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. If your birthday falls on the first of the month, your coverage begins the month before. For any other birthday, coverage begins the month you turn 65. You do not have to retire or stop working to sign up — the two are separate.

There are four parts to Medicare: Part A (hospital insurance), Part B (medical insurance), Part D (prescription drug coverage), and Part C (an alternative plan). Most people pay no premium for Part A if they or their spouse paid Medicare taxes for at least 10 years. Part B, Part D, and Part C have monthly premiums that vary based on your income and when you sign up.

You can sign up starting three months before the month you turn 65. The standard enrollment period lasts seven months total — three months before, the month of your birthday, and three months after. If you miss this window, you may face a permanent penalty on your premiums, so timing matters.

Key Takeaways

  • Medicare coverage begins the month you turn 65, and you can sign up three months before that date.
  • You do not have to be retired or stop working to sign up for Medicare at 65.
  • Missing the seven-month enrollment window around your 65th birthday can result in a permanent increase to your premiums.
  • Part A is usually free if you paid Medicare taxes for 10 years, but Part B and Part D have monthly costs that depend on your income.
  • Some people under 65 may be covered if they receive Social Security Disability Insurance or have end-stage renal disease.

Exceptions: Medicare before age 65

You can get Medicare before 65 in three situations. If you have received Social Security Disability Insurance (SSDI) for 24 months, you become covered at any age. If you have end-stage renal disease (permanent kidney failure requiring dialysis or transplant), you can enroll regardless of age. If you have ALS (amyotrophic lateral sclerosis, also called Lou Gehrig's disease), you are covered when ready upon approval for SSDI, without the 24-month wait.

To find out whether you may have access to under one of these exceptions, contact Social Security directly at 1-800-772-1213 or visit your local Social Security office. They can tell you whether your condition meets the criteria and when your coverage would start.

How to sign up at 65

You have three ways to sign up: online through Medicare.gov, by phone at 1-800-MEDICARE (1-800-633-4227), or in person at your local Social Security office. Online signup is the fastest — you can complete it in about 10 minutes if you have your Social Security number and birth certificate information ready.

If you are already receiving Social Security benefits when you turn 65, you are usually signed up for Part A and Part B automatically. Check your mail about two months before your 65th birthday for a notice confirming this. If you do not want Part B, you must decline it in writing during your enrollment period, or you will be charged the premium.

If you are still working and have health insurance through your employer, you may be able to delay Part B without penalty. This is called creditable coverage. Your employer's human resources or benefits department can tell you whether your plan qualifies. If it does, you have eight months after you leave that job to sign up for Part B without penalty.

What happens if you miss the enrollment important date

If you do not sign up during your seven-month enrollment window and you do not have creditable coverage through an employer, you will pay a permanent penalty. For Part B, the penalty is 10 percent of the standard premium for each full year you were not signed up. For Part D (prescription drugs), the penalty is 1 percent of the national base premium for each month you were not covered. These penalties stay with you for life, even if you sign up later.

There is one exception: if you sign up during the General Enrollment Period (January 1 to March 31 each year), you can enroll without penalty if you have a valid reason for missing your initial window. Valid reasons are limited and must be documented — for example, you were out of the country for more than six months, or you did not know you needed to sign up. Contact Medicare to ask whether your situation qualifies.

Part A versus Part B at 65

Part A covers hospital stays, skilled nursing facility care, hospice, and some home health services. Most people pay nothing for Part A premiums if they or their spouse paid Medicare taxes for at least 10 years while working. If you do not meet this requirement, you can still buy Part A, but the premium is higher.

Part B covers doctor visits, outpatient care, medical equipment, and preventive services. Part B has a monthly premium that changes each year. In 2024, the standard premium is $164.90 per month, but higher earners pay more. You also pay a yearly deductible ($240 in 2024) and 20 percent of the cost of most services after that.

You do not have to take Part B at 65 if you are still working and covered by your employer's health plan. But if you delay Part B and later lose that coverage, you have a limited time to sign up without penalty. The window is eight months after your employment or coverage ends — after that, the permanent penalty applies.

Income-based premiums and late enrollment

If your income is above a certain threshold, you pay a higher premium for Part B and Part D. Medicare uses your tax return from two years before to calculate this — so in 2024, they use your 2022 income. The thresholds change each year and are higher for married couples filing jointly than for single filers.

If your income drops significantly — because you retire, lose a job, or have a major life change — you can ask Medicare to recalculate your premium based on your current income instead of your past return. This is called a life-changing event. You must report it within 60 days of the event. Contact Medicare at 1-800-MEDICARE to file this request.

Frequently Asked Questions

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

Yes, if you have health insurance through your current employer. You can delay Part B without penalty as long as you are actively working and covered by that plan. Once you leave the job or lose the coverage, you have eight months to sign up for Part B. After that window closes, the permanent penalty applies.

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

No. Part A is automatic for most people, but you can decline it. Part B is optional — you can turn it down if you have other coverage. Part C and Part D are separate choices. You can take Part A and B but skip Part C and D, or take Part C (which includes drug coverage) instead of Part B and D. Your choices depend on your health needs and other insurance.

What if I turn 65 but am not a U.S. citizen?

You must be a U.S. citizen or a lawful permanent resident (green card holder) who has lived in the United States for at least five consecutive years to be covered by Medicare. If you are not yet a permanent resident, contact Social Security to learn what documentation you need. The rules vary by immigration status.

Does my spouse get Medicare when I turn 65?

No. Your spouse must sign up separately when they turn 65, or earlier if they meet the exceptions for disability or kidney disease. They have their own seven-month enrollment window. If they miss it and do not have credible coverage, they will face the same permanent penalty you would.

What if I was born on the first of the month?

Your Medicare coverage begins the month before you turn 65. For example, if you were born on January 1, your coverage starts December 1. You can sign up starting in September of that year. This rule exists because Medicare considers you to have reached your birthday on the first day of the month before if you were born on the first.