Medicare starts at age 65 for most people, but you can enroll 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 is the 15th or later, coverage begins the first of the following month. You do not have to wait until your actual birthday to sign up — you can enroll during the three months before you turn 65, the month you turn 65, or the three months after. That seven-month window is called your Initial Enrollment Period.

If you miss this window, you can still enroll later, but you may pay a permanent penalty on your premiums. The penalty is 10 percent for each full 12 months you were may be able to access but did not sign up, and it stays with you for life. The only way to avoid the penalty is to have had creditable coverage — meaning health insurance as good as or better than Medicare — during the time you were not enrolled.

You do not automatically receive Medicare at 65. You must enroll yourself, either online at Medicare.gov, by phone at 1-800-MEDICARE, or in person at your local Social Security office. If you are already receiving Social Security benefits, you will be enrolled automatically three months before you turn 65, but you should still check your enrollment status to make sure it went through correctly.

Key Takeaways

  • Most people become may be able to access for Medicare at age 65, and you can enroll starting three months before your birthday.
  • You can enroll earlier than 65 if you have been receiving Social Security Disability Insurance (SSDI) for 24 months, have end-stage renal disease, or have been diagnosed with ALS.
  • Missing your Initial Enrollment Period results in a permanent 10 percent premium penalty for each year you delay, unless you had other creditable coverage.
  • Enrollment happens through Medicare.gov, by phone, or at your local Social Security office — it is not automatic unless you are already collecting Social Security.

Enrolling before 65 if you have a disability

If you receive Social Security Disability Insurance (SSDI), you become may be able to access for Medicare after you have been receiving benefits for 24 months. This means if you started SSDI at age 40, you would be may be able to access for Medicare at age 42. You do not need to do anything — Medicare will enroll you automatically after the 24-month waiting period ends.

If you receive Railroad Retirement Board (RRB) disability benefits, the same 24-month rule applies. You will be enrolled automatically once the waiting period is over.

You should receive a notice in the mail about two months before your Medicare coverage begins. Check it carefully to make sure all your information is correct. If you do not receive a notice, contact Social Security at 1-800-772-1213 to confirm your enrollment status.

Enrolling before 65 if you have end-stage renal disease or ALS

You can enroll in Medicare at any age if you have been diagnosed with end-stage renal disease (ESRD) — permanent kidney failure that requires dialysis or a transplant. You become may be able to access the first month you start dialysis treatment or the month you receive a kidney transplant, whichever comes first. If you receive a pre-emptive transplant before starting dialysis, you are may be able to access the month of the transplant.

You can also enroll at any age if you have been diagnosed with ALS (amyotrophic lateral sclerosis), also called Lou Gehrig's disease. You become may be able to access the first month your doctor confirms the diagnosis. Unlike ESRD, there is no waiting period — coverage can begin as soon as you are diagnosed.

For both conditions, you must enroll yourself. Contact Medicare at 1-800-MEDICARE or enroll online at Medicare.gov. Bring documentation of your diagnosis — your doctor's letter, dialysis records, or transplant paperwork — when you enroll. Coverage typically begins the first of the month after you submit your enrollment.

What happens if you delay enrollment past your important date

If you do not enroll during your Initial Enrollment Period and you do not have creditable coverage, you will pay a late enrollment penalty for as long as you have Medicare Part B (medical insurance). The penalty is 10 percent of the standard Part B premium for each full 12 months you were may be able to access but did not enroll. If the standard premium is $165 per month and you were late by three years, your penalty would be 30 percent, or about $50 extra per month for life.

The same penalty applies to Part D (prescription drug coverage). If you go 63 days or more without Part D coverage and you do not have other creditable drug coverage, you pay a penalty of 1 percent of the national average Part D premium for each month you were without coverage. This penalty also stays with you permanently.

There is one exception: if you had creditable coverage through an employer or union health plan, or through a spouse's plan, you do not owe a penalty. Creditable coverage means the plan covered prescription drugs at least as well as Medicare Part D does. When you lose that coverage, you have a two-month grace period to enroll in Part D without penalty. Ask your former employer or plan administrator for a letter stating that your coverage was creditable.

