled. For Part D, the penalty is based on how many months you went without coverage. Both penalties are permanent and added to your monthly bill for life.
Can I change my Medicare plan after I enroll?
Yes, during the Annual Enrollment Period (October 15 through December 7 each year), you can switch between Original Medicare and Medicare Advantage, or change your prescription drug plan. Changes take effect January 1 of the following year.