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 sign up, and you do not have to be poor. Age 65 is the standard threshold, though a small number of younger people with specific conditions can join earlier.

The enrollment window opens three months before the month you turn 65 and closes three months after. If you miss this window, you may pay a higher premium for the rest of your life, so the timing matters. Most people should sign up during this seven-month period even if they plan to keep working.

Key Takeaways

  • Medicare enrollment begins three months before you turn 65 and ends three months after, a seven-month window you should not miss.
  • You can sign up online at Medicare.gov, by phone at 1-800-MEDICARE, or in person at your local Social Security office.
  • If you are still working and have employer health insurance, you may be able to delay Part B without penalty if your employer has 20 or more employees.
  • People under 65 with end-stage renal disease, ALS, or who have received Social Security Disability Insurance for 24 months can join Medicare before age 65.
  • Signing up late can add 10 percent to your Part B premium for each year you delay, and this penalty is permanent.

Who can join before age 65

Three groups of people under 65 are may be able to access for Medicare. The first is anyone with end-stage renal disease (permanent kidney failure requiring dialysis or transplant). The second is anyone diagnosed with ALS (amyotrophic lateral sclerosis, also called Lou Gehrig's disease). These two conditions allow when ready enrollment regardless of age.

The third group is people who have been receiving Social Security Disability Insurance (SSDI) for 24 consecutive months. Once you hit that 24-month mark, Medicare begins automatically. You do not have to do anything — CMS will send you information in the mail. If you have been on SSDI for fewer than 24 months, you are not yet may be able to access, but you will be once the period ends.

How to sign up when you turn 65

You have three ways to enroll. The first is online at Medicare.gov, where you can create an account and complete the process from home. The second is by phone at 1-800-MEDICARE (1-800-633-4227), available 24 hours a day, seven days a week. The third is 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 insurance. If you are still working, bring a recent pay stub or letter from your employer stating how many employees work there — this affects whether you can delay Part B without penalty. Have your doctor's name and any recent diagnoses handy as well, since some conditions affect which plan type makes sense for you.

What happens if you sign up late

Missing the seven-month enrollment window triggers a late enrollment penalty on Part B (medical insurance). The penalty is 10 percent of the standard Part B premium for each full year you delay. If the standard premium is $165 per month and you sign up three years late, you pay an extra $49.50 per month for life. This penalty never goes away, even if you move to a different plan.

Part D (prescription drug coverage) also has a late penalty: 1 percent of the national average premium per month of delay. If you go 12 months without Part D coverage and then enroll, you pay that penalty permanently as well. The only exception is if you had other drug coverage that was at least as good as Medicare Part D — in that case, you may avoid the penalty if you can prove it.

Delaying enrollment if you are still working

You can delay Part B enrollment without penalty if you are still working and covered by your employer's health insurance. This is called the Special Enrollment Period. The catch is that your employer must have 20 or more employees. If your company is smaller, you must enroll in Part B when you turn 65 or face the late penalty.

To use this exception, you do not sign up for Part B during your initial enrollment window. Instead, you sign up within eight months after your employment ends or your employer coverage stops, whichever comes first. You will still need to enroll in Part A (hospital insurance) at 65 — that has no penalty for delay, but it is simpler to do everything at once. Keep your employer coverage documents to prove you were covered, since Medicare will ask for proof when you eventually enroll in Part B.

Medicare Part A, Part B, Part C, and Part D explained

Part A covers hospital stays, skilled nursing care, hospice, and home health services. Most people do not pay a monthly premium for Part A because they or their spouse paid Medicare taxes while working. Part B covers doctor visits, outpatient care, and medical equipment. Part B has a monthly premium (currently around $165 for most people, though it varies by income).

Part C, also called Medicare Advantage, is an alternative to Parts A and B offered by private insurance companies. It bundles hospital and medical coverage and usually includes prescription drug coverage, but it comes with network restrictions and different out-of-pocket costs. Part D is prescription drug coverage you add to Original Medicare (Parts A and B). You choose a Part D plan from private insurers during your enrollment window.

You must enroll in Part A and Part B (or Part C as an alternative) at 65. Part D is optional but recommended if you take any medications — the late penalty applies even if you do not use it. If you have no prescription drugs now, you can still enroll in Part D later without penalty as long as you do so within 63 days of a gap in coverage.

Income-based premiums and extra help

Your Part B and Part D premiums may be higher if your income is above a certain threshold. This is called Income-Related Monthly Adjustment Amount (IRMAA). CMS uses your tax return from two years prior to calculate it. If your income drops due to retirement, job loss, or divorce, you can request a recalculation, and your premiums may go down.

If your income is low, you may be able to get help paying Part B and Part D premiums through Medicaid or the Medicare Savings Program. These are state-run programs, so what you may have access to for depends on where you live. Your state Medicaid office or local Area Agency on Aging can tell you what programs exist in your area and whether you meet the income limits.

Frequently Asked Questions

Can I sign up for Medicare before I turn 65?

You can sign up three months before your 65th birthday. If you have end-stage renal disease, ALS, or have been on Social Security Disability Insurance for 24 months, you may be may be able to access before age 65. Otherwise, the earliest you can enroll is three months before the month you turn 65.

What if I miss the enrollment window?

You can still enroll after the seven-month window closes, but you will pay a late penalty on Part B and Part D that lasts for life. The penalty is 10 percent of the Part B premium per year of delay. If you have an exception (such as employer coverage with 20+ employees), you have eight months after that coverage ends to enroll without penalty.

Do I have to enroll in Medicare if I am still working?

You must enroll in Part A at 65 — there is no penalty for delay, but you should do it anyway. Part B is optional if you have employer coverage from a company with 20 or more employees, but you should enroll anyway to avoid the late penalty. If your employer has fewer than 20 employees, you must enroll in Part B at 65.

What is the difference between Original Medicare and Medicare Advantage?

Original Medicare (Parts A and B) is run by the federal government and covers any doctor or hospital that accepts Medicare. Medicare Advantage (Part C) is sold by private insurers and usually has lower premiums but limits you to in-network providers. Both include hospital and medical coverage; you choose one or the other, not both.

Can I change my Medicare plan after I sign up?

Yes, during the Annual Enrollment Period from October 15 to December 7 each year. You can switch between Original Medicare and Medicare Advantage, or change your Part D plan. If you have a may have access to life event (such as loss of employer coverage), you may be able to change plans outside this window.