You become may be able to access for Medicare at age 65, or earlier if you have a disability or end-stage renal disease

Most people become Medicare may be able to access the month they turn 65, regardless of whether they are still working. If you are already receiving Social Security benefits, Medicare enrollment happens automatically. If you are not yet on Social Security, you will need to sign up for Medicare yourself during your enrollment window — usually the three months before the month you turn 65, the month itself, and three months after.

You can also become may be able to access before 65 in two situations: if you have been receiving Social Security Disability Insurance (SSDI) for 24 months, or if you have end-stage renal disease (ESRD) requiring dialysis or a transplant. People with ALS (amyotrophic lateral sclerosis) become may be able to access when ready upon approval for SSDI, without the 24-month wait.

Key Takeaways

  • You become may be able to access for Medicare at 65, or at any age if you have received SSDI for 24 months, have ALS, or have end-stage renal disease.
  • If you are already on Social Security, Medicare enrollment is automatic; if not, you must sign up during your seven-month enrollment window.
  • Signing up late without a valid reason can result in a permanent penalty on your Part B and Part D premiums.
  • You can delay enrollment past 65 only if you are still working and covered by your employer's health plan, or you may face higher costs later.

Age 65 and automatic enrollment through Social Security

If you are already collecting Social Security retirement or spousal benefits when you turn 65, Social Security will enroll you in Medicare Part A and Part B automatically. You will receive your Medicare card in the mail about two weeks before your 65th birthday. You do not need to do anything — the enrollment is handled between Social Security and Medicare.

This automatic enrollment applies whether you are still working or retired. Your age, not your employment status, determines your Medicare may be able to access. However, if you are still working and covered by your employer's health plan, you may want to delay Part B enrollment to avoid paying premiums while your employer plan is primary. You can do this by declining Part B in writing when you receive your Medicare card, but you must act before your initial enrollment period ends.

Signing up if you are not yet on Social Security

If you have not started collecting Social Security by age 65, you must sign up for Medicare yourself. Your initial enrollment period runs for seven months: three months before the month you turn 65, the month of your birthday, and three months after. For example, if you turn 65 in June, your window opens in March and closes in September.

You can sign up online at Medicare.gov, by phone at 1-800-MEDICARE, or in person at your local Social Security office. Have your Social Security number and proof of citizenship or legal residency ready. If you miss this seven-month window and do not have a valid reason, you will face a permanent late enrollment penalty on your Part B premium — typically 10 percent per year for each year you delayed, added to your premium for life.

Disability before age 65

If you are approved for Social Security Disability Insurance (SSDI), you become may be able to access for Medicare after you have been receiving SSDI for 24 consecutive months. The 24-month clock starts from the month your disability benefits begin, not the month you applied. Once you reach 24 months, Medicare enrollment happens automatically if you are already on SSDI; you will receive your card in the mail.

The exception is ALS (amyotrophic lateral sclerosis). People approved for SSDI due to ALS become may be able to access for Medicare when ready, without waiting 24 months. If you have ALS and have been approved for SSDI, contact Social Security to confirm your Medicare enrollment, as it should happen automatically but it is worth verifying.

End-stage renal disease and when ready may be able to access

If you have end-stage renal disease (ESRD) requiring dialysis or a kidney transplant, you become may be able to access for Medicare when ready, regardless of age. You do not need to be on Social Security or any other benefit program. ESRD may be able to access is based on your medical condition, not your age or work history.

You will need to sign up for Medicare yourself. Contact Medicare at 1-800-MEDICARE or visit Medicare.gov. Your dialysis center or transplant team can also help you understand your enrollment options. Your initial enrollment period is the month you are notified of your ESRD diagnosis, plus 12 months after. If you miss this window, you may face a late enrollment penalty on Part B and Part D.

What happens if you are still working at 65

Working past 65 does not delay your Medicare may be able to access — you still become may be able to access at 65. However, if your employer's health plan covers you as an active employee, you may not need to enroll in Medicare Part B right away. Your employer plan will be primary, and Medicare will be secondary.

If you choose to delay Part B enrollment while covered by an employer plan, you must have written proof that you are covered as an active employee (not as a retiree or dependent). When you eventually leave your job or lose that coverage, you will have an eight-month special enrollment period to sign up for Part B without a late penalty. This is one of the few situations where you can delay Part B without penalty.

Late enrollment penalties and how to avoid them

If you do not sign up for Part B during your initial enrollment period and 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 on your premium for as long as you have Medicare.

Valid reasons to delay without penalty include being covered by an employer's health plan as an active employee, or having a may have access to life event such as loss of employer coverage. If you missed your enrollment window but believe you have a valid reason, contact Social Security or Medicare to request a special enrollment period. The sooner you contact them, the better — penalties can be waived if you act quickly after losing coverage.

Frequently Asked Questions

Can I delay Medicare enrollment if I am still working?

You can delay Part B enrollment only if you are covered by your employer's active employee health plan. You must have written proof of this coverage. When you leave your job or lose that coverage, you have eight months to enroll in Part B without a late penalty. Part A has no penalty for delay if you are covered by an employer plan.

What if I turn 65 but have not received my Social Security approval yet?

You can still sign up for Medicare at 65 even if your Social Security process is pending. Sign up online at Medicare.gov, by phone, or at your local Social Security office. You do not need to wait for Social Security approval. If you are later approved for SSDI, your benefits will be coordinated with Medicare.

Do I have to enroll in Part D when I turn 65?

Part D (prescription drug coverage) is optional, but if you go without it and later enroll, you may pay a permanent penalty. The penalty is one percent of the national average Part D premium for each month you were may be able to access but not enrolled. If you do not take prescription drugs, you can decline Part D, but enroll later if your situation changes.

What if I am not a U.S. citizen?

You must be a U.S. citizen or have been a lawful permanent resident for at least five years to be may be able to access for Medicare at 65. If you are not yet a citizen or do not meet the residency requirement, contact Medicare at 1-800-MEDICARE to discuss your specific situation. Some people with work visas or other immigration statuses may have different rules.

Can I sign up for Medicare online?

Yes. You can create an account at Medicare.gov and sign up for Part A and Part B online. You can also call 1-800-MEDICARE or visit your local Social Security office. Online enrollment is available year-round during your enrollment period, and you will receive confirmation by mail within two weeks.