You have to sign up for Medicare yourself — it does not start on its own

When you turn 65, Medicare does not automatically enroll you. You must take action to sign up, or you risk losing coverage and paying penalties for the rest of your life. The Social Security Administration does not assume you want Medicare just because you reach that age.

If you are already receiving Social Security retirement benefits when you turn 65, you will be enrolled in Medicare Part A (hospital insurance) and Part B (medical insurance) automatically about three months before your 65th birthday. But if you have not yet claimed Social Security, you must sign up for Medicare separately, even if you plan to claim Social Security later.

The window to sign up without penalty is your Initial Enrollment Period, which runs for seven months: three months before the month you turn 65, the month you turn 65, and three months after. If you miss this window, you will owe a permanent surcharge on your Part B and Part D premiums.

Key Takeaways

  • You must sign up for Medicare yourself unless you are already receiving Social Security retirement benefits at age 65.
  • Your Initial Enrollment Period is seven months long: three months before you turn 65, your birth month, and three months after.
  • If you delay signing up past your Initial Enrollment Period, you will pay a penalty on Part B and Part D premiums for as long as you have Medicare.
  • You can sign up online at Medicare.gov, by phone at 1-800-MEDICARE, or in person at your local Social Security office.
  • If you are still working and have health insurance through your employer, you may be able to delay Part B without penalty under specific circumstances.

What happens if you miss your Initial Enrollment Period

A late enrollment penalty is a permanent increase to your monthly premiums. For Part B, the penalty is 10 percent of the standard premium for each full year you were may be able to access but not enrolled. For Part D (prescription drug coverage), the penalty is 1 percent of the national average premium for each month you were without coverage. These penalties stay with you for life, even if you move to a different state or change plans.

The only exception is if you had creditable coverage — health insurance through a current employer or a spouse's employer that is at least as good as Medicare Part B or Part D. If you were covered under an employer plan when you turned 65, you have eight months after that coverage ends to sign up for Medicare without penalty. You will need to provide proof of that coverage when you enroll.

If you are still working at 65 and your employer has 20 or more employees, you can delay Part B without penalty. But you must sign up for Part A (hospital insurance) during your Initial Enrollment Period, or you will owe a penalty on Part A premiums as well.

How to sign up during your Initial Enrollment Period

You have three ways to sign up: online, by phone, or in person. The fastest route is Medicare.gov, where you can create an account and complete your enrollment in about 15 minutes. You will need your Social Security number, date of birth, and information about any current health coverage.

You can also call 1-800-MEDICARE (1-800-633-4227) to speak with a representative. The line is open Monday through Friday, 8 a.m. to 8 p.m. Eastern time, and Saturday 9 a.m. to 1 p.m. Eastern time. Have your Social Security number and current insurance information ready.

A third option is to visit your local Social Security office in person. You can find the nearest office at ssa.gov or by calling 1-800-772-1213. Bring your Social Security card, proof of citizenship or legal residency, and proof of age. If you have current health coverage, bring that information too.

When you are automatically enrolled without taking action

If you are receiving Social Security retirement or railroad retirement benefits when you turn 65, Medicare will enroll you automatically. You do not have to do anything. You will receive your Medicare card in the mail about three months before your 65th birthday.

If you are receiving Social Security Disability Insurance (SSDI) or are a widow or widower receiving benefits, you are also automatically enrolled in Medicare at age 65. The same is true if you have been on dialysis or have received a kidney transplant — you become may be able to access for Medicare at any age, and enrollment happens automatically if you are already receiving Social Security benefits.

Even if you are automatically enrolled, you should review your Medicare options. Automatic enrollment puts you in Original Medicare (Part A and Part B). You can choose to switch to a Medicare Advantage plan (Part C) during the annual open enrollment period from October 15 to December 7 each year.

Part A, Part B, Part C, and Part D — what you are signing up for

Part A covers hospital stays, skilled nursing facility care, hospice, and some home health care. Most people do not pay a monthly premium for Part A if they or their spouse paid Medicare taxes for at least 10 years. If you do not meet that requirement, you can buy Part A, but the premium can be high.

