Your first Medicare payment depends on when you turn 65 or become may be able to access

Medicare does not send you a bill. Instead, you pay for coverage through premiums — monthly charges deducted from your Social Security check, your bank account, or paid directly to Medicare. Your first premium is due the month your coverage begins, which is usually the first day of the month you turn 65 or the month you become may be able to access through disability or end-stage renal disease.

If you sign up during your initial enrollment period and your coverage starts on the first of the month, your first payment is due that same month. If you delay signing up, your coverage start date shifts, and so does your first payment date. The exact timing depends on when you were born, when you enrolled, and which parts of Medicare you chose.

Key Takeaways

  • Your first Medicare premium is due the month your coverage begins, usually the month you turn 65 or become may be able to access through disability.
  • Part A (hospital insurance) is free for most people, but Part B (medical insurance) and Part D (prescription drug coverage) have monthly premiums.
  • You can pay by Social Security deduction, bank account withdrawal, or check — the method you choose during enrollment determines how you pay.
  • If you miss a payment, Medicare will send you a notice; you have a grace period to catch up before coverage stops.
  • Late enrollment penalties add to your monthly premium permanently if you delay signing up without a valid reason.

How the enrollment timeline affects your first payment date

Your initial enrollment period is a seven-month window: three months before the month you turn 65, the month you turn 65, and three months after. If you enroll during this window, your coverage typically starts on the first day of the month you turn 65, and your first premium is due that month.

If you turn 65 in March and enroll in February, your coverage starts March 1, and your first payment is due in March. If you wait and enroll in May, your coverage starts June 1, and your first payment is due in June. The later you enroll within your initial period, the later your coverage and first payment begin.

If you miss your initial enrollment period and enroll later, your coverage does not start until the first of the month after you enroll. You also face a late enrollment penalty — a permanent increase to your Part B and Part D premiums. This penalty stays on your account for as long as you have Medicare, so the timing of your first payment is less important than the cost of waiting.

Which parts of Medicare have premiums you must pay

Part A (hospital insurance) is free for most people age 65 and older who worked and paid Medicare taxes for at least 10 years. You do not pay a monthly premium for Part A, though you do pay a deductible when you use hospital services.

Part B (medical insurance for doctor visits and outpatient care) has a monthly premium. In 2024, the standard Part B premium is $164.90 per month, but the amount changes each year and varies based on your income. Higher-income beneficiaries pay more. This is the premium most people think of when they ask about their first Medicare payment.

Part D (prescription drug coverage) also has a monthly premium that varies by plan and insurance company. You choose a Part D plan during enrollment, and the premium depends on which plan you pick. If you do not enroll in Part D when you first become may be able to access and later sign up, you pay a late enrollment penalty on top of the plan premium.

Part C (Medicare Advantage) is an alternative to Parts A and B offered by private insurance companies. Some Part C plans have no monthly premium beyond Part B, while others charge an additional premium. Your first payment for Part C begins the month your coverage starts.

How you pay your first Medicare premium

During enrollment, you choose how to pay: through Social Security deduction, automatic bank withdrawal, or by mailing a check. Most people choose Social Security deduction because the premium comes out automatically before you receive your benefit.

If you choose Social Security deduction, your Part B premium is subtracted from your monthly Social Security payment starting the month your coverage begins. You do not write a check or set up a separate payment — it happens automatically. If your Social Security payment is not large enough to cover the premium, Medicare bills you directly for the difference.

If you choose bank withdrawal or check payment, you receive a bill from Medicare in the mail. The bill shows the amount due and the due date, which is usually the last day of the month before coverage begins. For example, if your coverage starts June 1, the bill arrives in May and is due by May 31.

What happens if you miss your first payment

If your first premium payment is late, Medicare sends you a notice explaining the amount owed and giving you a grace period to pay. You typically have until the end of the month following the month the payment was due. During this grace period, your coverage continues, but you must pay the overdue amount to keep it active.

If you do not pay by the end of the grace period, Medicare can terminate your coverage. Once coverage ends, you cannot restart it until the next general enrollment period (January 1 to March 31), and you may face additional late enrollment penalties when you re-enroll.

If you are having trouble paying your first premium, contact Medicare at 1-800-MEDICARE (1-800-633-4227) before the grace period ends. Some people may have access to for Part B premium information through Medicaid or other state programs, which can reduce or cover your monthly premium.

Late enrollment penalties and what they cost

If you do not enroll in Part B during your initial enrollment period and do not have other may have access to coverage, you pay a Part B late enrollment penalty for as long as you have Medicare. The penalty is 10 percent of the standard Part B premium for each full 12-month period you were may be able to access but not enrolled. If you delay enrollment by two years, your penalty is 20 percent of the standard premium, added to your monthly bill permanently.

The same rule applies to Part D. If you go 63 days or longer without creditable prescription drug coverage and later enroll in Part D, you pay a late enrollment penalty equal to 1 percent of the national average Part D premium for each month you were without coverage. This penalty also stays on your account indefinitely.

These penalties are one reason to enroll on time, even if you do not plan to use Medicare when ready. If you are still working and have employer coverage, you may be exempt from the late enrollment penalty, but you must notify Medicare of your situation during enrollment.

Special situations that change your first payment date

If you become may be able to access for Medicare before age 65 through disability, your first payment is due the month your coverage begins. You must have received Social Security disability benefits for 24 months before Medicare starts, so your first payment date depends on when you became disabled and when Social Security approved your claim.

If you have end-stage renal disease (ESRD) or ALS (amyotrophic lateral sclerosis), you may become may be able to access for Medicare when ready. Your first payment is due the month coverage begins, which is determined by when you were diagnosed and when you enrolled.

If you are still working and covered by an employer health plan, you can delay Part B enrollment without penalty as long as you enroll within eight months of losing that coverage. Your first Part B payment is then due the month your employer coverage ends and Medicare begins.

Frequently Asked Questions

Do I have to pay for Part A?

Most people do not pay a monthly premium for Part A if they or their spouse worked and paid Medicare taxes for at least 10 years. However, you do pay a deductible ($1,632 in 2024) when you use hospital services. If you do not meet the work requirement, you may pay a monthly Part A premium.

What if I turn 65 in the middle of the month?

Your coverage starts on the first day of the month you turn 65, regardless of which day of the month your birthday falls. If you turn 65 on March 15, your coverage begins March 1, and your first payment is due in March.

Can I delay my first Medicare payment?

No, your first premium is due the month your coverage begins. However, if you are still working and have employer coverage, you can delay enrolling in Part B without penalty. Once you lose that coverage, you have eight months to enroll without a late penalty.

What if I enrolled but never received a bill?

If you chose Social Security deduction, the premium is automatically taken from your benefit — you will not receive a separate bill. If you chose bank withdrawal or check payment and did not receive a bill, contact Medicare at 1-800-MEDICARE to confirm your payment method and mailing address.

Can I change how I pay my premium after my first payment?

Yes, you can change your payment method at any time by contacting Medicare or logging into your Medicare account online. Changes usually take effect the following month.