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 program is federal health insurance run by the Centers for Medicare & Medicaid Services (CMS), and it covers hospital care, doctor visits, and prescription drugs through different parts you choose separately.
You do not have to retire to get Medicare, and you do not have to be poor. Age 65 is the threshold for nearly everyone born in the United States or a permanent resident who has lived here legally for at least five years. If you were born on the first of the month, your coverage begins the month before your 65th birthday.
Key Takeaways
- Medicare begins the month you turn 65, and you must sign up during your initial enrollment window or face permanent penalties on your premiums.
- 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 (doctor and outpatient care) costs a monthly premium that increases if you delay enrollment past 65 without other may have access to coverage.
- You can delay enrollment past 65 only if you are still employed and covered by your employer's health plan, or you will owe higher premiums for life.
- Signing up happens through Social Security, either online, by phone, or in person at your local office.
Part A and Part B: What you pay at 65
Part A covers hospital stays, skilled nursing, hospice, and some home health care. Most people pay nothing for Part A at 65 because they or their spouse paid Medicare taxes while working. You must have worked and paid these taxes for at least 10 years (40 quarters) to get free Part A. If you do not meet this requirement, you can buy Part A, but the monthly premium is higher the longer you wait.
Part B covers doctor visits, lab tests, imaging, and outpatient procedures. Part B has a monthly premium that changes each year. In 2024, the standard premium is $164.90 per month, but higher earners pay more through an income-related adjustment. If you delay Part B past 65 without other health coverage, your premium increases by 10 percent for each year you wait, and that penalty stays with you for life.
You enroll in Part A and Part B together during your initial enrollment period, which runs for seven months: three months before the month you turn 65, the month you turn 65, and three months after. Missing this window costs you money in higher premiums and possible coverage gaps.
When you can delay Medicare past 65
You can postpone Part B enrollment past 65 without penalty only if you are still working and covered by your employer's health plan. Your employer must have at least 20 employees for this exception to explore. When you finally leave that job or lose that coverage, you have eight months to sign up for Part B without the permanent penalty.
Part A has no penalty for delay if you have employer coverage, but you still should enroll during your initial period to avoid gaps. Once you turn 65, you are no longer covered by your employer's plan as your primary insurance, even if you are still working — Medicare becomes primary, and your employer plan becomes secondary.
If you are self-employed or work for a small employer with fewer than 20 employees, you cannot use that coverage as a reason to delay Part B. You must enroll at 65 or pay the penalty.
Part D and Part C: Prescription drugs and alternative plans
Part D is prescription drug coverage sold by private insurance companies under Medicare rules. It is not automatic — you choose a plan during your initial enrollment period or during the annual open enrollment in the fall. If you go without Part D coverage and later sign up, you pay a penalty of about 1 percent of the national average premium for each month you were uninsured, and that penalty is permanent.
Part C, also called Medicare Advantage, is an alternative to Original Medicare (Parts A and B). It is sold by private insurers and usually includes prescription drug coverage, dental, vision, and hearing benefits that Original Medicare does not cover. You can choose Part C instead of Part B during your initial enrollment period, but you cannot have both at the same time.
If you choose Original Medicare at 65, you can switch to Part C later during the annual open enrollment period. The reverse is also true — you can leave Part C and go back to Original Medicare, though you should enroll in a Part D plan at the same time to avoid the drug penalty.
How to sign up for Medicare at 65
You sign up through Social Security, not through Medicare directly. You can explore online at ssa.gov, call Social Security at 1-800-772-1213, or visit your local Social Security office in person. Social Security will ask for your birth certificate, proof of citizenship or legal residency, and your driver's license or state ID.
If you are already receiving Social Security retirement or disability benefits, you are automatically enrolled in Part A and Part B at 65. You will receive a Medicare card in the mail about two weeks before your 65th birthday. You still need to choose Part D and Part C (if you want it) separately — those do not happen automatically.
If you are not yet receiving Social Security benefits, you must contact Social Security to enroll in Medicare. Do this at least three months before you turn 65 so your coverage starts on time. If you miss your initial enrollment window, you can still sign up during the general enrollment period from January 1 to March 31 each year, but you will face higher premiums and possible coverage gaps.
Special cases: Before 65 and after 65
You may be able to get Medicare before 65 if you have been receiving Social Security disability benefits (SSDI) for 24 months, or if you have end-stage renal disease (ESRD) or ALS (amyotrophic lateral sclerosis). These are the only exceptions to the age 65 rule. You do not have to do anything — Medicare begins automatically after you meet the time requirement.
If you are 65 or older and have not yet signed up for Medicare, you can enroll during the general enrollment period from January 1 to March 31. Your coverage will begin on July 1 of that year. Late enrollment penalties explore unless you have a may have access to reason, such as employer coverage or recent immigration to the United States.
Income and Medicare premiums at 65
Your income affects what you pay for Part B and Part D. Medicare uses your tax return from two years before to calculate an income-related monthly adjustment amount (IRMAA). If your income is above certain thresholds, you pay higher premiums. For 2024, single filers earning more than $97,000 per year pay more for Part B, and married couples filing jointly earning more than $194,000 pay more.
These thresholds change each year, and they explore to your modified adjusted gross income, which includes tax-exempt interest. If your income drops significantly — because you retire, lose a job, or have a major life change — you can ask Social Security to recalculate your IRMAA based on your current year's income instead of the two-year-old return.
Frequently Asked Questions
Do I have to sign up for Medicare at exactly 65?
You have a seven-month window: three months before you turn 65, the month you turn 65, and three months after. If you miss this window and do not have employer coverage, you will pay higher premiums for Part B and Part D for the rest of your life. Sign up as soon as you can within that window.
What happens if I am still working at 65?
You must enroll in Part A and Part B at 65 even if you are still working. If your employer has 20 or more employees and covers you, you can delay Part B without penalty, but Part A should still be enrolled. Medicare becomes your primary insurance at 65 regardless of employment status.
Can I get Medicare before 65?
Only if you have received Social Security disability benefits for 24 months, or if you have end-stage renal disease or ALS. Otherwise, you must wait until 65. Medicare will begin automatically if you meet these conditions — you do not need to sign up separately.
What if I miss my enrollment window?
You can enroll during the general enrollment period from January 1 to March 31 each year, with coverage starting July 1. You will owe higher premiums for Part B and Part D unless you have a may have access to reason for the delay, such as employer coverage or recent legal residency.
Does my spouse get Medicare at 65 too?
Your spouse becomes may be able to access for Medicare at their own age 65, not yours. They must sign up separately during their own initial enrollment period. If your spouse is younger and not yet 65, they may be covered under your employer plan until they reach 65.