Medicare may be able to access 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 month you turn 65, you enter your Initial Enrollment Period, a seven-month window that runs from three months before your birthday month through three months after it. During this window, you can sign up for Medicare Part A (hospital insurance) and Part B (medical insurance) without penalty. If you miss this window, you may pay a permanent surcharge on your premiums for as long as you have Medicare.

Some people become may be able to access before 65. If you have received Social Security Disability Insurance (SSDI) for 24 months, or if you have end-stage renal disease or ALS (amyotrophic lateral sclerosis), you can sign up at any age. Otherwise, 65 is the threshold.

Key Takeaways

  • You become may be able to access for Medicare at age 65 if you are a U.S. citizen or permanent resident who has lived in the country for at least five years.
  • Your Initial Enrollment Period runs for seven months — three months before your 65th birthday month, the month itself, and three months after — and missing it can cost you permanently higher premiums.
  • You can sign up before 65 if you have been on SSDI for 24 months, have end-stage renal disease, or have ALS.
  • You do not have to be retired to sign up for Medicare at 65, but if you are still working and have employer health insurance, you may want to delay Part B enrollment.

What happens if you are still working at 65

If you are working and covered by your employer's health insurance at 65, you have options. You must still sign up for Part A (hospital insurance) during your Initial Enrollment Period — there is no penalty for doing so, and it costs nothing if you have paid Medicare taxes for at least 10 years. However, you can delay Part B enrollment without penalty if your employer plan covers at least 20 employees.

This is called the Special Enrollment Period. When you leave your job or lose your employer coverage, you have eight months to sign up for Part B without a late-enrollment penalty. If you sign up after that eight-month window closes, you will pay a permanent 10 percent surcharge for each year you delayed — the surcharge compounds, so waiting years costs significantly more.

Tell your employer's benefits administrator that you are covered by Medicare Part A. Some employers coordinate their coverage with Medicare, and knowing you have Part A helps them process claims correctly.

How to sign up during your Initial Enrollment Period

You can sign up for Medicare three ways: online through Medicare.gov, by phone at 1-800-MEDICARE (1-800-633-4227), or in person at your local Social Security office. The online method is fastest — you can complete it in about 10 minutes if you have your Social Security number and information about any current health coverage.

If you are already receiving Social Security benefits, Medicare will contact you automatically about three months before you turn 65 and may enroll you in Part A and Part B without you taking action. Check the mail for a notice. If you do not want Part B yet (because you have employer coverage), you must contact Social Security or Medicare to decline it during your Initial Enrollment Period — declining in writing protects you from the late-enrollment penalty later.

Have ready: your Social Security number, proof of citizenship or permanent residency (passport, birth certificate, or green card), and information about any health insurance you currently have through an employer or spouse's employer.

What Part A and Part B cover

Part A covers inpatient hospital stays, skilled nursing facility care after a hospital stay, hospice care, and some home health services. There is no monthly premium for Part A if you or your spouse paid Medicare taxes for at least 10 years. If you have not, the premium ranges depending on how many years you paid in.

Part B covers doctor visits, outpatient care, lab tests, imaging, and preventive services. The standard monthly premium for 2024 is $164.90, though it varies by income — people with higher incomes pay more. You also pay a yearly deductible ($240 in 2024) and 20 percent of the cost of most services after the deductible is met.

Neither Part A nor Part B covers dental, vision, hearing aids, or long-term care. Many people add Part D (prescription drug coverage) or a Medigap or Medicare Advantage plan to fill these gaps. You can explore these options during your Initial Enrollment Period or during the annual open enrollment period from October 15 to December 7.

Delaying Medicare past 65

You can delay signing up for Medicare past your Initial Enrollment Period, but doing so costs you. For every 12 months you delay Part B after your Initial Enrollment Period ends, your monthly premium increases by 10 percent for the rest of your life. The surcharge applies even if you eventually sign up at 70 or 75.

The exception is if you have employer health insurance that covers at least 20 employees. In that case, you can delay Part B without penalty as long as you are actively employed and covered. Once you leave that job or lose the coverage, you have eight months to sign up. If you miss that eight-month window, the 10 percent annual surcharge applies.

Part A has no late-enrollment penalty, so you can delay it without financial consequence. However, if you do not sign up when you first become may be able to access and you later need hospital care, you will not be covered unless you enroll. It is safer to sign up for Part A even if you delay Part B.

Special situations: disability, ESRD, and ALS

If you have been receiving SSDI for 24 consecutive months, you become may be able to access for Medicare at any age. The 24-month clock starts the month after your SSDI benefits begin. You do not have to wait until 65. Social Security will contact you automatically when you reach 24 months and enroll you in Medicare Part A and Part B unless you decline Part B.

If you have end-stage renal disease (ESRD) — permanent kidney failure requiring dialysis or transplant — you can sign up for Medicare when ready, regardless of age. You have a three-month Initial Enrollment Period that starts the month your dialysis or transplant occurs. If you miss this window, you can still enroll, but you may face a late-enrollment penalty on Part B.

If you have ALS (amyotrophic lateral sclerosis), you become may be able to access for Medicare the month your SSDI benefits begin — you do not have to wait 24 months like other SSDI recipients. Social Security will enroll you automatically unless you decline Part B.

What to do if you missed your Initial Enrollment Period

If you did not sign up during your Initial Enrollment Period and you are not still covered by an employer plan, you can still enroll, but you will likely pay a permanent surcharge. The surcharge on Part B is 10 percent of the standard premium for each year you delayed, and it stays with you for life.

You can enroll during the General Enrollment Period, which runs from January 1 to March 31 each year. Coverage begins July 1 of that year. This is slower than enrolling during your Initial Enrollment Period, so if you need coverage sooner, contact Medicare at 1-800-MEDICARE to ask whether you may have access to for a Special Enrollment Period based on your specific situation.

Some life events — losing employer coverage, moving to a new state, or changes in your income — may open a Special Enrollment Period outside the standard windows. Call Medicare to discuss your circumstances.

Frequently Asked Questions

Do I have to sign up for Medicare at 65 if I have employer health insurance?

You must sign up for Part A, but you can delay Part B if your employer plan covers at least 20 employees and you are actively employed. Sign up for Part A to avoid gaps in coverage. When you leave your job, you have eight months to sign up for Part B without a penalty.

What if I turn 65 in the middle of the month?

Your Initial Enrollment Period is based on the month you turn 65, not the specific date. It runs from three months before that month through three months after. For example, if you turn 65 on June 15, your enrollment period is March through September.

Can my spouse sign up for Medicare before 65?

Only if they meet one of the special conditions: 24 months on SSDI, end-stage renal disease, or ALS. Otherwise, they must wait until 65. You can sign up at 65 even if your spouse is younger and still working.

What happens if I do not sign up for Part A?

Part A has no monthly premium if you paid Medicare taxes for 10 years, so there is no financial reason to skip it. If you do not sign up and later need hospital care, you will not be covered unless you enroll. It is safer to sign up during your Initial Enrollment Period.

Can I change my mind after I sign up?

Yes. You have until the end of the month following the month you sign up to change your coverage. After that, you can make changes only during the annual open enrollment period (October 15 to December 7) or if you experience a may have access to life event.