How to enroll in Medicare

You can enroll online at Medicare.gov using your Social Security number and date of birth. The website walks you through choosing between Original Medicare (Part A and Part B) and Medicare Advantage plans. You can also see what prescription drug plans (Part D) are available in your area and compare costs.

If you prefer to enroll by phone, call 1-800-MEDICARE (1-800-633-4227). Representatives are available seven days a week, 24 hours a day. They can answer questions about your coverage options and help you complete your enrollment over the phone. If you are deaf or hard of hearing, use TTY 1-877-486-2048.

You can also visit your local Social Security office in person to enroll. Find your nearest office at ssa.gov/locator. Bring your Social Security card, proof of citizenship or legal residency, and proof of age (birth certificate or passport). If you are enrolling early due to disability, bring documentation of your condition as well.

Understanding your enrollment period windows

Your Initial Enrollment Period is seven months long: the three months before the month you turn 65, the month you turn 65, and the three months after. If you enroll during this window, your coverage begins on the first of the month you turn 65 (or the first of the following month if your birthday is the 15th or later).

If you miss your Initial Enrollment Period, you can enroll during the General Enrollment Period, which runs from January 1 to March 31 each year. Coverage begins July 1 of that year. However, you will owe the late enrollment penalty unless you had creditable coverage.

If you are still working at 65 and you or your employer have health insurance through your job, you may may have access to for a Special Enrollment Period. This allows you to enroll in Medicare without penalty even after your Initial Enrollment Period ends. You must enroll within eight months of losing your job-based coverage or retiring. Ask your employer's benefits department whether you may have access to.

What to expect after you enroll

After you enroll, Medicare will mail you a Medicare card about two weeks before your coverage begins. The card shows your Medicare number, which parts of Medicare you have, and the date your coverage starts. Keep this card with you and show it to doctors, hospitals, and pharmacies.

You will also receive information about your coverage options, including what Part A (hospital insurance) and Part B (medical insurance) cover, what your costs will be, and how to find doctors and hospitals in your plan's network. If you chose a Medicare Advantage plan or a Part D prescription drug plan, you will get separate materials about those plans.

Your coverage begins on the date shown on your card. You are responsible for paying any costs Medicare does not cover, such as deductibles, copayments, and coinsurance. If you cannot afford these costs, you may be able to get help through programs like Medicaid or the Medicare Savings Program, depending on your income.

Frequently Asked Questions

Can I enroll in Medicare before I turn 65 if I am still working?

Yes, if you have a may have access to condition like SSDI, ESRD, or ALS, you can enroll at any age. If you are still working and have employer health insurance, you can delay enrolling in Part B without penalty as long as your employer has 20 or more employees. You must enroll within eight months of leaving your job or losing coverage.

What if I turn 65 outside the United States?

You can still enroll in Medicare during your Initial Enrollment Period even if you are living abroad. Enroll online at Medicare.gov or call 1-800-MEDICARE. Some parts of Medicare do not cover care outside the U.S., so review your coverage options carefully before you enroll.

Do I have to enroll in Part B if I am still working at 65?

You do not have to enroll in Part B at 65 if you have health insurance through your current job and your employer has 20 or more employees. However, you must enroll within eight months of retiring or losing that coverage to avoid a late enrollment penalty.

What is the difference between my Initial Enrollment Period and the General Enrollment Period?

Your Initial Enrollment Period is seven months long and centered on the month you turn 65. If you enroll then, your coverage starts at 65. The General Enrollment Period is January 1 to March 31 each year and is open to anyone who missed their Initial Enrollment Period, but coverage does not start until July 1 and you will owe a penalty.

If I delay Medicare, can I get the penalty waived?

The penalty is waived only if you had creditable coverage — health insurance as good as Medicare — during the time you were not enrolled. You must provide proof of that coverage, such as a letter from your former employer or plan. The penalty cannot be waived for any other reason.