Medicare starts at 65 for most people, but the exact date depends on your birthday and whether you have already claimed Social Security

If you turn 65, you become may be able to access for Medicare on the first day of the month in which you turn 65, or the first day of the month after you turn 65, depending on your birthday. If your birthday is the first of the month, coverage begins that month. If your birthday is any other day, coverage begins the first day of the next month.

You do not have to claim Social Security to get Medicare, and you do not have to be retired. You can work and carry Medicare at the same time. However, you must sign up during a specific window or face a penalty that lasts for as long as you have Medicare.

Some people become may be able to access before 65 — those on Social Security Disability Insurance (SSDI) for 24 months, or those with end-stage renal disease or ALS. This guide focuses on age-based may be able to access at 65.

Key Takeaways

  • Medicare may be able to access begins the month you turn 65 or the month after, depending on the day of your birthday.
  • You must sign up during your Initial Enrollment Period, which runs three months before you turn 65, the month you turn 65, and three months after — a seven-month window.
  • If you miss this window and do not have other coverage, you pay a permanent penalty on your Part B and Part D premiums for as long as you have Medicare.
  • You can delay enrollment past 65 without penalty only if you or your spouse are still working and covered by an employer health plan.
  • Social Security will not automatically enroll you in Medicare; you must sign up yourself through Medicare.gov or by calling 1-800-MEDICARE.

Your Initial Enrollment Period: The seven-month window

Your Initial Enrollment Period is the only time you can sign up for Medicare without a penalty. It 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, your enrollment period runs from March through September. You can sign up anytime during those seven months, and your coverage will begin on the first day of the month you turn 65 (or the first day of the month after, depending on your birthday).

You do not have to wait until the month you turn 65 to sign up. Many people sign up two or three months before, which gives Medicare time to process the paperwork and send your card before coverage begins.

What happens if you miss the enrollment window

If you do not sign up during your Initial Enrollment Period and you do not have a valid reason to delay, you will pay a late enrollment penalty for the rest of your life on Medicare.

For Part B (doctor visits and outpatient care), the penalty is 10 percent of the standard premium for each full 12-month period you were may be able to access but not enrolled. If you were may be able to access for three years and did not sign up, your Part B premium goes up 30 percent permanently. For Part D (prescription drugs), the penalty is 1 percent of the national average premium per month of delay.

The only way to avoid this penalty is to have had other health coverage — usually an employer plan — during the time you were may be able to access. If you or your spouse worked and stayed on the employer plan, you can sign up later without penalty. You have eight months after you or your spouse stop working or lose the employer coverage to enroll without a penalty.

Signing up before you turn 65

You can sign up for Medicare starting three months before your 65th birthday. The Social Security Administration and Medicare recommend signing up about three months ahead so your card arrives before coverage begins.

Go to Medicare.gov, click "Sign Up for Medicare," and follow the steps. You will need your Social Security number, date of birth, and citizenship or immigration status. The process takes about 10 minutes.

You can also call 1-800-MEDICARE (1-800-633-4227) to sign up by phone. A representative can walk you through the process and answer questions about which parts of Medicare you need. The line is open Monday through Friday, 8 a.m. to 8 p.m. Eastern time.

The difference between Medicare Parts A, B, C, and D

Part A covers hospital stays, skilled nursing care, and hospice. Most people do not pay a premium for Part A if they or their spouse paid Medicare taxes for at least 10 years (40 quarters). Part A is automatic — you do not have to sign up.

Part B covers doctor visits, lab tests, and outpatient care. It has a monthly premium (the standard amount is $164.90 in 2024, but it varies by income). You must sign up for Part B during your Initial Enrollment Period or pay the late penalty. If you are still working and covered by an employer plan, you can delay Part B without penalty.

Part C (Medicare Advantage) is an alternative to Original Medicare (Parts A and B). It is offered by private insurance companies and usually includes prescription drug coverage. You can choose Part C instead of Part B, but you cannot have both at the same time.

Part D is prescription drug coverage. It is optional, but if you do not sign up when you are first may be able to access and you go without it, you pay a penalty when you do enroll. The penalty is 1 percent of the national average premium for each month you were may be able to access but not enrolled.

If you are still working at 65

You can work past 65 and stay on your employer health plan instead of signing up for Medicare. If you do, you can delay Part B and Part D without a penalty — but only if your employer has 20 or more employees and the coverage is based on your current work.

When you or your spouse stop working or lose the employer coverage, you have eight months to sign up for Part B and Part D without a penalty. This is called your Special Enrollment Period. You will need a letter from your employer or health plan stating the date coverage ended and that it was based on current employment.

Part A is still automatic and free for most people, so you do not need to do anything about it. However, you should still sign up for Part B and Part D during your eight-month window after work ends.

Coordinating with Social Security

Signing up for Medicare is separate from claiming Social Security. You can claim Social Security at 62 (with a reduced benefit), wait until your full retirement age (between 66 and 67 for people born after 1954), or delay until 70 (for a larger benefit). Medicare may be able to access at 65 does not change any of those choices.

If you are already receiving Social Security when you turn 65, Social Security will send you information about Medicare, but they will not automatically enroll you. You still have to sign up yourself.

If you have not claimed Social Security yet and you sign up for Medicare at 65, you can still claim Social Security later at any age between 62 and 70. The two programs are independent.

Frequently Asked Questions

What if my birthday is on the first of the month?

Your Medicare coverage begins the month you turn 65. If you were born on January 1, your coverage starts January 1. If you were born on any other day of the month, coverage starts the first day of the following month.

Can I sign up for Medicare online?

Yes. Go to Medicare.gov, click "Sign Up for Medicare," and complete the form. You will need your Social Security number, date of birth, and citizenship or immigration status. You can also call 1-800-MEDICARE to sign up by phone or visit a local Social Security office in person.

Do I lose my employer health insurance when I turn 65?

No. If you are still working and your employer offers health insurance, you can keep it. However, once you sign up for Medicare, Medicare becomes your primary insurance and your employer plan becomes secondary. Talk to your employer's benefits department about how the two plans work together.

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

You must be a U.S. citizen or a lawful permanent resident (green card holder) who has lived in the United States for at least five consecutive years to get Medicare. If you are not sure about your status, call 1-800-MEDICARE and ask to speak with someone who handles immigration questions.

Can I change my mind after I sign up?

Yes, but only during specific periods. You have a seven-week window after your coverage begins to drop Part B or Part D if you change your mind. After that, you can only make changes during the annual Open Enrollment Period, which runs October 15 through December 7 each year.