You become may be able to access for Medicare at age 65, regardless of income or work history

Medicare may be able to access begins the month you turn 65. You do not have to be retired, and you do not have to have worked a certain number of years—age 65 is the standard entry point for most people. The program is federal, so the age rule is the same everywhere in the United States.

However, some people become may be able to access before 65. If you have received Social Security Disability Insurance (SSDI) for 24 months, you become may be able to access at any age. If you have end-stage renal disease (ESRD)—permanent kidney failure requiring dialysis or transplant—you may be may be able to access when ready, regardless of age. If you have ALS (amyotrophic lateral sclerosis), you become may be able to access right away without waiting.

If you are already receiving Social Security retirement benefits when you turn 65, Medicare enrollment happens automatically. If you are not yet taking Social Security, you will need to sign up for Medicare separately.

Key Takeaways

  • Medicare begins at age 65 for most people, and you must sign up during your enrollment window or face late penalties.
  • You can become may be able to access before 65 if you receive SSDI for 24 months, have end-stage renal disease, or have ALS.
  • Your initial enrollment period is seven months long: three months before the month you turn 65, the month itself, and three months after.
  • If you miss your initial enrollment window and do not have other health coverage, you will pay a permanent penalty on your Part B and Part D premiums.
  • You can delay enrollment past 65 without penalty only if you have employer coverage or are a government employee with health benefits.

Your enrollment window: when to sign up

Medicare has a specific window for signing up, called your Initial Enrollment Period (IEP). It runs for seven months: three months before the month you turn 65, the month you turn 65, and three months after. For example, if you turn 65 in June, your window opens in March and closes in September.

You should sign up during this window even if you do not plan to use Medicare right away. Signing up is free, and delaying past your window can cost you money later. You can sign up online at Medicare.gov, by phone at 1-800-MEDICARE, or in person at your local Social Security office.

If you are already receiving Social Security retirement or disability benefits, Medicare enrollment is automatic—you do not have to do anything. You will receive your Medicare card in the mail about three months before your 65th birthday.

What happens if you miss your enrollment window

If you do not sign up during your Initial Enrollment Period and you do not have other may have access to coverage, you will owe a late enrollment penalty. This penalty is permanent and applies to both Part B (medical insurance) and Part D (prescription drug coverage).

The Part B penalty is 10 percent of the standard premium for each full year you were may be able to access but not enrolled. The Part D penalty is 1 percent of the national average premium for each month you were without coverage. These penalties stay on your account for as long as you have Medicare, even if you enroll years later.

The only way to avoid the penalty is to have creditable coverage—health insurance through your employer, your spouse's employer, TRICARE (military), the Veterans Administration, or certain other sources. If you have this coverage, you can delay Medicare without penalty. Once you lose that coverage, you have a two-month window to enroll without penalty.

Medicare Parts A, B, C, and D explained

Part A covers hospital stays, skilled nursing facility care, hospice, and some home health services. Most people do not pay a monthly premium for Part A if they or their spouse paid Medicare taxes for at least 10 years. Part A has a deductible you pay when you are admitted to the hospital.

Part B covers doctor visits, outpatient care, medical equipment, and preventive services. Part B has a monthly premium that varies by income. In 2024, the standard premium is $164.90 per month, but higher earners pay more. Part B also has a yearly deductible and a 20 percent coinsurance for most services.

Part C, also called Medicare Advantage, is an alternative to Original Medicare (Parts A and B). Private insurance companies offer Part C plans that bundle hospital and medical coverage, usually with a lower out-of-pocket maximum. Most Part C plans include prescription drug coverage. You must have Part A and Part B to enroll in Part C.

Part D covers prescription drugs. It is optional but recommended—if you do not enroll when you first become may be able to access and you go without coverage, you will owe a late penalty. Part D plans are offered by private insurance companies and vary by pharmacy network and drug formulary.

Retiring before 65: what to do about health coverage

If you retire before 65, you will have a gap in health coverage unless you plan ahead. You cannot enroll in Medicare until you turn 65, so you will need to bridge that time with another plan.

Your options include continuing your employer coverage through COBRA (if your employer had 20 or more employees), buying a plan through the Affordable Care Act marketplace at Healthcare.gov, or enrolling in Medicaid if your income is low enough. Some people use a combination—for example, COBRA for a year and then a marketplace plan for the remaining time until 65.

If you are married and your spouse is still working, you may be able to stay on their employer plan until you turn 65. Check with your spouse's benefits administrator about the rules for your specific plan.

Special situations: disability, ESRD, and ALS

If you receive Social Security Disability Insurance (SSDI), you become may be able to access for Medicare after you have been receiving benefits for 24 months. You do not have to wait until 65. Your enrollment is automatic—you will receive your Medicare card in the mail.

If you have end-stage renal disease (ESRD)—permanent kidney failure that requires dialysis or a transplant—you may be may be able to access for Medicare when ready, even if you are under 65 and not receiving SSDI. You will need to provide medical documentation of your condition. Contact Social Security or Medicare directly to start the process.

If you have been diagnosed with ALS (amyotrophic lateral sclerosis), you become may be able to access for Medicare right away without the usual waiting periods. Like ESRD, you will need medical documentation. Social Security will help you enroll.

Income-related premiums and how they work

If your income is above a certain threshold, you will pay higher premiums for Part B and Part D. These are called Income-Related Monthly Adjustment Amounts (IRMAA). Medicare uses your tax return from two years prior to calculate your income, so there is a lag between when your income changes and when your premiums adjust.

For 2024, the income thresholds start at $97,000 for single filers and $194,000 for married couples filing jointly. If you earn above these amounts, your Part B and Part D premiums increase. The higher your income, the higher the adjustment. If your income drops—for example, because you retired or had a major life change—you can request that Medicare recalculate your premiums using your current year income.

You will receive a notice each year showing your IRMAA calculation. If you disagree with the income figure Medicare used, you can appeal and provide updated tax documents.

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 have employer coverage. Once you leave that job or lose the coverage, you have two months to enroll in Part B without penalty. You should still enroll in Part A at 65 because it is usually free and has no penalty for delay.

What if I turn 65 in the middle of the month?

Your Medicare coverage begins on the first day of the month in which you turn 65, regardless of the date. If you turn 65 on June 15, your coverage starts June 1. Your enrollment window is still three months before, the month of, and three months after your birth month.

Do I have to enroll in Part D if I do not take prescription drugs?

You do not have to enroll, but if you go without coverage and later need prescriptions, you will owe a late penalty. The penalty is 1 percent of the national average Part D premium for each month you were without coverage. If you think you will never need prescriptions, you can decline, but it is usually safer to enroll in a low-cost plan to avoid the penalty.

What happens to my Medicare if I move to another state?

Medicare is federal, so your coverage works the same in every state. Your Part A and Part B coverage does not change. If you have a Part C or Part D plan, check whether it covers your new state—some plans are regional. You may need to switch plans during the annual enrollment period (October 15 to December 7) if your current plan does not serve your new location.

Can my spouse enroll in Medicare at a different age than me?

Yes. Each person becomes may be able to access at 65 (or earlier if they may have access to through disability, ESRD, or ALS). Your spouse's enrollment window is based on their birth month, not yours. You can enroll at different times and have separate Medicare accounts.