You become may be able to access for Medicare at age 65

Medicare may be able to access begins the month you turn 65, regardless of whether you are still working. You do not have to retire or stop earning income to sign up. The program is federal health insurance run by the Centers for Medicare & Medicaid Services (CMS), and it covers hospital stays, doctor visits, prescription drugs, and preventive care once you enroll.

Most people become may be able to access automatically if they have been paying Medicare taxes through their paychecks for at least 10 years (40 quarters of work). If you do not meet that work history requirement, you may still enroll at 65, but your premiums will be higher. Your spouse's work history can also count toward your may be able to access if you have been married for at least one year.

You can sign up for Medicare starting three months before the month you turn 65. The enrollment window runs from three months before through three months after your 65th birthday. If you miss this window and do not have other health coverage, you will face a permanent penalty on your premiums for as long as you have Medicare.

Key Takeaways

  • Medicare enrollment begins three months before you turn 65 and closes three months after, so you have a seven-month window to sign up without penalty.
  • You become may be able to access at 65 even if you are still working and earning income, and continuing to work does not delay your coverage.
  • Ten years of work history paying Medicare taxes (40 quarters) makes you may be able to access at no extra cost; without it, your premiums will be higher.
  • Missing the enrollment window results in a permanent increase to your premiums, so signing up on time matters even if you do not plan to use Medicare when ready.
  • Your spouse can use your work history to become may be able to access if you have been married for at least one year.

How the 10-year work history requirement works

Medicare is funded by payroll taxes, and you become may be able to access for free Part A (hospital insurance) if you or your spouse paid into the system for at least 40 quarters—roughly 10 years of work. A quarter counts if you earned a minimum amount that year; in 2024, that threshold is $1,630 per quarter, though the amount changes yearly. You do not need those 40 quarters to be consecutive, and work from decades ago counts.

If you have fewer than 40 quarters, you can still enroll in Medicare at 65, but you will pay a monthly premium for Part A instead of receiving it free. The premium is higher the fewer quarters you have. If you have 30 to 39 quarters, your premium is reduced; if you have fewer than 30, you pay the full amount. Your spouse's work history can fill the gap if they have 40 quarters and you have been married for at least one year.

Self-employed people and immigrants who worked abroad may have gaps in their U.S. work record. If your record is incomplete, the Social Security Administration can review your history and count any quarters you may have missed. You can request a statement of your earnings record online at ssa.gov or by calling Social Security at 1-800-772-1213.

What happens if you are still working at 65

You can enroll in Medicare at 65 even if you are employed full-time and earning a substantial income. Working does not delay your may be able to access or reduce your benefits. However, if your employer offers health insurance and you decline it to use Medicare instead, you may face a gap in coverage or higher out-of-pocket costs, because employer plans and Medicare do not always coordinate well.

If you are covered by an employer plan at 65, you can delay enrolling in Medicare Part B (doctor and outpatient care) without penalty, as long as the employer has 20 or more employees. This is called the employer coverage exception. Once you leave that job or lose the coverage, you have eight months to enroll in Part B without a penalty. If you do not enroll within that window, you will pay a permanent surcharge on your Part B premium.

Part A (hospital insurance) has no such exception—you should enroll at 65 even if you have employer coverage, because Part A is usually free and covers inpatient hospital stays that employer plans may not fully cover. Delaying Part A enrollment can result in a permanent premium increase if you later need it.

Early Medicare may be able to access for people under 65

Most people wait until 65, but you may become may be able to access earlier if you have been receiving Social Security Disability Insurance (SSDI) for 24 months. The 24-month waiting period begins the month your disability benefits start, not the month you applied. Once you reach that milestone, Medicare Part A and Part B begin automatically, even if you are younger than 65.

People with end-stage renal disease (ESRD) or amyotrophic lateral sclerosis (ALS) can enroll in Medicare when ready, without waiting for age 65 or the 24-month SSDI period. If you have either condition, contact Social Security or Medicare directly to begin the enrollment process.

If you are under 65 and do not fall into these categories, you cannot enroll in Medicare. You would need to purchase coverage through the Affordable Care Act marketplace, your employer, or another private plan until you reach 65.

Enrollment important date and penalties for missing them

Your initial enrollment period (IEP) runs for seven months: three months before the month you turn 65, the month you turn 65, and three months after. During this window, you can enroll in Part A and Part B without any penalty. If you miss this window, the consequences depend on which part you are late for.

