What Age You Need to Be for Medicare Coverage

Medicare starts at age 65 for most people

You become covered by Medicare the month you turn 65, as long as you or your spouse paid Medicare taxes while working. You do not have to wait until your birthday month ends — coverage begins on the first day of the month in which you turn 65. If your birthday is on the first of the month, coverage starts the previous month.

This age requirement applies whether you are still working or already retired. The only exception is if you have been receiving Social Security Disability Insurance (SSDI) for 24 months, or if you have end-stage renal disease or ALS — in those cases, Medicare can start before 65.

Key Takeaways

Medicare coverage begins the first day of the month you turn 65, regardless of whether you have retired.
You must have paid Medicare taxes through work, or be married to someone who did, to receive Medicare at 65.
If you have been on SSDI for 24 months, you may receive Medicare before turning 65.
You should contact Social Security about three months before turning 65 to set up your coverage.
Delaying Medicare past 65 can result in permanent penalties on your premiums if you do not have other may have access to coverage.

How Medicare taxes and work history affect your age 65 may be able to access

Medicare is funded through payroll taxes, so your coverage at 65 depends on whether you or your spouse paid into the system. You need 40 credits of Medicare tax contributions — roughly 10 years of work — to be covered. If you worked for a government employer that did not pay Medicare taxes, you may not have earned these credits.

If you do not have 40 credits yourself, you may still be covered based on your spouse's work history. This applies whether your spouse is still living or deceased. If neither you nor your spouse has enough credits, you can still purchase Medicare Part A at age 65, though the monthly premium will be higher than for those who paid in.

Early Medicare may be able to access: SSDI, end-stage renal disease, and ALS

If you have been receiving SSDI for 24 consecutive months, Medicare coverage begins automatically in the 25th month, regardless of your age. This means someone who became disabled at 40 and received SSDI could be covered by Medicare at 42. You do not need to do anything — Social Security will enroll you.

Two medical conditions bypass the age requirement entirely. If you have end-stage renal disease (ESRD) requiring dialysis or a transplant, you may receive Medicare as early as the month dialysis begins or the month of transplant, at any age. If you have been diagnosed with amyotrophic lateral sclerosis (ALS), you become covered when ready upon receiving SSDI benefits, without waiting 24 months.

When to contact Social Security about Medicare

You should reach out to Social Security about three months before you turn 65. This gives the agency time to process your information and have your coverage ready on your first may be able to access day. You can contact Social Security by phone at 1-800-772-1213, visit your local Social Security office, or create an account on ssa.gov to manage your Medicare enrollment online.

If you are already receiving Social Security retirement or disability benefits when you turn 65, you will be enrolled in Medicare Part A and Part B automatically. If you are not yet receiving Social Security, you will need to contact them to set up Medicare even if you do not plan to claim retirement benefits right away.

What happens if you delay Medicare past 65

If you continue working past 65 and have health coverage through your employer, you may delay Medicare without penalty. However, if you do not have coverage through work and you do not sign up for Medicare by the end of your initial enrollment period (which runs three months before through three months after the month you turn 65), you will face a permanent increase to your Part B and Part D premiums.

The penalty is 10 percent of the Part B premium for each full year you delayed, added to your premium for life. Part D carries a similar penalty. These penalties do not go away even if you later sign up, so the cost of waiting is permanent unless you had may have access to employer coverage during the delay.

Medicare coverage types available at 65

Once you reach 65 and are covered, you choose between Original Medicare (Part A and Part B) or a Medicare Advantage plan. Original Medicare is run by the federal government and covers hospital stays, doctor visits, and some preventive care. Medicare Advantage is offered by private insurance companies and often includes prescription drug coverage and extra benefits like dental or vision, though with different rules about which doctors you can see.

You also need to decide about prescription drug coverage. If you choose Original Medicare, you can add Part D through a private insurer. If you choose Medicare Advantage, most plans include drug coverage already. Your initial enrollment period for these choices is the same three-month window around your 65th birthday, so decisions made then lock in your coverage for the year.

Frequently Asked Questions

Can I get Medicare before 65 if I am still working?

Only if you meet one of the three exceptions: you have been on SSDI for 24 months, you have end-stage renal disease, or you have ALS. Working past 65 does not change the age requirement. However, if you have employer coverage, you can delay signing up for Medicare without penalty.

What if I worked outside the United States?

Work done in most countries counts toward your 40 Medicare credits if you paid into that country's social insurance system and the U.S. has a totalization agreement with that country. Social Security can tell you whether your foreign work counts. Contact them before you turn 65 to verify your credits.

Do I have to sign up for Medicare at 65 even if I am still working?

If you have health coverage through your current employer, you can delay Part B without penalty. However, you should still sign up for Part A at 65 since it is usually free and covers hospital care. Check with your employer's benefits office about the best timing for your situation.

What if I turned 65 but did not sign up for Medicare?

You can still sign up during the General Enrollment Period, which runs January 1 through March 31 each year. Coverage would begin July 1. However, you will owe the permanent premium penalty for each year you delayed, unless you had may have access to employer coverage during that time.

Can my spouse get Medicare at a different age than me?

Yes. Each person becomes covered at their own age 65, or earlier if they meet one of the exceptions. Your spouse's coverage does not depend on yours. You can both be on Medicare at different times based on when each of you turns 65.

This guide is for general information only and is not medical, financial, legal, or other professional advice. For decisions specific to your situation, consult a qualified professional. See our Editorial Policy.