Medicare starts at 65 for most people

You become may be able to access for Medicare on the first day of the month you turn 65, or the month after, depending on your birthday. If you turn 65 on the first of any month, coverage begins that same month. If your birthday falls on any other day, coverage begins the first day of the following month.

This age requirement applies whether you are still working or already retired. Your work status does not change when Medicare coverage can begin. You do not have to stop working to enroll, and you do not have to be retired to be covered.

There are rare exceptions to the 65-year-old rule. People under 65 with end-stage renal disease (ESRD), amyotrophic lateral sclerosis (ALS), or who have received Social Security Disability Insurance (SSDI) for 24 months may become may be able to access earlier. These situations are uncommon and have their own specific rules.

Key Takeaways

  • Medicare may be able to access begins at age 65 for most people, on the first day of the month you turn 65 or the month after.
  • You must be a U.S. citizen or permanent resident who has lived in the country for at least five consecutive years to be covered.
  • You can enroll in Medicare starting three months before you turn 65, and you should do so to avoid late enrollment penalties.
  • People under 65 with ESRD, ALS, or 24 months of SSDI may become may be able to access earlier, but these cases follow different rules.
  • If you delay enrollment past your initial window, you will pay higher premiums for as long as you have Medicare.

Citizenship and residency requirements you must meet

Age alone is not enough. You must also be a U.S. citizen or a permanent resident (green card holder) to enroll in Medicare. Temporary visa holders, undocumented immigrants, and people on other visa statuses cannot enroll, regardless of age.

If you are a permanent resident, you must have lived in the United States for at least five consecutive years before you turn 65. Those five years do not have to be when ready before you turn 65—they can be any five years of your residency—but they must be unbroken. A single trip outside the country that breaks your continuous residency resets the clock.

Citizenship is verified through Social Security records. If you became a citizen after age 60, Social Security will have that information on file. If there is a discrepancy between your records and your citizenship status, you will need to contact Social Security directly to correct it before you turn 65.

When to enroll: the three-month window before 65

You can begin the enrollment process three months before the month you turn 65. This three-month window is your initial enrollment period, and it is the easiest time to sign up without penalties. For example, if you turn 65 in June, you can enroll starting in March.

Your initial enrollment period lasts seven months total: the three months before you turn 65, the month you turn 65, and three months after. Even though you have this full window, enrolling early—during those first three months—gives you the most time to resolve any problems before coverage begins.

If you miss this window, you can still enroll later, but you will face a permanent penalty on your premiums. For every year you delay past 65, your Part B and Part D premiums increase by 10 percent. That penalty stays with you for life, even if you eventually enroll.

What happens if you are still working at 65

You can turn 65 and keep working without losing Medicare coverage. Your age determines your may be able to access, not your employment status. Many people continue to work past 65 and carry both employer health insurance and Medicare at the same time.

If you have employer coverage through your job, you may be able to delay enrolling in Medicare Part B without penalty, as long as your employer has 20 or more employees. This is called the special enrollment period for group health plan coverage. You must enroll in Part B within eight months of leaving that job or losing that coverage, or you will face a penalty.

Part A (hospital insurance) has no penalty for delay if you have employer coverage, so you can delay that as well. Part D (prescription drug coverage) does carry a penalty if you delay, even with employer coverage, unless your employer plan is considered creditable coverage for drugs. Check with your employer's benefits office to understand whether your drug plan qualifies.

Exceptions: people under 65 who can enroll

Three groups of people under 65 may become may be able to access for Medicare. The first group is people with end-stage renal disease (ESRD)—permanent kidney failure requiring dialysis or a transplant. ESRD may be able to access begins the first month you are on dialysis or the month after a transplant, regardless of age.

The second group is people with amyotrophic lateral sclerosis (ALS), also called Lou Gehrig's disease. ALS may be able to access begins the first month you receive an ALS diagnosis and are approved for Social Security Disability Insurance (SSDI), with no waiting period.

The third group is people who have received SSDI for 24 consecutive months. Once you have been on SSDI for two years, you become may be able to access for Medicare on the first day of the 25th month, regardless of your age. This applies to people disabled since childhood, people who became disabled as adults, and surviving spouses and children of workers who have died.

How to enroll when you reach 65

You can enroll through three main routes: 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 is the fastest option and can be completed in about 10 minutes if you have your Social Security number and citizenship information ready.

If you enroll by phone, a representative will walk you through the process and answer questions about which parts of Medicare you need. The call typically takes 15 to 20 minutes. In-person enrollment at a Social Security office takes longer but may be helpful if you have complex questions or need documents reviewed.

You will need your Social Security number, proof of citizenship (birth certificate, passport, or naturalization papers), and proof of residency (utility bill, lease, or bank statement). If you are a permanent resident, bring your green card. Have this information ready before you contact Medicare or Social Security.

Late enrollment penalties and how they work

If you do not enroll during your initial seven-month window, you will pay a penalty for every month you delay. For Part B, the penalty is 10 percent of the standard monthly premium for each year you were late. If the standard Part B premium is $165 and you delay for two years, your premium becomes $181.50 per month—and that higher amount stays with you permanently.

Part D (prescription drug coverage) has a similar penalty: 1 percent of the national base beneficiary premium for each month you delay. If you go 12 months without Part D coverage, your penalty is 12 percent of that base premium, added to your premium for life.

Part A (hospital insurance) has no penalty if you have been covered by employer insurance or if you are still working. If neither applies to you and you delay Part A enrollment, you pay 10 percent more for twice as long—10 years instead of the usual lifetime penalty period.

Frequently Asked Questions

Can I enroll in Medicare before I turn 65?

You can begin the enrollment process three months before you turn 65, but coverage does not start until the month you turn 65 or the month after, depending on your birthday. Enrolling early gives you time to resolve any issues before your coverage date arrives.

What if I am not a U.S. citizen but have a green card?

Permanent residents with a green card can enroll in Medicare at 65, but you must have lived in the United States for at least five consecutive years. Those five years do not have to be recent, but they must be unbroken. Any trip outside the country that breaks your continuous residency resets the requirement.

Do I have to enroll in all parts of Medicare at 65?

No. Part A (hospital insurance) is automatic for most people at 65 and has no premium. Part B (medical insurance) is optional and has a monthly premium. Part D (prescription drugs) is optional. You can enroll in some parts and delay others, but delaying Part B or Part D past your initial window triggers a permanent penalty.

What if I am still working and have health insurance through my job?

You can delay enrolling in Part B without penalty if your employer has 20 or more employees. You must enroll within eight months of leaving that job or losing that coverage. Part D still carries a penalty if delayed, unless your employer's drug plan is creditable coverage.

Can I get Medicare before 65 if I am disabled?

Yes, if you have received SSDI for 24 consecutive months, you become may be able to access for Medicare on the first day of the 25th month. People with ALS become may be able to access when ready upon approval for SSDI. People with ESRD become may be able to access the first month they begin dialysis or the month after a transplant.