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

You become may be able to access for Medicare Part A (hospital insurance) at age 65 if you or your spouse paid Medicare taxes for at least 10 years while working. You do not have to stop working to sign up. If you were born on the first of the month, Medicare considers your birthday to be the first of the previous month for enrollment purposes.

You can sign up starting three months before the month you turn 65. If you miss that window, you can still join during the general enrollment period from January 1 to March 31 each year, but you may face a permanent penalty on your premiums if you delay without a valid reason.

If you do not have 10 years of work history under your name, you may still join at 65 based on your spouse's work record, even if you are divorced (as long as the marriage lasted at least 10 years and you are at least 62). Your spouse does not need to have signed up yet for you to use their record.

Key Takeaways

  • You can join Medicare at 65 if you or your spouse paid Medicare taxes for at least 10 years, and you should sign up three months before your 65th birthday to avoid penalties.
  • You may join before 65 if you receive Social Security disability benefits, have end-stage renal disease, or have been diagnosed with ALS, regardless of age.
  • If you are still working at 65 and have health insurance through your employer, you can delay Medicare Part B without penalty as long as your employer has 20 or more employees.
  • Signing up late without a valid reason triggers a permanent 10 percent increase in Part B premiums for each year you delayed, plus a similar penalty on Part D drug coverage.

Joining Medicare before 65 due to 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 on disability for 24 months. The 24 months is measured from the date your benefits began, not from the date you applied.

You do not have to do anything to enroll — Medicare will contact you automatically about two months before your 24-month mark. Part A coverage starts the 25th month of your disability benefits. Part B is optional and has its own enrollment rules; if you do not sign up when first offered, you will pay a permanent surcharge.

If you are on disability and turn 65, your Medicare coverage continues without interruption. Your may be able to access does not change, and you do not need to re-enroll.

End-stage renal disease and ALS

You can join Medicare at any age if you have end-stage renal disease (ESRD) — permanent kidney failure requiring dialysis or a transplant. You become may be able to access the first day of the month in which your dialysis treatment begins, or the month you receive a kidney transplant, whichever comes first. If you are already on dialysis when you explore, Medicare can cover you retroactively for up to three months before your process date.

You can also join at any age if you have been diagnosed with ALS (amyotrophic lateral sclerosis), also called Lou Gehrig's disease. Unlike ESRD, you do not have to wait for a specific treatment to start — diagnosis alone makes you may be able to access. Medicare coverage begins the first day of the month after you are approved.

For both conditions, you will need medical documentation from your doctor. Contact Medicare directly or visit Medicare.gov to start the process, since these cases do not follow the standard age-based enrollment timeline.

Working past 65 and employer coverage

If you are still employed at 65 and your employer offers health insurance, you can delay Medicare Part B without penalty as long as your employer has 20 or more employees. This rule applies whether the coverage is through your current employer or your spouse's employer. You must have actual coverage — being offered a plan is not enough.

You should still sign up for Part A at 65 even if you delay Part B, because Part A has no monthly premium if you have the required work history. Delaying Part A can result in a permanent penalty.

When you leave your job or your employer coverage ends, you have eight months to sign up for Part B without penalty. This is called a special enrollment period. If you miss this window, the 10 percent annual surcharge applies for each year you were may be able to access but not enrolled.

Spouse and family coverage

Your spouse can join Medicare at 65 based on your work record if you have paid Medicare taxes for at least 10 years, even if your spouse never worked or worked less than 10 years. Your spouse does not have to wait for you to sign up first. They can enroll in their own right starting three months before they turn 65.

If you are divorced, you can use your ex-spouse's work record to join at 65 if the marriage lasted at least 10 years and you are at least 62. You do not need your ex-spouse's permission or knowledge. If you remarry, you can still use your ex-spouse's record.

Children and grandchildren cannot join Medicare based on a family member's work record. Medicare is for people 65 and older, or younger people with specific disabilities or conditions.

What happens if you miss the enrollment window

If you do not sign up for Part B during your initial enrollment period (the three months before, the month of, and the three months after your 65th birthday), you can still join during the general enrollment period from January 1 to March 31 each year. However, your Part B premium will increase by 10 percent for each full year you were may be able to access but not enrolled.

This penalty is permanent — it stays on your premium for as long as you have Medicare. The same 10 percent annual surcharge applies to Part D (prescription drug coverage) if you go without creditable drug coverage and then sign up late.

The only exceptions are if you were covered by an employer plan with 20 or more employees, or if you had other creditable coverage. You will need to provide proof of that coverage when you enroll.

Frequently Asked Questions

Can I sign up for Medicare before I turn 65?

Yes, if you receive disability benefits (after 24 months), have end-stage renal disease, or have ALS. Otherwise, you must wait until three months before your 65th birthday. You cannot sign up early based on age alone.

Do I have to be a U.S. citizen to join Medicare?

No, but you must be a permanent resident (green card holder) or have been lawfully present in the U.S. for at least five consecutive years. Citizenship is not required. You still need the 10-year work history or a may have access to family connection.

What if I worked outside the United States?

Work you did in other countries may count toward the 10-year requirement if you paid into the U.S. Social Security system. Contact Social Security to verify your work history. Some countries have agreements with the U.S. that allow credits to transfer.

Can I delay Medicare if I have health insurance through my job?

Yes, you can delay Part B if your employer has 20 or more employees and you have actual coverage. You should still sign up for Part A at 65. When you leave the job, you have eight months to enroll in Part B without penalty.

What is the penalty for signing up late?

Part B premiums increase by 10 percent for each year you delayed enrollment without creditable coverage. This penalty is permanent. The same surcharge applies to Part D drug coverage if you go without creditable prescription coverage and then enroll late.