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), and it covers hospital stays, doctor visits, prescription drugs, and preventive care. You do not have to retire to sign up — you can keep working and have Medicare at the same time.

The month your 65th birthday falls in is when your coverage can begin. If your birthday is on the first of the month, coverage starts that month. If your birthday is any other day, coverage starts the month after. For example, if you turn 65 on March 15, your coverage can start in April.

Key Takeaways

  • You become may be able to access for Medicare the month you turn 65, and you can sign up starting three months before that birthday.
  • If you are already receiving Social Security benefits, you are enrolled automatically and do not need to take any action.
  • If you are still working and have health insurance through your employer, you may want to delay signing up to avoid paying premiums for two plans.
  • Some people under 65 can get Medicare if they have been on Social Security disability for 24 months or have end-stage renal disease or ALS.

When to sign up before you turn 65

You can sign up for Medicare starting three months before the month you turn 65. The enrollment window lasts seven months total — three months before, the month you turn 65, and three months after. For example, if you turn 65 in June, you can sign up starting in March and the window closes at the end of September.

Signing up during this window means your coverage will start on time. If you miss this window and do not sign up when you are first may be able to access, you may face a late enrollment penalty that increases your premiums permanently. The penalty is 10 percent of the Part B premium for each full year you could have had coverage but did not sign up.

Automatic enrollment if you get Social Security

If you are already receiving Social Security retirement or disability benefits when you turn 65, you are enrolled in Medicare automatically. You will receive your Medicare card in the mail about three months before your 65th birthday. You do not have to do anything — the enrollment happens without you taking action.

Even if you are enrolled automatically, you should review your coverage options. Automatic enrollment puts you in Original Medicare (Part A and Part B), but you may want to choose a Medicare Advantage plan or add prescription drug coverage instead. You have until the end of the year to make changes to your plan.

People under 65 who may be may be able to access

Most people cannot get Medicare until 65, but three groups can may have access to earlier. If you have been receiving Social Security Disability Insurance (SSDI) for 24 months, you become may be able to access at any age. If you have end-stage renal disease (ESRD) — permanent kidney failure requiring dialysis or a transplant — you may be may be able to access regardless of age. If you have been diagnosed with amyotrophic lateral sclerosis (ALS), you are may be able to access when ready without waiting.

To learn about you fall into one of these groups, contact Social Security at 1-800-772-1213 or visit your local Social Security office. They can tell you whether you meet the requirements and help you understand your next steps.

Coverage options once you turn 65

Once you are may be able to access, you choose between two main paths. Original Medicare is run by the federal government and includes Part A (hospital insurance) and Part B (medical insurance). You pay a monthly premium for Part B and a deductible when you use services. Medicare Advantage is offered by private insurance companies approved by Medicare and usually includes hospital, medical, and prescription drug coverage in one plan, often with a lower monthly cost.

Most people also need to decide about prescription drug coverage. If you choose Original Medicare, you add Part D (prescription drug coverage) through a private plan. Medicare Advantage plans usually include drug coverage already. If you go without drug coverage when you are first may be able to access and sign up later, you may pay a penalty on top of your premiums.

What happens if you are still working at 65

You can stay on your employer's health plan and delay Medicare if you are still working and your employer has 20 or more employees. This is called the working exception. You can wait to sign up for Medicare without facing a late enrollment penalty, as long as you sign up within eight months of leaving your job or losing your employer coverage, whichever comes first.

If your employer has fewer than 20 employees, Medicare becomes your primary insurance when you turn 65, even if you are still working. Your employer plan becomes secondary. In this case, you should sign up for Medicare during your initial enrollment window to avoid penalties.

How to sign up for Medicare

You can sign up online at Medicare.gov, by phone at 1-800-MEDICARE (1-800-633-4227), or in person at your local Social Security office. Online signup is fastest — you can complete the process in about 10 minutes if you have your Social Security number and information about your current health coverage. The phone line has wait times but offers help in multiple languages.

Have ready your Social Security number, date of birth, citizenship or immigration status, and information about any current health insurance. If you are signing up for Medicare Advantage or Part D, you will choose your specific plan during signup or shortly after. Plans change every year, so you should review your options each fall during the annual enrollment period.

Frequently Asked Questions

Can I sign up for Medicare before I turn 65?

Yes. You can sign up starting three months before the month you turn 65. Signing up early means your coverage will start on time. If you wait until after your initial enrollment window closes, you may face a permanent penalty on your premiums.

What if I am still working and have health insurance through my job?

If your employer has 20 or more employees, you can stay on that plan and delay Medicare without penalty. Sign up within eight months of leaving your job or losing coverage. If your employer has fewer than 20 employees, you should sign up for Medicare when you turn 65 because it becomes your primary insurance.

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

If you have employer coverage through a company with 20 or more employees, you can delay. Otherwise, you should sign up during your initial enrollment window to avoid a permanent late enrollment penalty, even if you do not use Medicare right away.

What if I miss my initial enrollment window?

You can still sign up after your window closes, but you will likely pay a penalty. The Part B penalty is 10 percent of the premium for each full year you could have had coverage but did not. The penalty stays on your premiums for as long as you have Medicare.

Can someone under 65 get Medicare?

Yes, if you have been on Social Security disability for 24 months, have end-stage renal disease, or have ALS. Contact Social Security at 1-800-772-1213 to learn about you meet the requirements.