You become may be able to access for Medicare at age 65, with limited exceptions for younger people with disabilities or end-stage renal disease

Medicare may be able to access begins the month you turn 65 if you or your spouse has worked and paid Medicare taxes for at least 10 years. You do not have to retire to sign up — you can keep working and still enroll. The program has four parts: Part A covers hospital stays, Part B covers doctor visits and outpatient care, Part D covers prescription drugs, and Part C (Medicare Advantage) is an alternative way to get Parts A and B through a private insurer.

If you were born on the first of the month, your may be able to access begins the month before. Otherwise it begins the month of your birthday. You have a three-month window before and after your birthday month to sign up without penalty — this is called your Initial Enrollment Period. Missing this window can cost you permanently higher premiums.

Key Takeaways

  • Medicare starts the month you turn 65 if you or your spouse paid Medicare taxes for at least 10 years.
  • You can sign up during a three-month window around your 65th birthday without paying a late penalty.
  • Some people under 65 with disabilities or end-stage renal disease can enroll earlier.
  • If you are still working at 65 and have employer health insurance, you may be able to delay Part B enrollment without penalty.

Who can enroll before age 65

You can sign up for Medicare before 65 if you have been receiving Social Security Disability Insurance (SSDI) for 24 months. The 24 months do not have to be consecutive, but they must have occurred within a rolling window. Once you have been on SSDI for two years, Medicare becomes available automatically — you do not need to take any action, though you can choose to decline it.

You can also enroll if you have end-stage renal disease (ESRD) — permanent kidney failure requiring dialysis or transplant. ESRD may be able to access begins the month your doctor determines you need dialysis or have had a transplant, regardless of age. You have a three-month window to sign up, the same as people turning 65.

People with ALS (amyotrophic lateral sclerosis) can enroll when ready upon approval for SSDI, without waiting 24 months. This is the only condition with an exception to the two-year waiting period.

What happens if you miss your enrollment window

If you do not sign up during your three-month Initial Enrollment Period and you do not have a valid reason to delay, you will pay a permanent penalty on your Part B and Part D premiums. 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 with you for life, even if you enroll later. The only way to avoid them is to sign up during your Initial Enrollment Period or to have creditable coverage — health insurance through an employer or spouse's employer that is at least as good as Medicare. If you have creditable coverage, you can delay enrollment without penalty, but you must provide proof when you do enroll.

Delaying enrollment if you are still working

If you are 65 and still working, you may be able to delay Part B without penalty if your employer has 20 or more employees and you are enrolled in their health plan. This is called the Special Enrollment Period for group health plan coverage. You can delay Part B as long as you remain employed and covered by the employer plan.

Part A (hospital insurance) is different — you should still enroll in Part A at 65 even if you delay Part B, because Part A has no premium if you or your spouse paid Medicare taxes for 10 years. Delaying Part A can result in a penalty if you enroll later.

When you do leave your job or lose employer coverage, you have eight months to enroll in Part B without penalty. This is called your Special Enrollment Period, and it is separate from your Initial Enrollment Period.

How to sign up for Medicare

You can sign up online 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, proof of citizenship or legal residency, and information about any current health coverage.

If you are already receiving Social Security benefits, you will be enrolled in Part A and Part B automatically three months before the month you turn 65. You can decline Part B if you have employer coverage, but you must do so in writing. If you are not yet receiving Social Security, you must sign up for Medicare separately.

Medicare parts and what they cover at 65

Part A covers inpatient hospital care, skilled nursing facility care after a hospital stay, hospice care, and some home health services. There is no monthly premium if you paid Medicare taxes for 10 years, but you pay a deductible when you are admitted to the hospital.

Part B covers doctor visits, outpatient care, lab tests, imaging, and some preventive services. It has a monthly premium (the standard amount in 2024 is $164.90, but it varies by income) and an annual deductible. You also pay 20 percent of the cost of most services after you meet the deductible.

Part D covers prescription drugs and is optional. If you do not enroll when you are first may be able to access, you pay a penalty for each month you go without it. You choose a Part D plan from private insurers, and the premium and coverage vary by plan.

Part C (Medicare Advantage) is an alternative to Parts A and B offered by private insurers. It usually has lower premiums and out-of-pocket costs, but a smaller network of doctors. You must have Part A and Part B to enroll in Part C.

Income-related premiums and extra help

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). The thresholds change each year and depend on your modified adjusted gross income from two years prior.

If your income is low, you may be able to get help paying premiums and cost-sharing through Medicaid or the Medicare Savings Program. Each state runs these programs differently, so you will need to contact your state Medicaid office to learn what you may be able to access. You can also call 1-800-MEDICARE to find your state office.

Frequently Asked Questions

Do I have to retire to sign up for Medicare at 65?

No. You can continue working and enroll in Medicare at 65. If your employer has 20 or more employees and you are covered by their health plan, you can delay Part B without penalty, but you should still enroll in Part A.

What if I was born on the first of the month?

Your Medicare may be able to access begins the month before you turn 65. Your Initial Enrollment Period still runs three months before and after your birthday month, so you have the same window to sign up without penalty.

Can I change my mind after I enroll?

Yes, during your Initial Enrollment Period you can change or drop coverage. After that window closes, you can only make changes during the annual Open Enrollment Period (October 15 to December 7) or if you have a may have access to life event like losing employer coverage.

What if I do not have 10 years of work history?

If you do not have 10 years of Medicare tax payments yourself, you may be able to use your spouse's work history if you have been married for at least one year. If neither of you qualifies, you can still buy Part A at age 65, but the premium will be higher.

Does my spouse have to sign up at the same time?

No. Each person has their own Initial Enrollment Period based on their own birthday. Your spouse can sign up at a different time without affecting your coverage.