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

You become may be able to access for Medicare Part A (hospital insurance) the month you turn 65, as long as you or your spouse paid Medicare taxes for at least 10 years while working. 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 you turn 65.

You can also draw Medicare before 65 if you have been receiving Social Security disability benefits for 24 months, or if you have end-stage renal disease (permanent kidney failure requiring dialysis or transplant) or ALS (amyotrophic lateral sclerosis). People with these conditions can enroll as soon as they meet the medical criteria, regardless of age.

If you do not have 10 years of work history under your name, you may still be covered as a spouse or widow. A current spouse age 62 or older can claim on your record, and a widow or widower at any age can claim if caring for your child under 16.

Key Takeaways

  • Most people become may be able to access for Medicare Part A at age 65 if they or a spouse paid Medicare taxes for at least 10 years.
  • You can draw Medicare before 65 if you have been on Social Security disability for 24 months, have end-stage renal disease, or have ALS.
  • Your coverage month depends on your birth date: if born on the first of the month, coverage starts the month before you turn 65.
  • You must actively enroll in Medicare Part B (medical insurance) during your enrollment window or pay a permanent penalty if you delay without a valid reason.
  • Spouses and widows may be covered under your work record even if they did not work the required 10 years themselves.

How the 65-year-old enrollment window works

Your initial enrollment period is seven months long: it starts three months before the month you turn 65 and ends three months after. During this window, you can enroll in Medicare Part B (medical insurance) without penalty. If you miss this window and do not have employer coverage or a valid reason for the delay, you will pay a permanent 10 percent surcharge on your Part B premium for as long as you have Medicare.

You do not have to enroll in Part B at 65 if you are still working and covered by your employer's health plan. In that case, you have an eight-month window after you leave that job to enroll in Part B without penalty. This is called your special enrollment period. You will need to show proof that you had employer coverage when you turned 65.

Part A enrollment is automatic for most people. If you are already receiving Social Security benefits, Medicare Part A will start automatically at 65. If you are not yet taking Social Security, you will need to contact Social Security to enroll in Part A, or you can enroll through Medicare.gov or by phone at 1-800-MEDICARE.

Drawing Medicare before age 65 with a disability

If you have been approved for Social Security Disability Insurance (SSDI) and have been receiving benefits for 24 consecutive months, you become may be able to access for Medicare Part A at that point, regardless of your age. The 24-month waiting period is built into the SSDI program itself—you do not need to do anything extra to trigger Medicare once those 24 months have passed.

Your Medicare coverage will begin automatically in the 25th month of your disability benefits. You will receive a Medicare card in the mail before your coverage starts. You should still enroll in Part B during your initial enrollment period (which runs from three months before through three months after the month your Part A coverage begins) to avoid the permanent penalty.

If you are receiving Supplemental Security Income (SSI) instead of SSDI, the rules are different. SSI recipients become may be able to access for Medicare after 24 months of SSI payments, but the timing and process can vary. Contact Social Security directly to confirm your enrollment date.

End-stage renal disease and ALS exceptions

People with end-stage renal disease (ESRD)—permanent kidney failure that requires dialysis or a transplant—can enroll in Medicare when ready upon diagnosis, regardless of age. You do not have to wait until 65 or meet any work history requirement. Your coverage begins the first day of the month in which your dialysis treatment begins, or the month of your transplant.

People with ALS (Lou Gehrig's disease) can also enroll in Medicare right away without waiting for age 65 or a disability benefit approval. Your coverage begins the first day of the month after you are diagnosed. You will need medical documentation of your ALS diagnosis to enroll.

For both ESRD and ALS, you should contact Medicare directly at 1-800-MEDICARE or visit Medicare.gov to enroll. Bring your diagnosis documentation and any relevant medical records. These conditions bypass the normal age and work-history rules entirely.

Spousal and survivor coverage before 65

If your spouse is 62 or older and you are 65 or older, your spouse can draw Medicare Part A on your work record even if they did not work the required 10 years themselves. Your spouse will need to be married to you for at least one year (or be the parent of your child) to claim on your record.

A widow or widower can draw Medicare Part A at any age if they are caring for your child who is under 16 years old. If they are not caring for a child, they can draw at age 60. A divorced spouse can also draw on your record at age 62 if the marriage lasted at least 10 years.

Spouses and survivors do not have to wait until 65 to enroll in Part B, but they should enroll during their own initial enrollment period to avoid penalties. The enrollment window is the same seven-month period (three months before through three months after the month they turn 65, or the month they become may be able to access due to disability or ESRD).

What happens if you delay enrollment past 65

If you do not enroll in Part B during your initial enrollment period and you do not have a valid reason for the delay, you will pay a permanent penalty. The penalty is 10 percent of the standard Part B premium for each full year you were may be able to access but not enrolled. This penalty stays with you for life, even if you enroll later.

Valid reasons for delay include having employer coverage through your job or your spouse's job, or having COBRA continuation coverage. If you had one of these, you have an eight-month special enrollment period after the coverage ends to enroll in Part B without penalty. You will need to provide proof of the employer coverage.

Part A does not have a penalty for late enrollment if you have the required work history, but you should still enroll as soon as you turn 65 to avoid gaps in coverage. If you do not have 10 years of work history and you delay, you may lose the chance to claim on a spouse's record if circumstances change.

How to enroll when you are ready

You can enroll in Medicare three ways: online at Medicare.gov, by phone at 1-800-MEDICARE (1-800-633-4227), or in person at your local Social Security office. If you are already receiving Social Security benefits, Part A will start automatically at 65 and you will receive your card in the mail. You only need to take action if you want to enroll in Part B or if you are not yet taking Social Security.

Have your Social Security number and information about any current health coverage ready when you enroll. If you are enrolling due to a disability or ESRD, bring medical documentation. The enrollment process takes about 15 minutes online or by phone.

If you miss your initial enrollment period, you can still enroll during the general enrollment period, which runs from January 1 to March 31 each year. Coverage would begin July 1 of that year. However, you will owe the permanent penalty unless you have a valid reason for the delay.

Frequently Asked Questions

Can I draw Medicare if I never worked?

Not on your own record. However, you may be covered as a spouse (if age 62 or older and married at least one year), a widow or widower (at any age if caring for a child under 16, or at age 60 otherwise), or a divorced spouse (if the marriage lasted 10 years and you are 62 or older). Contact Social Security to explore these options.

What if I am still working at 65?

You can still enroll in Medicare Part A at 65. For Part B, you can delay enrollment without penalty if you have employer coverage through your job. Once you leave that job, you have eight months to enroll in Part B. You will need to show proof of the employer coverage to avoid the permanent penalty.

Do I have to take Social Security to get Medicare?

No. You can enroll in Medicare Part A at 65 without claiming Social Security retirement benefits. However, if you delay Social Security past 65, your benefit amount will be higher. You must actively enroll in Medicare if you are not already receiving Social Security.

How long does it take to get my Medicare card after I enroll?

It typically takes two to four weeks to receive your card in the mail after you enroll. You can view your coverage information online at Medicare.gov using your login before the card arrives. If you need coverage to start on a specific date, enroll at least one month in advance.

What if I turned 65 and did not enroll—can I still sign up?

Yes, but you may owe a permanent penalty on Part B if you do not have a valid reason for the delay, such as employer coverage. You can enroll during the general enrollment period (January 1 to March 31), though coverage would not start until July 1. Contact Medicare to discuss your situation and any penalties that may explore.