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 enrollment does not depend on your income or medical history.

If you were born on the first of the month, your coverage begins the month before. If you were born on any other day, coverage begins the month you turn 65. You can enroll starting three months before the month you turn 65 and continuing for three months after — a seven-month window. Missing this window can mean paying a penalty on your premiums for as long as you have Medicare.

Key Takeaways

  • You become may be able to access for Medicare at age 65, and you should enroll during the three months before and three months after your 65th birthday.
  • If you are already receiving Social Security before age 65, you will be enrolled automatically; otherwise, you must enroll yourself through Medicare.gov or your local Social Security office.
  • Medicare has four parts — Part A (hospital), Part B (doctor visits), Part D (prescription drugs), and Part C (private alternative) — and you choose which parts you need.
  • Delaying enrollment past your birthday window can result in permanent premium increases unless you have other may have access to coverage.
  • Some people under 65 may be may be able to access if they receive Social Security Disability Insurance (SSDI) for 24 months or have end-stage renal disease or ALS.

How to enroll when you turn 65

You have three ways to enroll: online at Medicare.gov, by phone at 1-800-MEDICARE (1-800-633-4227), or in person at your local Social Security office. The online route is fastest — you can complete enrollment in about 10 minutes if you have your Social Security number and birth date ready.

If you are already receiving Social Security retirement or disability benefits before you turn 65, Medicare will enroll you automatically three months before your 65th birthday. You will receive a Medicare card in the mail. You do not need to do anything unless you want to change which parts of Medicare you choose.

If you are not yet receiving Social Security, you must enroll yourself. Do this during your seven-month window (three months before, the month of, and three months after your 65th birthday). The earlier you enroll, the sooner your coverage begins.

What happens if you miss the enrollment window

If you do not enroll during your seven-month window and you do not have other may have access to coverage, you will pay a late enrollment penalty for as long as you have Medicare. For Part B, the penalty is 10 percent of the standard premium for each full 12 months you were may be able to access but not enrolled. For Part D (prescription drugs), the penalty is 1 percent of the national average premium for each month you were may be able to access but not enrolled.

These penalties are permanent — they do not go away after a certain time. The only way to avoid them is to enroll during your initial window or to have had other health coverage (such as employer coverage or TRICARE) that counts as "creditable coverage" during the months you were not enrolled in Medicare.

If you are still working and covered by your employer's health plan, you may be able to delay Part B enrollment without penalty. You will need to enroll in Part A (hospital insurance) at 65, but you can wait to enroll in Part B until you leave your job or lose the employer coverage, as long as you enroll within eight months of that event.

Medicare before age 65: who qualifies

Most people wait until 65, but three groups of people under 65 can receive Medicare. If you have received Social Security Disability Insurance (SSDI) for 24 consecutive months, you become may be able to access for Medicare regardless of age. The 24-month clock starts the month your disability benefits begin, not the month you explore.

If you have end-stage renal disease (permanent kidney failure requiring dialysis or transplant), you may be may be able to access for Medicare at any age. You must have worked long enough to be insured under Social Security, or be the spouse or child of someone who did. Coverage typically begins the month your dialysis treatment starts or the month you have a kidney transplant, whichever comes first.

If you have been diagnosed with ALS (amyotrophic lateral sclerosis, also called Lou Gehrig's disease), you become may be able to access for Medicare when ready upon approval for SSDI, without waiting the usual 24 months. You do not have to wait for your first disability check.

The four parts of Medicare and what you choose

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 while working for at least 10 years. Part A has a deductible you pay when you are admitted to the hospital.

Part B covers doctor visits, outpatient care, medical equipment, and preventive services. Part B has a monthly premium (the standard amount in 2024 is $164.90, but it varies by income). You pay 20 percent of the cost of most services after you meet your annual deductible.

Part D covers prescription drugs. You choose a plan from private insurers, and the premium and coverage vary by plan. If you do not enroll in Part D when you first become may be able to access and you go without creditable drug coverage, you will pay a penalty when you do enroll.

Part C (Medicare Advantage) is an alternative to Parts A and B. Private insurance companies offer Part C plans that bundle hospital and doctor coverage, often with prescription drug coverage included. If you choose Part C, you are still enrolled in Medicare, but you receive your benefits through the private plan instead of directly from Medicare.

When your coverage actually begins

If you enroll during your initial seven-month window, your coverage begins on the first day of the month you turn 65 (or the first day of the month before, if you were born on the first of the month). If you enroll after your initial window closes, your coverage begins the first day of the month after the month you enroll.

If you are automatically enrolled because you are already receiving Social Security, your coverage begins the first day of the month you turn 65. You will receive your Medicare card in the mail before your coverage starts.

Frequently Asked Questions

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

You can delay Part B enrollment without penalty if you are covered by your employer's health plan and still working. You must enroll in Part A at 65. When you leave your job or lose the employer coverage, you have eight months to enroll in Part B without paying a late penalty.

What if I turn 65 while living outside the United States?

You can still enroll in Medicare at 65 even if you are living abroad. Part A and Part B coverage work the same way. However, Part A hospital coverage does not work outside the U.S. except in limited circumstances (Canada, Mexico, and some situations involving U.S. hospitals). You should still enroll to avoid penalties.

Do I need to be a U.S. citizen to get Medicare at 65?

You must be a U.S. citizen or a permanent resident who has lived in the U.S. for at least five consecutive years. If you meet these requirements and have worked long enough to earn Medicare coverage (or are the spouse of someone who did), you can enroll at 65.

What happens to my Medicare if I move to another state?

Your Medicare coverage follows you to any state. You do not need to re-enroll or update anything with Medicare itself. If you have a Medicare Advantage plan (Part C) or a prescription drug plan (Part D), you should check whether your plan is available in your new state, as coverage areas vary by plan.

Can my spouse enroll in Medicare based on my work record?

Yes. If you have worked long enough to earn Medicare coverage, your spouse can enroll at 65 based on your work record, even if your spouse did not work or did not work long enough. Your spouse must be at least 65 and a U.S. citizen or permanent resident.