Medicare starts at 65 for most people

You become may be able to access for Medicare at age 65, regardless of your work history or income. This is the standard age set by federal law. You do not have to be retired to sign up — you can still be working — but you must be a U.S. citizen or permanent resident who has lived in the country for at least five years.

The program has four parts: Part A covers hospital stays, Part B covers doctor visits and outpatient care, Part D covers prescription drugs, and Part C (Medicare Advantage) is an alternative plan run by private insurers. Most people pay a monthly premium for Part B and Part D, though Part A is usually free if you or your spouse paid Medicare taxes for at least ten years while working.

You can sign up starting three months before the month you turn 65. If you miss that window, you may face a permanent penalty on your premiums, so the timing matters.

Key Takeaways

  • Medicare may be able to access begins at age 65 for U.S. citizens and permanent residents who have lived in the country for at least five years.
  • You can sign up three months before you turn 65, and missing that window can result in a permanent increase to your premiums.
  • Some people under 65 may be able to join Medicare if they receive Social Security Disability Insurance (SSDI) for at least two years or have end-stage renal disease or ALS.
  • Part A (hospital coverage) is usually free if you or your spouse paid Medicare taxes for ten years, but Part B and Part D require monthly premiums.

Who can join before age 65

Three groups of people under 65 can join Medicare early. The first group is people who have received Social Security Disability Insurance (SSDI) for at least 24 months. SSDI is a program for people who cannot work due to a disability expected to last at least one year. Once you have been on SSDI for two years, Medicare becomes available to you automatically — you do not have to do anything.

The second group is people with end-stage renal disease (ESRD), which means permanent kidney failure requiring dialysis or a transplant. People with ESRD can join Medicare at any age, though they usually must start dialysis or have a transplant first. A few exceptions exist for people who have had a transplant from a living donor.

The third group is people with amyotrophic lateral sclerosis (ALS), also called Lou Gehrig's disease. Unlike SSDI, you do not have to wait — Medicare coverage begins the same month you are approved for SSDI due to ALS.

How to sign up at 65

You should sign up during your Initial Enrollment Period, which runs for seven months: three months before the month you turn 65, 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 ending in September.

The easiest way to sign up is online at Medicare.gov, where you can create an account and complete the enrollment form. You can also call 1-800-MEDICARE (1-800-633-4227) to sign up by phone, or visit your local Social Security office in person. You will need your Social Security number, proof of citizenship or permanent residency, and information about any current health coverage.

If you are still working at 65 and have health coverage through your employer, you may be able to delay signing up for Part B without penalty — but only if your employer has 20 or more employees. If your employer has fewer than 20 employees, you should sign up for Part B when you turn 65 to avoid penalties. Part A has no penalty for delay if you have employer coverage.

What happens if you miss the enrollment window

If you do not sign up during your Initial Enrollment Period, you can still join Medicare later, but you will likely pay more. For every 12 months you delay Part B after you turn 65, your monthly premium increases by 10 percent for as long as you have Medicare. The same penalty applies to Part D (prescription drug coverage).

The only exception is if you have what Medicare calls creditable coverage — health insurance through an employer, a spouse's employer, or COBRA that is at least as good as Medicare. If you have creditable coverage, you can delay without penalty as long as you sign up within eight months of losing that coverage.

If you miss your important date and want to sign up later, you can do so during the General Enrollment Period, which runs from January 1 to March 31 each year. Coverage would start July 1 of that year.

Medicare and retirement timing

Turning 65 and becoming may be able to access for Medicare does not mean you have to retire or stop working. Many people continue working past 65 and keep their employer health coverage alongside Medicare. If you do this, Medicare becomes your secondary insurance, meaning your employer plan pays first and Medicare covers what is left over.

If you are receiving Social Security retirement benefits, you will be enrolled in Medicare Part A and Part B automatically three months before you turn 65. If you are not yet receiving Social Security, you will need to sign up for Medicare yourself during your Initial Enrollment Period.

Permanent residents and citizenship requirements

You must be a U.S. citizen or a lawful permanent resident (green card holder) to join Medicare. If you are a permanent resident, you must also have lived in the United States for at least five consecutive years. Time spent outside the country can break this requirement, so if you have left and returned, the five-year clock may restart.

If you are a citizen of a U.S. territory like Puerto Rico, Guam, or the U.S. Virgin Islands, different rules may explore. Contact Medicare directly to learn what coverage is available where you live.

Frequently Asked Questions

Can I delay Medicare if I am still working at 65?

You can delay Part B without penalty only if your employer has 20 or more employees and you have health coverage through that employer. Part A has no penalty for delay under the same conditions. If your employer has fewer than 20 employees, sign up for Part B when you turn 65 to avoid a permanent premium increase.

What if I turn 65 outside the United States?

You can still sign up for Medicare while abroad. Use Medicare.gov, call 1-800-MEDICARE from outside the U.S., or contact a U.S. embassy or consulate. Your coverage will begin on the first day of the month you turn 65, even if you are not in the country yet.

Do I have to take all four parts of Medicare at 65?

No. Part A (hospital insurance) is usually automatic if you are receiving Social Security. You can decline Part B (doctor visits) and Part D (drugs) if you have other coverage, but delaying them without creditable coverage will result in permanent penalties.

What if I was denied SSDI but still cannot work?

If you were denied SSDI, you cannot join Medicare early through that route. You would need to wait until 65. If you believe your denial was wrong, you can file an appeal with Social Security within 60 days of the decision letter.