When You Can Start Medicare: Age, Work Status, and Special Circumstances

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

You become may be able to access for Medicare on the first day of the month you turn 65. If your birthday falls on the first of the month, that is your start date. If it falls on any other day, Medicare begins on the first of the following month. You do not have to be retired to sign up — your age alone qualifies you, whether you are still working or not.

The main exception is if you have already been receiving Social Security disability benefits for 24 months. In that case, Medicare starts automatically at age 65, but you may have already been covered for years. Three other groups can start before 65: people with end-stage renal disease (ESRD), people with amyotrophic lateral sclerosis (ALS), and people who have been on Social Security disability for the full 24-month waiting period.

Key Takeaways

Medicare begins the first day of the month you turn 65, regardless of whether you are working.
If you have been on Social Security disability for 24 months, Medicare starts automatically without you needing to sign up again.
People with end-stage renal disease or ALS can start Medicare before age 65, sometimes when ready after diagnosis.
You should sign up during your Initial Enrollment Period, which runs three months before your 65th birthday through three months after, to avoid late penalties.
If you miss your Initial Enrollment Period, you can still sign up during General Enrollment (January 1 to March 31 each year), but you may owe higher premiums.

Starting Medicare at 65 if you are still working

Working past 65 does not delay your Medicare start date. You become may be able to access at 65 and should sign up during your Initial Enrollment Period even if you plan to keep working. Your employer health insurance and Medicare can work together — Medicare becomes your primary coverage, and your employer plan covers what Medicare does not.

There is one situation where timing matters: if your employer has 20 or more employees, your employer plan is primary and Medicare is secondary. In that case, you can delay Medicare Part B (medical insurance) without penalty as long as you are covered by the employer plan. Once you leave that job or lose the coverage, you have eight months to sign up for Part B without paying extra. If you wait longer than eight months, you will owe a permanent 10 percent increase to your Part B premium for each year you were late.

Medicare for people on Social Security disability before age 65

If you have been receiving Social Security Disability Insurance (SSDI) for 24 months, Medicare starts automatically. You do not need to explore separately. The 24-month clock starts from the month your disability benefits began, not from when you were approved. After 24 months pass, you are enrolled in Medicare Part A (hospital insurance) and Part B (medical insurance) without having to do anything.

You will receive a Medicare card in the mail about three months before your coverage begins. If you do not receive one, contact Social Security to confirm your enrollment. Some people on SSDI also may have access to for Medicaid, depending on their state and income — these two programs can cover different services, so having both is common.

Starting Medicare with end-stage renal disease or ALS

People with end-stage renal disease (ESRD) can start Medicare as soon as they begin dialysis or receive a kidney transplant, regardless of age. You do not have to wait until 65. Medicare Part A covers dialysis and transplant care. You will need to sign up for Part B separately if you want coverage for doctor visits and outpatient services.

People with ALS (amyotrophic lateral sclerosis) can start Medicare when ready upon diagnosis, also regardless of age. You must explore through Social Security — the diagnosis alone does not enroll you automatically. Bring medical documentation of your ALS diagnosis to your local Social Security office or explore online at ssa.gov. Once approved, Medicare Part A and Part B coverage begins.

Your Initial Enrollment Period and what happens if you miss it

Your Initial Enrollment Period is a seven-month window: it starts three months before the month you turn 65 and ends three months after. For example, if you turn 65 in June, your period runs from March through September. During this window, you can sign up for Medicare Part A and Part B without paying a penalty, no matter what your health status is.

If you miss this window, you can still sign up during General Enrollment, which runs January 1 through March 31 each year. However, you will owe a permanent 10 percent increase to your Part B premium for each full 12-month period you were late. This penalty stays with you for life, even if you switch plans later. The only exception is if you had creditable coverage (health insurance from an employer with 20 or more employees) when you turned 65 — in that case, you have eight months after losing that coverage to sign up without penalty.

How to sign up for Medicare

You can sign up online at Medicare.gov, by phone at 1-800-MEDICARE (1-800-633-4227), or in person at your local Social Security office. Online signup is fastest — you will need your Social Security number and information about any current health coverage. The process takes about 10 minutes.

If you are already receiving Social Security benefits, you may be able to sign up automatically without doing anything. Social Security will contact you about three months before you turn 65 to confirm whether you want automatic enrollment. If you do not want it, you can decline and sign up yourself during your Initial Enrollment Period.

Late enrollment penalties and how they work

Missing your Initial Enrollment Period costs money. For Part B, you pay an extra 10 percent of the standard premium for each 12-month period you were late. If the standard Part B premium is $165 per month and you were one year late, you would pay an extra $16.50 per month for life. For Part D (prescription drug coverage), the penalty is 1 percent of the national average premium per month late, also permanent.

Part A does not usually have a penalty if you sign up within your Initial Enrollment Period or General Enrollment. However, if you wait more than 12 months after your Initial Enrollment Period ends and you do not have creditable coverage, you may owe a 10 percent penalty on Part A premiums as well. The safest approach is to sign up during your Initial Enrollment Period, even if you do not plan to use Medicare right away.

Frequently Asked Questions

What if I turn 65 but do not want Medicare yet because I have employer coverage?

You can delay Part B without penalty if your employer has 20 or more employees and you are still working. You must sign up for Part A (hospital insurance) during your Initial Enrollment Period to avoid a penalty. Once you leave your job or lose coverage, you have eight months to sign up for Part B penalty-free.

Do I have to retire to start Medicare?

No. Medicare is based on age or disability status, not retirement. You can work full-time and still be covered by Medicare at 65. Your earnings do not affect your coverage or your benefits.

Can I delay Medicare past 65 if I am still healthy and do not need it?

You can delay Part B if you have creditable employer coverage, but you should still sign up for Part A during your Initial Enrollment Period. Delaying Part B beyond your Initial Enrollment Period without creditable coverage will result in a permanent premium increase.

What happens to my Medicare if I move to another state?

Medicare coverage follows you anywhere in the United States. Your benefits and premiums stay the same. You may want to review your prescription drug plan and Medicare Advantage plan options in your new state, since networks vary by location.

If I was denied Social Security disability, can I still get Medicare before 65?

Only if you have end-stage renal disease or ALS. Social Security disability denial does not open other early Medicare pathways. You would need to wait until 65 or until you meet the medical criteria for ESRD or ALS coverage.

This guide is for general information only and is not medical, financial, legal, or other professional advice. For decisions specific to your situation, consult a qualified professional. See our Editorial Policy.