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). You do not have to retire to enroll, and you do not have to stop working — but you do have to sign up during the right window, or you may face a permanent penalty on your premiums.
If you were born on the first of the month, your coverage starts the month before. If you were born on any other day, coverage starts the month you turn 65. You have a seven-month window to enroll without penalty: three months before you turn 65, the month you turn 65, and three months after.
Key Takeaways
- You can enroll in Medicare starting three months before you turn 65, and you have until three months after your 65th birthday to sign up without penalty.
- If you miss the enrollment window and do not have other may have access to coverage, you will pay a permanent 10 percent increase on your Part B premium for each year you delayed.
- You can enroll online at Medicare.gov, by phone at 1-800-MEDICARE, or in person at your local Social Security office.
- Some people under 65 become may be able to access if they receive Social Security disability benefits for 24 months or have end-stage renal disease or ALS.
How to enroll when you turn 65
You have three ways to sign up. The easiest is online at Medicare.gov — you can create an account, answer questions about your coverage, and submit your enrollment in about 15 minutes. You will need your Social Security number and information about any current health insurance you have.
You can also call 1-800-MEDICARE (1-800-633-4227) and speak to a representative who will walk you through enrollment over the phone. This takes about 20 to 30 minutes. A third option is to visit your local Social Security office in person and enroll there — you can find the nearest office at ssa.gov.
Whichever method you choose, enrollment is free. Medicare will send you a card in the mail within two weeks of your enrollment. Your coverage typically starts on the first day of the month in which you enroll, though if you enroll in the three months before your 65th birthday, coverage will not start until the month you turn 65.
What happens if you miss the enrollment important date
If you do not enroll during your seven-month window and you do not have other may have access to coverage (such as employer health insurance), you will owe a late enrollment penalty. This penalty is permanent and stays on your account for as long as you have Medicare.
The penalty for Part B (medical insurance) is 10 percent of the standard premium amount for each full year you delayed enrollment. If the standard Part B premium is $165 per month and you delayed for two years, you would pay an extra $33 per month for life. The penalty for Part D (prescription drug coverage) works the same way — 1 percent of the national base premium for each month you delayed.
The only way to avoid this penalty is to have had creditable coverage — health insurance through an employer, a spouse's employer, TRICARE, the Veterans Administration, or certain other sources — during the time you were not enrolled in Medicare. If you had creditable coverage, you can enroll without penalty even after your seven-month window closes.
People under 65 who can get Medicare
You do not have to wait until 65 if you receive Social Security Disability Insurance (SSDI) for 24 months. Once you have been on SSDI for two years, Medicare coverage begins automatically — you do not have to enroll. Your coverage starts on the first day of the 25th month of your disability benefits.
You also become may be able to access before 65 if you have end-stage renal disease (ESRD) — permanent kidney failure requiring dialysis or a transplant. With ESRD, you can enroll in Medicare when ready, and coverage can start as early as the month your treatment begins. You will need documentation from your doctor or dialysis center.
A third group is people with ALS (amyotrophic lateral sclerosis), also called Lou Gehrig's disease. You become may be able to access for Medicare the month you are approved for Social Security disability benefits due to ALS — you do not have to wait 24 months like other disability recipients.
Enrollment important date if you are still working
If you are still employed and covered by your employer's health plan, you can 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. You must enroll within eight months after your employment ends or your employer coverage stops, whichever comes first.
You should still enroll in Part A (hospital insurance) at 65 even if you are working, because Part A is usually free and has no penalty for late enrollment if you had employer coverage. Part B is where the penalty applies, so that is the one you can safely delay if you have may have access to employer insurance.
When you do leave your job, contact Medicare right away to enroll in Part B. If you wait longer than eight months after your coverage ends, you will owe the late enrollment penalty even though you had creditable coverage.
Medicare Parts and what they cover at 65
Part A covers hospital stays, skilled nursing facility care, hospice, and some home health services. Most people pay nothing for Part A premiums because they or their spouse paid Medicare taxes while working. Part A has a deductible — currently $1,676 per hospital stay — but no monthly premium for most people.
Part B covers doctor visits, outpatient care, lab tests, and medical equipment. Part B has a monthly premium (currently around $165 for most people, though it varies by income) and a yearly deductible (currently $240). You pay 20 percent of the cost of most services after you meet the deductible.
Part D is prescription drug coverage. You enroll in a Part D plan through a private insurance company, not directly through Medicare. Part D has a monthly premium that varies by plan, a yearly deductible, and cost-sharing for medications. You should enroll in Part D when you turn 65 or face a penalty if you go without drug coverage.
Many people also buy Medigap (supplemental insurance) or enroll in Part C (Medicare Advantage) to cover costs that Original Medicare does not pay. These are optional but can reduce your out-of-pocket costs.
Frequently Asked Questions
Do I have to enroll in Medicare if I am still working at 65?
You should enroll in Part A at 65 because it is usually free and covers hospital care. If your employer has 20 or more employees and covers you under their health plan, you can delay Part B without penalty. Once you leave your job, you have eight months to enroll in Part B before penalties begin.
What if I was born outside the United States?
You can enroll in Medicare at 65 if you are a U.S. citizen or a permanent resident who has lived in the United States for at least five years. You will need proof of citizenship or permanent residency when you enroll. Contact Medicare at 1-800-MEDICARE if you have questions about your specific situation.
Can I change my mind after I enroll?
Yes. You have a seven-month Initial Enrollment Period, and you can make changes during that time. After that, you can make changes only during the Annual Enrollment Period (October 15 to December 7 each year) or if you have a may have access to life event such as losing employer coverage.
What if I do not think I need Medicare at 65?
You still need to enroll in Part A even if you feel healthy, because hospital stays can be very expensive. If you have employer coverage, you can delay Part B, but delaying Part D (prescription drugs) without creditable coverage will result in a permanent penalty. It is safer to enroll and then make changes later if needed.