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. You do not have to retire or stop earning income. The program is federal health insurance run by the Centers for Medicare & Medicaid Services (CMS), and it covers hospital care, doctor visits, prescription drugs, and other medical services.

If your birthday falls on the first of the month, your coverage begins the month before. Otherwise, coverage starts the first day of the month you turn 65. You will receive a Medicare card in the mail before your coverage date, usually about two weeks ahead of time.

Key Takeaways

  • You are may be able to access for Medicare when you turn 65, and you should sign up during the three months before and three months after your birthday month.
  • If you delay signing up past your initial enrollment window without a valid reason, you may pay a permanent penalty on your premiums.
  • You can sign up online at Medicare.gov, by phone at 1-800-MEDICARE, or in person at your local Social Security office.
  • Some people under 65 may be may be able to access if they receive Social Security Disability Insurance (SSDI) for at least 24 months or have end-stage renal disease or ALS.

When to sign up during your 65th birthday year

Your Initial Enrollment Period is seven months long: the three months before you turn 65, the month you turn 65, and the three months after. You should sign up during this window to avoid delays and penalties.

If you sign up during the three months before your birthday, your coverage will start the first day of the month you turn 65. If you sign up during your birthday month or the three months after, your coverage will start the first day of the following month. For example, if you turn 65 on March 15 and sign up in April, your coverage begins May 1.

Waiting past this seven-month window can cost you money. If you do not sign up when you first become may be able to access and you do not have a valid reason for the delay, you will pay a late enrollment penalty for as long as you have Medicare. The penalty is 10 percent of the standard Part B premium for each full 12 months you could have had coverage but did not sign up.

Exceptions: Medicare before age 65

You may be may be able to access for Medicare before 65 if you have received Social Security Disability Insurance (SSDI) for at least 24 months. Once you have been on SSDI for two years, you automatically become may be able to access for Medicare, even if you are in your 30s or 40s. You do not have to explore separately; CMS will contact you.

Two other conditions also may have access to you for Medicare before 65: end-stage renal disease (ESRD) — permanent kidney failure requiring dialysis or a transplant — and ALS (amyotrophic lateral sclerosis), also called Lou Gehrig's disease. If you have either condition, you can sign up for Medicare regardless of age. You will need medical documentation from your doctor to prove the diagnosis.

How to sign up for Medicare

You have three ways to sign up. The easiest is online at Medicare.gov, where you can create an account and complete your enrollment in about 15 minutes. You will need your Social Security number, date of birth, and contact information.

You can also call 1-800-MEDICARE (1-800-633-4227) and speak with a representative. They can answer questions about your coverage options and help you enroll over the phone. The line is open Monday through Friday, 8 a.m. to 8 p.m. Eastern time, and Saturday 9 a.m. to 1 p.m. Eastern time.

A third option is to visit your local Social Security office in person. You can find the nearest office at ssa.gov or by calling 1-800-772-1213. Bring your Social Security card, birth certificate, and proof of citizenship or legal residency.

Understanding Medicare Parts A, B, C, and D

Medicare has four parts, and you need to understand what each covers. 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 while working.

Part B covers doctor visits, outpatient care, medical equipment, and preventive services. It has a monthly premium that changes each year; in 2024 it is $164.90 per month for most people, though higher earners pay more. You must actively choose to enroll in Part B during your Initial Enrollment Period, or you may face a late penalty.

Part C, also called Medicare Advantage, is an alternative to Original Medicare (Parts A and B). Private insurance companies offer Part C plans that bundle hospital and doctor coverage, usually with lower out-of-pocket costs but smaller networks of doctors. Part D covers prescription drugs and is offered by private insurers. You can add Part D to Original Medicare, or it may be included in your Part C plan.

What happens if you miss your enrollment window

If you do not sign up during your Initial Enrollment Period and you do not have a valid reason for the delay, you enter a situation called General Enrollment Period. This runs from January 1 to March 31 each year, and you can sign up then, but your coverage will not start until July 1.

More importantly, you will owe a late enrollment penalty. For Part B, the penalty is 10 percent of the standard premium for each 12-month period you were not enrolled. This penalty stays on your bill for as long as you have Medicare. For Part D, the penalty is 1 percent of the national average premium for each month you were not enrolled, also permanent.

A few situations excuse you from the penalty: if you were covered by an employer health plan while you were working and signed up within eight months of losing that coverage, or if you were outside the United States for more than six months. These are called creditable coverage exceptions. You will need to prove your employer coverage or your time abroad.

Preparing to turn 65

Start preparing about three months before your 65th birthday. Gather your Social Security number, birth certificate, and any documents about current health coverage. Visit Medicare.gov and read the overview of Parts A, B, C, and D to understand which options fit your situation.

If you are still working and have employer health insurance, check with your benefits office about how Medicare coordinates with your plan. Some employers require you to enroll in Medicare Part A and B even while you are working; others do not. Getting this wrong can cost you money or leave you without coverage.

If you have questions specific to your health or finances, consider speaking with a counselor at your local State Health Insurance information Program (SHIP). SHIP offers free, unbiased counseling about Medicare options. You can find your state's program at shiptalk.org or by calling 1-877-839-2675.

Frequently Asked Questions

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

You do not have to sign up for Part B if you have health insurance through your current employer and the employer has 20 or more employees. However, you should still sign up for Part A, which is usually free. If you delay Part B and later lose your job, you have eight months to sign up without a penalty.

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

You must be a U.S. citizen or a permanent resident who has lived in the United States for at least five consecutive years to be may be able to access for Medicare. Bring proof of legal residency when you sign up. Undocumented immigrants are not may be able to access for Medicare.

Can I change my Medicare plan after I sign up?

Yes, but only during certain times. If you have Original Medicare (Parts A and B), you can switch to a Medicare Advantage plan (Part C) during the Annual Enrollment Period, October 15 to December 7 each year. If you have Medicare Advantage, you can switch back to Original Medicare during the same window. Changes take effect January 1.

What if I move to another state after I turn 65?

Your Medicare coverage follows you anywhere in the United States. If you have Original Medicare, your coverage works the same in every state. If you have a Medicare Advantage plan, check whether your plan operates in your new state, because some plans are regional. You may need to switch plans when you move.

Do I pay taxes on Medicare?

Medicare is funded by payroll taxes (2.9 percent of your wages, split between you and your employer) and general tax revenue. You do not pay income tax on your Medicare benefits themselves, but you may pay income tax on other retirement income, such as Social Security or pensions.