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 be poor. If you are already receiving Social Security benefits when you turn 65, Medicare enrollment happens automatically. If you are not yet collecting Social Security, you will need to sign up for Medicare yourself during your enrollment window.

The enrollment window opens three months before the month you turn 65 and closes three months after. For example, if you turn 65 in June, your window runs from March through September. Missing this window can cost you in penalties that last for life, so the timing matters.

Key Takeaways

  • You are may be able to access for Medicare at 65, and enrollment is automatic if you are already collecting Social Security.
  • If you are not on Social Security, you must sign up yourself during the three-month window before and after your 65th birthday.
  • Some people under 65 can enroll if they have been on Social Security disability for 24 months or have end-stage renal disease or ALS.
  • Delaying enrollment past your window can result in permanent premium increases unless you have employer coverage or other may have access to circumstances.
  • Medicare has four parts—A (hospital), B (doctor visits), C (Medicare Advantage), and D (prescription drugs)—and you choose which ones you need.

Who qualifies before age 65

Three groups of people under 65 can enroll in Medicare. The first is anyone who has been receiving Social Security Disability Insurance (SSDI) for 24 consecutive months. The second is people with end-stage renal disease (permanent kidney failure requiring dialysis or transplant). The third is people diagnosed with ALS (amyotrophic lateral sclerosis, also called Lou Gehrig's disease), who can enroll when ready without waiting.

If you fall into one of these categories, you can enroll in Medicare even though you have not reached 65. The enrollment process is the same: you sign up through Social Security or Medicare.gov, and coverage typically begins the first day of the month after you enroll.

How to enroll when you turn 65

If you are already receiving Social Security retirement or disability benefits, Medicare Part A and Part B are added to your coverage automatically the month you turn 65. You do not have to do anything. You will receive a Medicare card in the mail about two weeks before your coverage starts.

If you are not yet collecting Social Security, you must enroll yourself. You can sign up online at Medicare.gov, by phone at 1-800-MEDICARE, or 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 coverage. Enrollment takes about 15 minutes online.

Part A (hospital insurance) and Part B (medical insurance) are the standard parts. You can also choose Part C (Medicare Advantage, an alternative plan) or Part D (prescription drug coverage) during this window. These choices affect your monthly costs and what doctors and pharmacies you can use.

What happens if you miss the enrollment window

If you do not enroll during your initial window and you do not have a valid reason to delay, you will face a late enrollment penalty. For Part B, the penalty is 10 percent of the standard monthly premium for each full year you were may be able to access but not enrolled. This penalty is permanent—you pay it for as long as you have Medicare.

For Part D (prescription drugs), the penalty is 1 percent of the national average premium for each month you were without coverage. This penalty also stays with you permanently. The only way to avoid these penalties is to have may have access to coverage during the gap, such as employer health insurance or TRICARE (military coverage).

If you miss your window, you can still enroll during the General Enrollment Period, which runs January 1 through March 31 each year. Coverage would start July 1 of that year. But the penalty applies whether you enroll then or later.

Medicare coverage options at 65

Part A covers hospital stays, skilled nursing facility care, hospice, and home health services. Most people do not pay a monthly premium for Part A if they or their spouse paid Medicare taxes for at least 10 years. You pay a deductible when you use it.

Part B covers doctor visits, outpatient care, medical equipment, and preventive services. The standard monthly premium in 2024 is $174.70, though it varies by income. You also pay a deductible and coinsurance when you use services.

Part C (Medicare Advantage) is an alternative to Parts A and B offered by private insurance companies. It usually costs less out of pocket but limits you to a specific network of doctors. Most plans include Part D (prescription drugs) built in.

Part D covers prescription medications. You can add it to Original Medicare (Parts A and B) or get it through a Medicare Advantage plan. The cost varies by plan and by income.

Delaying enrollment if you are still working

If you are still working at 65 and have health insurance through your employer, you can delay enrolling in Medicare Part B without penalty. You must enroll within eight months after your employment ends or your employer coverage stops, whichever comes first. This is called the Special Enrollment Period.

Part A (hospital insurance) does not have the same delay option. You should still enroll in Part A at 65 even if you delay Part B, because Part A has no monthly premium for most people and covers hospital care you might need unexpectedly.

If you delay Part B and do not enroll within the eight-month window after work ends, you will owe the late enrollment penalty. Keep your employer coverage documents and the date your coverage ended so you can prove your may have access to reason if you need to.

Frequently Asked Questions

Can I enroll in Medicare before I turn 65?

Only if you have been on Social Security disability for 24 months, have end-stage renal disease, or have ALS. Otherwise, you must wait until the month you turn 65. If you turn 65 on the first day of the month, you can enroll starting three months before that date.

What if I am still working and do not want Medicare yet?

You can delay Part B if you have employer coverage, but you should still enroll in Part A at 65 because it is usually free and covers hospital care. Delaying Part B requires you to enroll within eight months after your job or coverage ends to avoid penalties.

Do I have to choose between Part C and Original Medicare?

Yes. You choose either Original Medicare (Parts A and B) plus optional Part D, or Medicare Advantage (Part C), which includes hospital and medical coverage and usually includes Part D. You cannot have both at the same time, though you can switch during the annual enrollment period.

What if I am not a U.S. citizen?

You must be a U.S. citizen or permanent legal resident who has lived in the United States for at least five consecutive years to enroll in Medicare. Bring proof of legal residency when you sign up.

Can I change my mind after I enroll?

Yes. You have a seven-day period after you enroll to cancel and restart your coverage. After that, you can change plans during the Annual Enrollment Period (October 15 through December 7 each year) or if you have a may have access to life event like losing employer coverage.