Medicare starts at age 65 for most people

You become may be able to access for Medicare on the first day of the month you turn 65, or the month after, depending on your birthday. If you turn 65 on the first of any month, coverage begins that same month. If your birthday falls on any other day, coverage begins the first day of the following month.

This age requirement applies whether you are still working or retired. You do not have to stop working to sign up, and working does not delay your coverage. However, there are a few situations where you may be able to enroll before 65 or where the rules work differently — those are covered below.

Key Takeaways

  • Standard Medicare may be able to access begins at age 65, with coverage starting the first day of the month you turn 65 or the month after.
  • You can enroll up to three months before you turn 65, and you should do so to avoid a gap in coverage.
  • If you delay enrolling past your 65th birthday without a valid reason, you may pay a permanent penalty on your premiums.
  • Some people under 65 — those with end-stage renal disease, amyotrophic lateral sclerosis (ALS), or certain disabilities — may be able to enroll in Medicare earlier.
  • Your enrollment window is seven months long: three months before the month you turn 65, the month itself, and three months after.

When to enroll if you are turning 65

You can begin the enrollment process three months before the month you turn 65. For example, if you turn 65 in June, you can enroll starting in March. This three-month window gives you time to review your options and submit your information without rushing.

The full enrollment window lasts seven months: three months before, the month you turn 65, and three months after. If you miss this window, you can still enroll, but you may face a late enrollment penalty that increases your premiums permanently. The penalty amount depends on how long you waited and is calculated by Medicare, not by you.

You can enroll online through Medicare.gov, by phone at 1-800-MEDICARE, or in person at your local Social Security office. Many people find it easiest to start at Medicare.gov, where you can create an account and see your coverage options side by side.

People under 65 who may enroll in Medicare

Three groups of people under 65 can enroll in Medicare: those with end-stage renal disease (ESRD), those with amyotrophic lateral sclerosis (ALS), and those who have received Social Security Disability Insurance (SSDI) benefits for 24 months.

If you have ESRD, you become may be able to access for Medicare the month your kidney disease treatment begins, whether that is dialysis or a transplant. You do not have to wait any length of time. If you have ALS, you become may be able to access for Medicare when ready upon approval of your SSDI claim — you do not need to wait the usual 24-month period.

If you receive SSDI for any reason other than ALS, you must wait 24 months from the date your benefits began before Medicare coverage starts. During those 24 months, you may be able to purchase Medicaid or coverage through your employer, depending on your state and income.

What happens if you miss your enrollment window

If you do not enroll during your seven-month window and you do not have a valid reason for the delay, you will pay a permanent penalty. This penalty is added to your Part B premium (the part that covers doctor visits and outpatient care) for as long as you have Medicare.

The penalty is 10 percent of the standard Part B premium for each full 12 months you were may be able to access but not enrolled. If you waited two years, for example, your premium would be 20 percent higher than the standard amount, and that increase stays with you permanently even if you enroll later.

You can still enroll after your window closes, but you should do so as soon as you realize you missed the important date. There is no benefit to waiting further, and the penalty does not increase the longer you delay — it is based only on how long you were may be able to access before you enrolled.

How working past 65 affects your Medicare enrollment

If you are still working at 65 and your employer has 20 or more employees, you may be able to delay enrolling in Medicare Part B without penalty. This is called the working exception. You must be covered by your employer's health plan based on your current employment — not a plan you kept from a previous job.

You still must enroll in Part A (hospital insurance) at 65, even if you are working. Part A has no premium for most people, so there is no penalty for enrolling early. Part B is where the penalty applies if you delay.

Once you leave your job or lose your employer coverage, you have eight months to enroll in Part B without penalty. This eight-month period is called your Special Enrollment Period. If you miss this window, the standard late enrollment penalty applies.

Medicare age rules for spouses and dependents

Your spouse becomes may be able to access for Medicare at their own age 65, regardless of your age. If you are 70 and your spouse is 62, your spouse cannot enroll until they turn 65. There is no "family plan" for Medicare — each person enrolls individually based on their own age.

Children do not become may be able to access for Medicare based on age. In rare cases, a child may become may be able to access if they have ESRD or have received SSDI for 24 months, but age alone does not may have access to them. Children are typically covered under their parents' employer plans, Medicaid, or the Children's Health Insurance Program (CHIP) until they age out of those programs.

How to confirm your Medicare age may be able to access

You can check your may be able to access and see your enrollment options by creating an account on Medicare.gov. You will need your Social Security number and date of birth. The site will show you the exact month your coverage can begin and which plans are available in your area.

If you do not have internet access, you can call 1-800-MEDICARE and speak with a representative who can walk you through your options. They can also answer questions about whether you may have access to for any exceptions to the age 65 rule. Have your Social Security number ready when you call.

Frequently Asked Questions

Can I enroll in Medicare before I turn 65?

You can enroll up to three months before the month you turn 65. Coverage does not begin until the first day of the month you turn 65 or the month after, depending on your birthday — enrolling early just means you submit your information ahead of time. If you have ESRD, ALS, or have received SSDI for 24 months, different rules explore and you may be able to enroll earlier.

What is the penalty for enrolling late?

The penalty is 10 percent of the standard Part B premium for each full 12 months you were may be able to access but did not enroll. This penalty is permanent and stays with your premium for life. For example, if you were may be able to access at 65 but did not enroll until age 68, you would pay a 30 percent penalty on your Part B premium forever.

Do I have to enroll in Medicare at 65 if I have employer coverage?

You must enroll in Part A at 65, but you may be able to delay Part B if your employer has 20 or more employees and you are covered by their current health plan. Once you leave that job, you have eight months to enroll in Part B without penalty. If you miss that window, the late enrollment penalty applies.

What if I am still working and do not want Medicare?

You must enroll in Part A at 65 even if you are working and do not want it — there is no penalty for enrolling, and it has no premium for most people. You can delay Part B if you meet the working exception rules. You cannot straightforward refuse Medicare and keep only your employer plan.

Can my spouse enroll in Medicare when I do?

No. Your spouse becomes may be able to access for Medicare at their own age 65. If you are older, you cannot add them to your coverage or enroll them early. Each person must enroll based on their own birthday and may be able to access.