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

Medicare is federal health insurance that begins the month you turn 65, as long as you or your spouse paid Medicare taxes for at least 10 years while working. If you have a disability, you can start at any age after you have received Social Security disability benefits for 24 months. If you have end-stage renal disease (permanent kidney failure) or ALS (Lou Gehrig's disease), you may start right away without waiting.

The month you become may be able to access is the month your coverage can begin — but you have to sign up during a specific window, or you may face a permanent penalty on your premiums. The rules differ slightly depending on whether you are turning 65, explore for disability, or have one of the two conditions that bypass the age requirement.

Key Takeaways

  • You become may be able to access for Medicare the month you turn 65 if you or your spouse paid Medicare taxes for at least 10 years while working.
  • If you receive Social Security disability benefits, you can start Medicare after 24 months of receiving those benefits, regardless of your age.
  • People with end-stage renal disease or ALS can start Medicare when ready upon diagnosis, without an age requirement or waiting period.
  • You must sign up during your enrollment window or face a permanent increase to your premiums for as long as you have Medicare.
  • Your coverage start date depends on when you sign up and which month you become may be able to access — these are not always the same.

Turning 65: The standard enrollment window

If you are turning 65, your Initial Enrollment Period runs for seven months: three months before the month you turn 65, the month you turn 65, and three months after. For example, if you turn 65 in June, you can sign up from March through September. You can sign up online at Medicare.gov, by phone at 1-800-MEDICARE, or in person at your local Social Security office.

Your coverage start date depends on when you sign up within that window. If you sign up in the month you turn 65 or earlier, coverage starts the month you turn 65. If you sign up after the month you turn 65, coverage starts the month after you sign up. For example, if you turn 65 in June and sign up in August, your coverage begins in September.

If you miss this seven-month window and do not have a reason that counts as a may have access to life event (such as losing employer coverage), you will pay a permanent 10 percent penalty on your Part B premium for as long as you have Medicare. This penalty compounds each year you go without coverage.

Disability: Starting Medicare before 65

If you receive Social Security Disability Insurance (SSDI) or Railroad Retirement Board disability benefits, you become may be able to access for Medicare after you have been receiving those benefits for 24 months. You do not have to be any particular age. Medicare will contact you automatically about three months before your 24-month mark, but you should not wait for that letter — you can sign up as soon as you know your 24-month date.

Your 24-month period starts the month your disability benefits begin, not the month you applied. If you applied for disability in January but your benefits were approved and started in April, your 24-month clock begins in April. You become may be able to access for Medicare in April of the following year.

Once you are may be able to access, you have the same seven-month enrollment window as someone turning 65: three months before, the month you become may be able to access, and three months after. If you miss that window, the same 10 percent permanent penalty applies.

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

If you are diagnosed with end-stage renal disease (ESRD) — permanent kidney failure that requires dialysis or a transplant — you can start Medicare the month your treatment begins, regardless of your age. You do not have to wait 24 months or reach 65. Your doctor or dialysis center will usually help you sign up, but you can also contact Medicare directly.

If you are diagnosed with ALS (amyotrophic lateral sclerosis, also called Lou Gehrig's disease), you can start Medicare the month you are diagnosed, with no age requirement and no waiting period. This is the only condition that does not require you to have started treatment first. You will need documentation of your diagnosis from your doctor.

For both conditions, your enrollment window is still seven months, and the same permanent penalty applies if you miss it. However, because your may be able to access date is tied to diagnosis or treatment start rather than a birthday, make sure you know exactly which month your coverage can begin.

What happens if you miss your enrollment window

If you do not sign up during your Initial Enrollment Period and you do not have a may have access to life event, you enter a General Enrollment Period that runs from January 1 to March 31 each year. You can sign up then, and your coverage will start July 1 of that year. However, you will pay a permanent 10 percent penalty on your Part B premium for each full 12 months you went without coverage.

For example, if you turned 65 in June 2023 and did not sign up until February 2025, you missed your enrollment window by about eight months. You would pay a 10 percent penalty for the rest of your life on Medicare. If your Part B premium is $165 per month, the penalty would add $16.50 per month permanently.

The only way to avoid this penalty is to have a may have access to life event — such as losing health coverage through an employer, moving to a new state, or a change in your citizenship status. If you have one, you get a two-month window to sign up without penalty. You will need to provide documentation of the event.

Employer coverage and delayed enrollment

If you or your spouse is still working and covered by an employer health plan, you may be able to delay Medicare without penalty. This is called creditable coverage. You can stay on your employer plan and sign up for Medicare later, as long as your employer has 20 or more employees and you sign up within eight months of losing that coverage.

You must tell Medicare that you have creditable coverage when you sign up, or you may still face a penalty. Your employer's benefits office can tell you whether your plan counts as creditable coverage. If it does, you avoid the permanent premium penalty even if you sign up years after turning 65.

If your employer coverage ends before you turn 65, you have two months to sign up for Medicare without penalty. If you wait longer than two months, the penalty applies.

How to sign up and what to have ready

You can sign up for Medicare online at Medicare.gov, by calling 1-800-MEDICARE, or by visiting your local Social Security office. Have your Social Security number ready, and know the date you become may be able to access (your 65th birthday, your 24-month disability date, or your ESRD or ALS diagnosis date).

If you are signing up online, the process takes about 15 minutes. If you call, expect to spend 20 to 30 minutes on the phone, depending on how busy the line is. Wait times are shortest on weekday mornings before 10 a.m. If you go in person, bring your Social Security card and a photo ID.

You do not need to choose your specific Medicare plans (Part B, Part D, or Medigap) when you sign up — you can do that later. However, you should sign up for Part B during your enrollment window to avoid the permanent penalty, even if you plan to stay on your employer coverage a while longer.

Frequently Asked Questions

What if I turned 65 but I'm still working and have health insurance through my job?

You should still sign up for Medicare Part A (hospital insurance) during your enrollment window to avoid a penalty. You can delay Part B (medical insurance) if your employer has 20 or more employees, but you must sign up within eight months of losing that job coverage. Tell Medicare about your employer coverage when you sign up.

Can I start Medicare before the month I turn 65?

No. Your coverage cannot start before the month you turn 65, even if you sign up three months early. However, signing up early ensures you do not miss your window and face a penalty. Coverage starts the month you turn 65 if you sign up during the three months before your birthday.

What counts as a may have access to life event that lets me sign up late?

may have access to events include losing employer health coverage, moving to a new state, a change in citizenship or immigration status, and certain family changes like divorce or death of a spouse. You typically have two months from the event to sign up without penalty. Contact Medicare to confirm whether your situation qualifies.

If I have ESRD, do I need to wait for Medicare to contact me?

No. You can sign up as soon as your treatment begins. Your dialysis center or transplant team can help you, or you can call 1-800-MEDICARE directly. Do not wait for a letter — sign up right away to make sure your coverage starts the month your treatment begins.

What if I do not know my exact may be able to access date?

Contact Social Security at 1-800-772-1213 if you are unsure about your 24-month disability date. If you have ESRD or ALS, ask your doctor or treatment center for the exact month your condition began or treatment started. Medicare can also look this up for you when you call to sign up.