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. You do not have to stop working to sign up, and your employer coverage does not automatically end when you reach 65. However, the timing of when you sign up matters — missing the window can result in higher premiums for the rest of your life.

Key Takeaways

  • Medicare coverage begins the month you turn 65, or the month after, depending on the day of your birthday.
  • You must sign up during your initial enrollment period, which starts three months before the month you turn 65 and ends three months after.
  • Some people under 65 may be covered if they have received Social Security disability benefits for 24 months or have end-stage renal disease or ALS.
  • Delaying enrollment past your initial period can lock you into permanently higher premiums unless you have continuous employer coverage.
  • You can sign up online through Medicare.gov, by phone, or in person at your local Social Security office.

When to sign up: your initial enrollment period

Your initial enrollment period is a seven-month window centered on the month you turn 65. It begins three months before that month and ends three months after. For example, if you turn 65 in June, your enrollment period runs from March through September.

You should sign up during this window even if you do not plan to use Medicare right away. If you have health coverage through your employer and you are still working, you may be able to delay Part B (medical insurance) without penalty, but you must still enroll in Part A (hospital insurance) to avoid late fees later. The rules differ depending on whether your employer has 20 or more employees.

Signing up on time protects you from permanent premium increases. If you miss your initial enrollment period and do not have a valid reason, you will pay a 10 percent surcharge on your Part B premium for as long as you have Medicare — and the same applies to Part D (prescription drug coverage).

People under 65 who may get Medicare

Age 65 is the standard threshold, but three groups of younger people can receive Medicare coverage. If you have been receiving Social Security disability benefits for 24 months, you become may be able to access regardless of age. This applies to disabled workers, disabled adult children, and widows or widowers who became disabled before age 60.

You also become may be able to access at any age if you have end-stage renal disease (permanent kidney failure requiring dialysis or a transplant) or ALS (amyotrophic lateral sclerosis, also called Lou Gehrig's disease). For end-stage renal disease, you can sign up as soon as your doctor determines you will need dialysis or a transplant, even if you have not started treatment yet.

If you fall into one of these categories, you will receive a notice from Social Security explaining your coverage start date. You do not need to take any action — Medicare will begin automatically.

How to sign up for Medicare

You have three ways to sign up: online through Medicare.gov, by phone at 1-800-MEDICARE (1-800-633-4227), or in person at your local Social Security office. The online method is fastest and requires only your Social Security number, date of birth, and contact information.

If you sign up by phone, a representative will walk you through the same questions. Processing typically takes about two weeks. If you prefer to sign up in person, bring your Social Security card, proof of citizenship (such as a passport or birth certificate), and proof of residency (such as a utility bill or lease).

You can also sign up at your local Social Security office even if you have not yet reached 65, as long as you are within your initial enrollment period. Some people choose to do this in person to confirm their information is correct before coverage begins.

What happens if you miss the enrollment important date

If you do not sign up during your initial enrollment period, you enter a general enrollment period that runs from January 1 through March 31 each year. Coverage would not begin until July 1 of that year, creating a gap in your protection.

More importantly, you will face permanent premium penalties. Part B premiums increase by 10 percent for each 12-month period you were not enrolled but should have been. If you miss by two years, your premium goes up 20 percent — and that increase stays with you for life.

The only exception is if you had continuous health coverage through an employer with 20 or more employees during the time you were not enrolled in Medicare. In that case, you may be able to enroll without penalty during a special enrollment period that lasts eight months after your employment or coverage ends.

Medicare Parts and what they cover at 65

When you turn 65, you become may be able to access for four parts of Medicare. Part A covers hospital stays, skilled nursing care, hospice, and some home health services. Part B covers doctor visits, outpatient care, and medical equipment. Most people pay no premium for Part A if they or their spouse paid Medicare taxes for at least 10 years, but Part B has a monthly premium that increases with income.

Part D covers prescription drugs and requires separate enrollment. Part C, also called Medicare Advantage, is an alternative to Original Medicare that combines Parts A, B, and usually D through a private insurance company. You do not have to choose Part C — it is optional — but if you want drug coverage, you must enroll in either Part D or a Part C plan that includes it.

You can enroll in any of these parts during your initial enrollment period. If you delay Part B or Part D without a valid reason, you will pay higher premiums when you do enroll.

Special situations that change the age requirement

If you are a federal employee, railroad employee, or member of certain other groups, your Medicare may be able to access may follow different rules. Federal employees who retired before 1983 may have different coverage options. Railroad employees are covered under the Railroad Retirement Board, which has its own Medicare-like program.

If you are not a U.S. citizen, you must have been a permanent resident for at least five years to be may be able to access for Medicare at 65. Undocumented immigrants are not may be able to access for Medicare, though they may be able to receive emergency care through Medicaid in some states.

If you are still working at 65 and your employer offers health coverage, you can delay enrolling in Part B without penalty as long as your employer has 20 or more employees. However, you must still enroll in Part A, and you should enroll in Part B within eight months of your coverage ending to avoid permanent penalties.

Frequently Asked Questions

Can I sign up for Medicare before I turn 65?

Yes, you can sign up during your initial enrollment period, which begins three months before the month you turn 65. You cannot sign up earlier than that unless you are under 65 and disabled, have end-stage renal disease, or have ALS.

What if I am still working at 65 and have employer health coverage?

You can keep your employer coverage and delay Part B enrollment without penalty if your employer has 20 or more employees. However, you must still enroll in Part A. When your employment or coverage ends, you have eight months to enroll in Part B without paying a penalty.

Do I have to enroll in all four parts of Medicare?

No. Part A is automatic for most people at 65. Part B is optional if you have employer coverage. Part D (drug coverage) is optional but carries a penalty if you delay. Part C is optional and replaces Parts A and B if you choose it.

What happens to my Social Security if I sign up for Medicare at 65?

Medicare and Social Security are separate programs. Signing up for Medicare does not affect your Social Security benefits. However, you must sign up for Social Security separately if you have not already done so.

Can I change my Medicare plan after I sign up?

Yes. You have an annual enrollment period from October 15 through December 7 each year when you can switch between Original Medicare and Medicare Advantage, or change your Part D plan. Changes take effect January 1 of the following year.