Medicare starts at age 65 for most people, but you can claim earlier if you have a disability or end-stage renal disease

You become may be able to access for Medicare Part A (hospital insurance) and Part B (medical insurance) the month you turn 65, as long as you or your spouse worked and paid Medicare taxes for at least 10 years. You do not have to retire to claim it. If you were born on the first of the month, your coverage begins the month before your 65th birthday; otherwise it begins the month of your birthday.

You can claim before 65 if you have been receiving Social Security Disability Insurance (SSDI) for 24 months, or if you have end-stage renal disease (permanent kidney failure requiring dialysis or transplant). People with ALS (amyotrophic lateral sclerosis) can claim Medicare when ready upon approval for SSDI, without waiting 24 months.

If you do not sign up during your initial enrollment window, you will face a permanent penalty on your Part B and Part D premiums — 10 percent per year you delayed, for as long as you have Medicare. The only exception is if you or your spouse were still working and covered by an employer health plan when you turned 65.

Key Takeaways

  • You become may be able to access for Medicare at 65 if you paid Medicare taxes for at least 10 years through work, whether or not you have retired.
  • You can claim Medicare before 65 if you have been on SSDI for 24 months, or if you have end-stage renal disease or ALS.
  • Your initial enrollment window is the three months before, the month of, and the three months after your 65th birthday — sign up during this time to avoid permanent premium penalties.
  • If you were covered by an employer health plan when you turned 65, you have a special enrollment period and can delay Part B without penalty.
  • You must actively enroll in Medicare; it does not happen automatically even if you receive Social Security.

The three-month enrollment window around your 65th birthday

Your Initial Enrollment Period (IEP) runs for seven months: three months before the month you turn 65, the month itself, and three months after. You should enroll during this window to avoid late penalties.

If you miss this window and do not have employer coverage or a may have access to reason for delay, you will pay a permanent 10 percent surcharge on your Part B premium for each full year you were may be able to access but not enrolled. This penalty sticks with you for life — it does not go away after a few years. Part D (prescription drug coverage) carries a similar penalty of about 1 percent per month of delay.

You can enroll online at Medicare.gov, by phone at 1-800-MEDICARE, or in person at your local Social Security office. You will need your Social Security number and information about any current health coverage.

Claiming Medicare before 65 through disability

If you are receiving SSDI, you automatically become may be able to access for Medicare after you have been on SSDI for 24 months. You do not have to explore separately — Social Security will notify you when you become may be able to access and will enroll you automatically in Parts A and B.

If you have ALS, Medicare coverage begins the same month your SSDI begins, with no waiting period. You will still need to enroll in Part D (prescription drugs) separately if you want it.

If you have end-stage renal disease, you become may be able to access for Medicare when ready upon diagnosis, regardless of age or work history. Your dialysis center or transplant team can help you understand the enrollment process, as these cases often move quickly.

What happens if you are still working at 65

You do not have to claim Medicare when you turn 65 if you are covered by an active employer health plan through your own job or your spouse's job. This is called creditable coverage, and it gives you a special enrollment period.

When you or your spouse eventually retires or lose that employer coverage, you have eight months to enroll in Medicare Part B without penalty. You must enroll within this window — waiting longer will trigger the permanent surcharge. Part A (hospital insurance) typically has no penalty for delay if you had employer coverage, but you should still enroll when your employer plan ends.

Tell your employer's benefits office that you are turning 65 and ask whether your plan is considered creditable coverage. If it is, ask them to document this in writing, as you may need proof later.

Enrolling in Part D and Medigap at the right time

Part D (prescription drug coverage) is separate from Parts A and B and requires a separate enrollment decision. You can enroll in Part D during your Initial Enrollment Period, or during the annual open enrollment period (October 15 to December 7 each year). If you go without Part D coverage when you are may be able to access, you will pay a penalty of about 1 percent of the national average Part D premium for each month you were not enrolled.

Medigap (supplemental insurance sold by private insurers) has its own enrollment rules. You have the best rates and may provide acceptance if you enroll within six months of turning 65 and enrolling in Part B. After that window closes, insurers can charge more or deny you based on health history.

You cannot have both Medigap and Medicare Advantage (Part C) at the same time. Decide which path makes sense for your situation before you enroll.

How to enroll and what documents you need

You can enroll online at Medicare.gov, by calling 1-800-MEDICARE (1-800-633-4227), or by visiting your local Social Security office. Have your Social Security number, date of birth, and information about any current health insurance ready.

If you are enrolling through Social Security (because you are already receiving benefits), the process is often automatic or can be done when you visit a Social Security office. If you are not yet receiving Social Security, you will enroll through Medicare directly.

Enrollment typically takes a few minutes by phone or online. Your coverage will begin on the first day of the month you enroll, or the first day of the following month if you enroll after the 15th.

What to do if you missed your enrollment window

If you missed your Initial Enrollment Period and do not have a may have access to reason for delay, you can still enroll, but you will face a permanent premium penalty. The penalty applies to Part B and Part D and does not expire.

You can enroll during the annual General Enrollment Period (January 1 to March 31 each year), and your coverage will begin July 1 of that year. This is a slower route than enrolling during your initial window, but it is still open to you.

If you believe you have a may have access to reason for delay — such as employer coverage you did not know about, or a medical condition that prevented you from explore — contact Medicare at 1-800-MEDICARE to discuss your situation. Some circumstances may allow you to avoid or reduce the penalty.

Frequently Asked Questions

Do I have to claim Social Security to get Medicare at 65?

No. You can claim Medicare without claiming Social Security retirement benefits. However, if you are already receiving Social Security, Medicare enrollment often happens automatically. If you are not receiving Social Security, you must enroll in Medicare separately through Medicare.gov or by calling 1-800-MEDICARE.

What if I turn 65 while still working and do not want Medicare yet?

If you have employer coverage through your job, you can delay Medicare Part B without penalty. You must enroll within eight months of losing that coverage. Part A (hospital insurance) typically has no penalty for delay if you had employer coverage, but you should still enroll when your employer plan ends to avoid gaps.

Can I change my mind after I enroll in Medicare?

Yes, but only during specific periods. You have a seven-month Initial Enrollment Period, and you can make changes during the annual open enrollment period (October 15 to December 7). Outside these windows, changes are limited unless you have a may have access to life event like losing employer coverage or moving to a new state.

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

You must be a U.S. citizen or permanent resident (green card holder) for at least five years to be may be able to access for Medicare. If you are a permanent resident, you will need to show proof of your status when you enroll. Contact Medicare at 1-800-MEDICARE if you have questions about your specific situation.

Do I lose Medicare if I move out of the country?

You can keep Medicare Part A (hospital insurance) if you move abroad, but Part B coverage ends if you leave the United States for more than six months. Part D (prescription drugs) does not cover prescriptions filled outside the U.S. If you plan to move, contact Medicare before you go to understand how your coverage will change.