Medicare starts at age 65 for most people, but you can enroll earlier if you have certain disabilities or conditions

You become may be able to access for Medicare Part A (hospital insurance) at age 65, no matter your work history, as long as you or your spouse paid Medicare taxes for at least 10 years. You do not have to retire to collect it. If you are younger than 65, you may still enroll if you have been receiving Social Security disability benefits for 24 months, have end-stage renal disease (ESRD), or have amyotrophic lateral sclerosis (ALS). Part B (medical insurance) follows the same age and disability rules, though it costs a monthly premium that increases if you delay enrollment past 65.

The month you turn 65 is your Initial Enrollment Period—a seven-month window that starts three months before your birthday month and ends three months after. If you miss this window, you will pay a permanent penalty on Part B premiums for as long as you have Medicare, unless you have employer coverage or other may have access to circumstances. Enrollment happens through Social Security, Medicare.gov, or your local Social Security office.

Key Takeaways

  • You are may be able to access for Medicare Part A at 65 if you or your spouse paid Medicare taxes for at least 10 years, even if you are still working.
  • You can enroll in Medicare before 65 if you have been on Social Security disability for 24 months, have end-stage renal disease, or have ALS.
  • Your Initial Enrollment Period is seven months long—three months before your 65th birthday month through three months after—and missing it triggers a permanent premium penalty.
  • Part A is usually free at 65; Part B requires a monthly premium that increases if you delay enrollment without may have access to coverage.

Enrolling at 65 without a disability

If you reach 65 and have no may have access to disability or condition, you enter your Initial Enrollment Period automatically. You do not have to do anything on your 65th birthday—Social Security sends you information about three months before. Part A enrollment is automatic if you are already receiving Social Security retirement benefits; if you are not yet taking retirement, you must enroll in Part A separately.

Part B enrollment is not automatic and requires a choice. If you are still working and covered by your employer's health plan, you may be able to delay Part B without penalty—but only if your employer has 20 or more employees. If your employer has fewer than 20 employees, enroll in Part B when you turn 65 or face a penalty. Check with your employer's benefits office about your specific situation before your birthday month arrives.

Enrolling before 65 due to disability

You can enroll in Medicare at any age if you have been receiving Social Security Disability Insurance (SSDI) for 24 consecutive months. The 24-month clock starts from the month Social Security approves your disability claim, not from the month you filed. Once you hit 24 months of SSDI, Medicare Part A begins automatically; you still choose whether to enroll in Part B.

If you have end-stage renal disease (ESRD)—permanent kidney failure requiring dialysis or transplant—you are may be able to access when ready, regardless of age or work history. You have a three-month enrollment window: the month ESRD is diagnosed, the month before, and the month after. If you miss this window, you can still enroll, but coverage will not start until the first day of the month after you enroll.

If you have amyotrophic lateral sclerosis (ALS), you do not need to wait 24 months of disability benefits. You become may be able to access for Medicare the month your ALS diagnosis is made, with the same three-month enrollment window as ESRD. Contact Social Security directly to enroll; do not wait for them to contact you.

What happens if you miss your enrollment window

Missing your Initial Enrollment Period at 65 triggers a late enrollment penalty on Part B that lasts for life. 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 enrolled. If the standard premium is $165 per month and you waited three years to enroll, you would pay an extra $49.50 per month forever—even after you switch plans or move to a different state.

Part A does not have a late enrollment penalty, but if you do not enroll within three years of turning 65, you will have a gap in coverage. You can still enroll after that window closes, but your coverage will not start until the month after you enroll. If you were uninsured during that gap and had medical bills, Medicare will not cover them retroactively.

The only way to avoid the Part B penalty is to have may have access to coverage during the time you were not enrolled. Employer coverage (if your employer has 20 or more employees), TRICARE, the Veterans Health Administration, or certain other government plans count as may have access to coverage. You will need documentation from your employer or plan showing continuous coverage during the months you were not enrolled in Medicare.

Delaying enrollment if you are still working

If you are working at 65 and your employer offers health insurance, you may delay Part B enrollment without penalty—but only if your employer has 20 or more employees. This is called the working aged exception. You can stay on your employer plan and skip Medicare Part B until you retire or lose the employer coverage, whichever comes first.

When you do leave your job or lose employer coverage, you have eight months to enroll in Part B without penalty. This eight-month window is called your Special Enrollment Period. You will need a letter from your employer or benefits office stating the date your coverage ended and confirming that your employer had 20 or more employees. Keep this letter—you may need it to prove you may have access to for the exception.

Part A works differently. Even if you are working and covered by employer insurance, you should still enroll in Part A at 65 because it is usually free and has no penalty for late enrollment. Delaying Part A only makes sense if you have ESRD or ALS and are already covered by employer insurance; in those cases, you can coordinate the timing with your employer plan.

Coordinating Medicare with other coverage

If you have coverage through a current or former spouse's employer, a union plan, TRICARE, or the Veterans Health Administration, Medicare rules change. You may be able to delay Part B without penalty even if your employer has fewer than 20 employees, depending on the type of coverage. The rules are complex and vary by plan type.

If you are covered by TRICARE as a military retiree or family member, you can delay Part B until you lose TRICARE coverage. If you have Veterans Health Administration coverage, you can also delay Part B, though you should still enroll in Part A at 65. If you have coverage through a union or multi-employer plan, contact the plan administrator to learn whether you may have access to for a Special Enrollment Period.

Do not assume your current coverage counts as may have access to coverage for the working aged exception. Call your benefits office and ask directly: "Does my coverage count as creditable coverage that lets me delay Medicare Part B without penalty?" Get the answer in writing if possible.

Frequently Asked Questions

Can I enroll in Medicare before I turn 65?

Yes, if you have been on Social Security disability for 24 months, have end-stage renal disease, or have ALS. Otherwise, you must wait until the month you turn 65. Contact Social Security to confirm your may be able to access if you think you may may have access to early.

What if I turn 65 while still working?

You can enroll in Medicare at 65 even if you are working. If your employer has 20 or more employees and offers health insurance, you can delay Part B without penalty, but you should still enroll in Part A. If your employer has fewer than 20 employees, enroll in both Part A and Part B to avoid penalties.

How much does Medicare cost at 65?

Part A is free for most people at 65 if you or your spouse paid Medicare taxes for at least 10 years. Part B requires a monthly premium; the standard amount changes yearly. If you delay Part B past 65, your premium increases permanently by 10 percent for each year you waited.

What if I miss the enrollment important date?

You can still enroll after your Initial Enrollment Period ends, but you will pay a permanent penalty on Part B premiums unless you had may have access to coverage during the time you were not enrolled. Part A has no penalty, but coverage will not start until the month after you enroll.

Do I have to retire to collect Medicare?

No. You can enroll in Medicare at 65 and keep working. Your Medicare coverage is separate from your job and retirement benefits. You do not have to file for Social Security retirement to enroll in Medicare, though many people do both around the same time.