Part B covers doctor visits, outpatient care, medical equipment, and preventive services. Part B has a monthly premium that changes each year. In 2024, the standard premium is $164.90 per month, but higher-income beneficiaries pay more. You must sign up for Part B during your Initial Enrollment Period or face a permanent penalty, unless you have creditable coverage through an employer.

Part C (Medicare Advantage) is an alternative to Original Medicare. Private insurance companies offer Part C plans that cover everything Part A and Part B cover, usually with lower out-of-pocket costs but smaller networks of doctors. You do not have to choose Part C at 65 — you can enroll during the annual open enrollment period any year you have Medicare.

Part D covers prescription drugs. You must sign up during your Initial Enrollment Period or within 63 days of losing creditable drug coverage, or you will owe a permanent penalty. Even if you do not take many medications, signing up for a plan with low premiums protects you from future penalties.

Questions to ask your doctor and Social Security before you turn 65

Ask your doctor whether your current medications are covered under the Part D plans available in your area. Different plans cover different drugs, and some require prior authorization or step therapy. Your doctor's office can help you check which plans cover your prescriptions at the lowest cost.

Ask whether your doctor accepts Medicare. Not all doctors do, and some accept Original Medicare but not Medicare Advantage. If you have a doctor you want to keep, confirm they accept the type of Medicare you are considering before you enroll.

Contact Social Security at 1-800-772-1213 to ask whether you are already on record as may be able to access for Medicare. If you have worked and paid Medicare taxes, you may already have Part A may be able to access. Knowing this before you turn 65 helps you plan which parts you need to sign up for.

When to seek help from a counselor or advisor

If you have complex health needs, take many medications, or are unsure which plan is right for you, a State Health Insurance information Program (SHIP) counselor can help you understand your options at no cost. SHIP is a federally funded program with counselors in every state. You can find your state's SHIP at shiptalk.org or by calling 1-877-839-2675.

If you are still working at 65 and have employer health insurance, talk to your employer's benefits department before you turn 65. They can tell you whether your coverage is creditable and what happens to your coverage when you become may be able to access for Medicare. Some employers require you to enroll in Medicare Part A even if you delay Part B.

If you miss your Initial Enrollment Period and realize you owe a penalty, contact Medicare when ready. In rare cases, if you can show that Social Security or Medicare gave you incorrect information, you may be able to appeal the penalty. Call 1-800-MEDICARE to ask about your options.

Frequently Asked Questions

What if I turn 65 but do not plan to retire yet?

You can still delay Part B without penalty if you have health insurance through your current employer and your employer has 20 or more employees. However, you must sign up for Part A during your Initial Enrollment Period. If you do not enroll in Part B now, you will have eight months after you leave your job or lose your employer coverage to sign up without penalty.

Do I have to take Part A if I do not want it?

If you are receiving Social Security benefits at 65, you are automatically enrolled in Part A and cannot decline it. If you are not yet receiving Social Security, you can choose not to sign up for Part A during your Initial Enrollment Period. However, if you enroll in Part B later, you will be automatically enrolled in Part A at that time.

Can I change my mind after I sign up?

Yes. You have a seven-month window during your Initial Enrollment Period to make changes. After that, you can only change plans during the annual open enrollment period from October 15 to December 7, or if you have a may have access to life event like moving out of state or losing employer coverage.

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

You must be a U.S. citizen or a lawful permanent resident who has lived in the United States for at least five consecutive years to be may be able to access for Medicare. If you meet these requirements, you can sign up during your Initial Enrollment Period just like anyone else. Bring proof of your legal status when you enroll.

Do I have to sign up for Part D if I do not take medications?

You are not required to sign up for Part D if you do not take prescription drugs. However, if you enroll in Part D later, you will owe a penalty for each month you were without coverage. Many people sign up for a low-cost Part D plan just to avoid the penalty, even if they do not use it when ready.