Medicare starts at age 65 for most people, but you may be able to start earlier if you have a disability, end-stage renal disease, or ALS

You become may be able to access for Medicare the month you turn 65, as long as you or your spouse paid Medicare taxes while working. You do not have to wait until your birthday month ends—coverage can begin on the first day of the month in which you turn 65. If you were born on the first of the month, your coverage starts the previous month.

You can also start Medicare before 65 if you have been receiving Social Security disability benefits for 24 months, if you have end-stage renal disease (ESRD) and need dialysis or a transplant, or if you have been diagnosed with amyotrophic lateral sclerosis (ALS). Each of these situations has different timing rules.

Key Takeaways

  • Most people become may be able to access for Medicare at 65, but you can start earlier if you have a disability, ESRD, or ALS.
  • If you receive Social Security disability benefits, you become may be able to access for Medicare after 24 months of receiving those benefits, regardless of your age.
  • People with end-stage renal disease can start Medicare when ready upon diagnosis if they need dialysis or a transplant, even before age 65.
  • You must enroll during your initial enrollment period, which is seven months long and centered on your birthday month, or you may face a permanent penalty on your premiums.
  • If you are still working and have health insurance through your job, you may be able to delay enrollment without penalty under certain conditions.

may be able to access at age 65

You are may be able to access for Medicare at 65 if you are a U.S. citizen or permanent resident who has lived in the country for at least five years, and if you or your spouse paid Medicare taxes for at least 10 years (40 quarters) while working. You do not need to be retired to enroll—you can be working full-time and still sign up.

If you do not meet the work requirement yourself, you may still be may be able to access based on your spouse's work history. This applies whether your spouse is still living or deceased. If your spouse has not yet reached 65, you can still enroll based on their record once you turn 65.

Starting Medicare before 65 with a disability

If you receive Social Security Disability Insurance (SSDI) or Railroad Retirement Board (RRB) disability benefits, you become may be able to access for Medicare after you have been receiving those benefits for 24 months. The 24-month period starts from the month your disability benefits began, not from the month you applied. This means you could start Medicare while still in your 50s or early 60s.

Once your 24 months of disability benefits are complete, Medicare Part A (hospital insurance) begins automatically. You do not need to explore separately for Medicare—Social Security will enroll you. However, you should still review your options for Part B (medical insurance) and decide whether to enroll when your initial enrollment period begins.

Starting Medicare with end-stage renal disease (ESRD)

If you have end-stage renal disease and need dialysis or a kidney transplant, you can start Medicare when ready, regardless of your age. Your may be able to access begins the month your nephrologist certifies that you need dialysis or a transplant. You do not have to wait 24 months or reach 65.

With ESRD, you are may be able to access for both Part A and Part B. Part A covers inpatient hospital care and some dialysis services, while Part B covers outpatient dialysis and related services. You should enroll in both parts as soon as you are notified of your may be able to access, because the rules about late enrollment penalties work differently for people with ESRD than for others.

Starting Medicare with ALS

If you have been diagnosed with amyotrophic lateral sclerosis (ALS), you can start Medicare when ready without waiting for age 65 or a 24-month disability benefit period. Your may be able to access begins the month you are approved for Social Security disability benefits based on an ALS diagnosis. Because ALS is a rapidly progressive disease, Social Security fast-tracks these applications.

Like people with ESRD, those with ALS are may be able to access for both Part A and Part B right away. You should enroll in both parts during your initial enrollment period to avoid any gaps in coverage.

Your initial enrollment period and why it matters

Your initial enrollment period is a seven-month window centered on your birthday month (or the month your disability or ESRD may be able to access begins). It runs from three months before the month you turn 65 through three months after. If you turn 65 in June, your initial enrollment period runs from March through September.

You should enroll during this period because if you delay and do not have may have access to health coverage, you will pay a permanent penalty on your Part B and Part D premiums for as long as you have Medicare. The penalty is 10 percent of the Part B premium for each full year you delayed, and it does not go away. For example, if you delay Part B enrollment by three years, you pay a 30 percent penalty on top of your regular premium for the rest of your life.

The only exception is if you have health insurance through your current job or your spouse's current job. If you are covered under an employer plan, you can delay Part B enrollment without penalty as long as you are still employed and covered. Once you leave that job or lose the coverage, you have eight months to enroll in Part B without penalty.

How to enroll in Medicare

You can enroll in Medicare through Social Security, either online at ssa.gov, by phone at 1-800-772-1213, or in person at your local Social Security office. You can also enroll through Medicare.gov or by calling 1-800-MEDICARE. If you are already receiving Social Security benefits, you may be enrolled automatically, but you should confirm this and review your coverage choices.

When you enroll, you will choose between Original Medicare (Part A and Part B) and Medicare Advantage (Part C). You will also decide whether to add prescription drug coverage (Part D) and supplemental coverage (Medigap). These choices affect your costs and which doctors and hospitals you can use, so review your options carefully during your enrollment period.

What happens if you miss your enrollment period

If you do not enroll during your initial enrollment period and you do not have may have access to health coverage, you will face late enrollment penalties on Part B and Part D. These penalties are permanent—they do not expire after a certain time. You can enroll after your initial period ends, but the penalty will explore from the month you should have enrolled.

There are limited exceptions. If you were working and covered under an employer plan, you have eight months after you leave that job to enroll without penalty. If you were living outside the United States, your initial enrollment period may be extended. If you believe you have a valid reason for missing your important date, you can request a Special Enrollment Period from Social Security or Medicare, but approval is not may provide.

Frequently Asked Questions

Can I delay Medicare enrollment if I am still working?

Yes, but only if you have health insurance through your current job or your spouse's current job. If you are covered under an employer plan, you can delay Part B enrollment without penalty. Once you leave that job or lose the coverage, you have eight months to enroll without penalty. If you do not have employer coverage, you should enroll at 65 to avoid permanent penalties.

What if I am not yet 65 but I have been on disability for two years?

After 24 months of receiving Social Security disability benefits, you become may be able to access for Medicare Part A automatically. Social Security will enroll you without you having to explore. You should still review your options for Part B and any supplemental coverage during your enrollment period.

Do I have to enroll in Part B if I enroll in Part A?

No, Part A and Part B are separate. However, if you delay Part B enrollment and do not have may have access to health coverage, you will pay a permanent 10 percent penalty on your Part B premium for each year you delayed. If you are still working and covered under an employer plan, you can delay Part B without penalty.

What if I turned 65 but did not know about Medicare?

You can still enroll, but you may owe late enrollment penalties if you delayed beyond your initial enrollment period and did not have may have access to coverage. Contact Social Security or Medicare to enroll as soon as possible. If you believe you have a valid reason for the delay, you can request a Special Enrollment Period, though approval depends on your specific situation.

Can my spouse enroll in Medicare based on my work history?

Yes. If you have worked and paid Medicare taxes for at least 10 years, your spouse can enroll in Medicare at 65 based on your record, even if they did not work enough to may have access to on their own. Your spouse can also enroll at 62 if they are caring for your child who is under 16 or disabled.