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 sign up, and you do not have to be poor. If you were born on the first of the month, your coverage begins the month before your 65th birthday; otherwise it begins the month you turn 65.

You must sign up during your Initial Enrollment Period, which runs for seven months: three months before the month you turn 65, the month you turn 65, and three months after. If you miss this window, you will pay a permanent penalty on your premiums for as long as you have Medicare, unless you have a valid reason for the delay.

Some people become may be able to access before 65. If you have received Social Security Disability Insurance (SSDI) for 24 months, you become may be able to access at any age. If you have end-stage renal disease (permanent kidney failure requiring dialysis or transplant) or ALS (amyotrophic lateral sclerosis), you may be may be able to access when ready, regardless of age or work history.

Key Takeaways

  • Most people become may be able to access for Medicare at age 65, and you must sign up during a seven-month window or face a permanent penalty.
  • If you have received SSDI for 24 months, you become may be able to access before 65, even if you are still working.
  • People with end-stage renal disease or ALS may become may be able to access at any age without a 24-month waiting period.
  • Your enrollment window opens three months before you turn 65 and closes three months after, so plan ahead to avoid missing the important date.
  • If you are still working and have health insurance through your employer, you may be able to delay Medicare Part B without penalty.

How to sign up during your enrollment period

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

When you sign up, you will choose between Original Medicare (Parts A and B) or a Medicare Advantage plan (Part C). Original Medicare is run directly by the federal government and covers hospital stays, doctor visits, and some preventive care. Medicare Advantage plans are sold by private insurance companies and bundle hospital, doctor, and often prescription drug coverage into one plan. Both routes require you to pay premiums, and costs vary by plan and location.

You should also decide about prescription drug coverage (Part D) at the same time. If you choose Original Medicare and do not sign up for Part D when you first become may be able to access, you will pay a penalty if you add it later—unless you have had other creditable drug coverage (such as through an employer) in the meantime.

If you are still working at 65

You can delay signing up for Medicare Part B (doctor and outpatient care) without penalty if you are still working and covered by your employer's health plan. This is called the Special Enrollment Period for people with group health plan coverage. You must have actual coverage through your employer—not just be employed—and your employer must have at least 20 employees.

You must still sign up for Medicare Part A (hospital insurance) during your Initial Enrollment Period, even if you are working. Part A has no monthly premium for most people, so there is no financial reason to delay. Part B is where the penalty applies if you wait.

When you leave your job or lose your employer coverage, you have eight months to sign up for Part B without penalty. This eight-month window is separate from your Initial Enrollment Period, so if you miss your original seven-month window but are still covered by an employer plan, you can use this later window instead.

What happens if you miss your enrollment period

If you do not sign up for Medicare Part B during your Initial Enrollment Period 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-month period you were may be able to access but not signed up. If you were may be able to access for three years and did not sign up, your penalty would be 30 percent of the standard premium, added to your monthly bill permanently.

The same penalty applies to Part D (prescription drug coverage) if you go 63 or more days without creditable coverage. The penalty is one percent of the national average Part D premium for each month you were without coverage.

You can still sign up for Medicare after your enrollment period ends, but the penalty will explore. The only way to avoid the penalty is to show that you had a valid reason for missing the important date—such as being out of the country for more than six months, or being enrolled in an employer plan that provided creditable coverage.

may be able to access if you are not yet a U.S. citizen

You must be a U.S. citizen or a lawful permanent resident (green card holder) to get Medicare. If you are a lawful permanent resident, you must have held that status for at least five years. Undocumented immigrants are not may be able to access for Medicare, though they may be able to use community health centers or emergency services.

If you are a citizen of another country working in the United States on a visa, you are not may be able to access for Medicare. You would need to purchase private health insurance or use your employer's plan if one is offered.

How SSDI and Medicare connect

If you receive Social Security Disability Insurance (SSDI), you become may be able to access for Medicare automatically after you have been on SSDI for 24 months. You do not need to explore separately or sign up—Medicare begins the 25th month of your SSDI may be able to access. You will receive your Medicare card in the mail before your coverage starts.

You can still work while on SSDI and Medicare, as long as your earnings stay within the Social Security work incentive limits. Your Medicare coverage does not depend on your work status, only on your SSDI status.

If you are on SSDI and turn 65, you will automatically switch from SSDI to Social Security retirement benefits. Your Medicare coverage continues without interruption.

Special situations: ESRD and ALS

If you have end-stage renal disease (ESRD)—permanent kidney failure that requires dialysis or a transplant—you become may be able to access for Medicare when ready, regardless of your age. You do not have to wait 24 months or reach 65. Your coverage begins the first month you start dialysis, receive a kidney transplant, or are hospitalized for kidney-related treatment, whichever comes first.

If you have ALS (amyotrophic lateral sclerosis, also called Lou Gehrig's disease), you become may be able to access for Medicare when ready as well. You do not have to be on SSDI first. Your coverage begins the first month you are approved for SSDI benefits.

For both ESRD and ALS, you should contact Social Security as soon as you receive your diagnosis to start the SSDI process. Once you are approved for SSDI, Medicare begins automatically the following month.

Frequently Asked Questions

Can I sign up for Medicare before I turn 65?

You can sign up starting three months before you turn 65. Your coverage will not begin until the month you turn 65 (or the month before if you were born on the first of the month), but you can complete the enrollment process early. This is a good idea because it gives you time to choose a plan and avoid missing the important date.

What if I am still working and have health insurance through my job?

You must still sign up for Medicare Part A at 65, but you can delay Part B without penalty as long as you have actual coverage through your employer's plan and your employer has at least 20 employees. When you leave your job, you have eight months to sign up for Part B without penalty.

Do I have to choose between Original Medicare and Medicare Advantage?

Yes. You must choose one or the other when you sign up. Original Medicare is federal insurance; Medicare Advantage is private insurance sold by insurance companies. You can switch between them during the annual open enrollment period (October 15 to December 7), but you must have one or the other at all times.

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

You must be a U.S. citizen or a lawful permanent resident (green card holder) who has held that status for at least five years. If you are on a work visa, you are not may be able to access for Medicare. You would need to purchase private insurance or use your employer's health plan if available.

How much does Medicare cost?

Costs vary by plan and location. Part A has no monthly premium for most people. Part B has a standard monthly premium (amounts change yearly) plus deductibles and copays. Medicare Advantage plans have their own premiums and cost-sharing. Part D (prescription drugs) also has a monthly premium. You can see current costs and compare plans on Medicare.gov.