If you do not enroll in Part B during your IEP and you do not have employer coverage, you will pay a permanent 10 percent surcharge on your Part B premium for each year you were may be able to access but not enrolled. This penalty stays with you for life. For example, if you turn 65 in January 2024 and do not enroll until January 2026, you owe a 20 percent penalty on your Part B premium forever.

Part A penalties are similar: if you do not enroll during your IEP and you do not have employer coverage, you pay a permanent 10 percent surcharge on your Part A premium. The only way to avoid these penalties is to enroll during your seven-month window or to have creditable coverage (employer insurance or TRICARE) that counts as a valid reason to delay.

How to enroll in Medicare at 65

You can enroll online at Medicare.gov, by phone at 1-800-MEDICARE (1-800-633-4227), or in person at your local Social Security office. Online enrollment through Medicare.gov is the fastest option and takes about 10 minutes. You will need your Social Security number, date of birth, and information about any current health coverage.

If you are already receiving Social Security benefits, you may be enrolled in Medicare automatically. Social Security sends you a notice in the mail about three months before you turn 65. If you do not receive this notice or if you are not yet receiving Social Security, you must enroll yourself.

After you enroll, Medicare sends you a Medicare card in the mail within two weeks. Your coverage typically begins on the first day of the month you turn 65, or the first day of the month after you enroll, whichever is later. Keep your Medicare card with you and show it to doctors and hospitals when you receive care.

Medicare Parts and what each covers at 65

Medicare has four parts, and understanding what each covers helps you decide which to enroll in. Part A covers inpatient hospital stays, skilled nursing facility care, hospice, and home health services. It is usually free if you have 40 quarters of work history. Part B covers doctor visits, outpatient care, lab tests, and preventive services. Part B requires a monthly premium, which in 2024 ranges from $174.70 to $560.50 depending on your income.

Part D is prescription drug coverage. It is optional but recommended if you take medications regularly; if you do not enroll when you turn 65 and later want it, you pay a permanent penalty. Part C, also called Medicare Advantage, is an alternative to Parts A and B offered by private insurers. It bundles hospital and doctor coverage and usually includes prescription drug coverage, but it has network restrictions and may have higher out-of-pocket costs.

Most people enroll in Part A and Part B at 65. Part D and Part C are optional choices you make during your enrollment period. You can change your Part C or Part D plan every year during the annual enrollment period (October 15 to December 7), but you cannot change your mind about Part A and Part B once you enroll.

Frequently Asked Questions

Do I have to enroll in Medicare at 65 if I have employer insurance?

If your employer has 20 or more employees and covers you under their health plan, you can delay Part B enrollment without penalty. However, you should still enroll in Part A at 65, because Part A is usually free and employer plans do not always cover hospital stays as well as Medicare does. Once you leave your job or lose coverage, you have eight months to enroll in Part B without a penalty.

What if I was not born in the United States?

You can become may be able to access for Medicare at 65 if you are a U.S. citizen or permanent resident and have 40 quarters of work history. Immigrants who worked abroad may have gaps in their U.S. record; Social Security can review your history and count any quarters you earned. Contact Social Security at 1-800-772-1213 to request a statement of your earnings record.

Can my spouse enroll in Medicare using my work history?

Yes. If you have 40 quarters of work history and have been married for at least one year, your spouse can use your record to become may be able to access for free Part A at 65, even if they have no work history of their own. Your spouse still needs to enroll separately and will have their own Medicare card and coverage.

What is the penalty for enrolling late in Part D?

If you do not enroll in Part D during your initial enrollment period and you go without creditable drug coverage, you pay a permanent penalty of about 1 percent of the national average Part D premium for each month you were may be able to access but not enrolled. This penalty is added to your Part D premium for as long as you have Medicare. For example, if you delay enrollment by one year, you owe roughly a 12 percent surcharge.

Do I lose Medicare if I move out of the United States?

Medicare generally does not cover care outside the United States, except in limited situations near the border (Canada and Mexico). If you move abroad permanently, you can keep your Medicare enrollment, but you will not be able to use it for routine care. You would need to purchase health insurance in your new country. Contact Medicare at 1-800-MEDICARE to discuss your situation before you move.