Medicare Doesn't Start Automatically at 65 — You Have to Sign Up

You must enroll in Medicare yourself — it does not happen automatically

Turning 65 does not put you on Medicare. You have to take action during your enrollment window, or you will lose coverage and face penalties that last for years. The Social Security Administration does not sign you up, your employer does not sign you up, and Medicare does not sign you up on its own. If you want coverage to start on your 65th birthday, you must enroll before that date arrives.

The enrollment window is seven months long: it starts three months before the month you turn 65 and ends three months after. If you miss this window and do not have other coverage, you will pay a permanent surcharge on your Part B and Part D premiums for as long as you have Medicare. That surcharge is 10 percent per year you were late, and it compounds — if you enroll five years late, you pay 50 percent more forever.

The one exception is if you are still working and covered by your employer's health plan. You can delay enrollment without penalty, but you still have to enroll within eight months of leaving that job or losing that coverage, or the same surcharge applies.

Key Takeaways

• You must enroll in Medicare during the seven-month window centered on your 65th birthday, or you will owe a permanent surcharge on your premiums.
• Enrollment happens through Medicare.gov, by phone at 1-800-MEDICARE, or in person at your local Social Security office — not through Social Security itself.
• If you are still working and covered by your employer's plan, you can delay enrollment without penalty, but you must enroll within eight months of leaving that job.
• Part A (hospital insurance) is usually free if you or your spouse paid Medicare taxes for at least 10 years, but you still have to enroll to receive it.
• Coverage can start on the first day of the month you turn 65 if you enroll by the 15th of the previous month, or on the first day of the following month if you enroll later.

The seven-month enrollment window and what happens if you miss it

Your enrollment window opens on the first day of the third month before you turn 65. If you turn 65 in June, your window opens April 1. It closes on the last day of the third month after you turn 65 — in this example, September 30. You can enroll any day during those seven months.

If you do not enroll during this window and you do not have a may have access to reason for the delay, you will pay a late enrollment penalty for the rest of your life on Medicare. For Part B (medical insurance), 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 late. These penalties are added to your regular premium every month.

The surcharge does not go away if you enroll later. If you turn 65 in 2024 and do not enroll until 2029, you owe five years of penalties starting when ready, and you will keep paying them for the rest of your life. This is one of the few Medicare rules that cannot be waived or forgiven.

How to enroll and when coverage starts

You can enroll through three routes: online at Medicare.gov, by phone at 1-800-MEDICARE (1-800-633-4227), or in person at your local Social Security office. Online enrollment is usually the fastest — you can complete it in 15 to 20 minutes if you have your Social Security number and information about any current health coverage.

When you enroll, you choose which parts of Medicare you want. Part A covers hospital stays, skilled nursing care, and hospice. Part B covers doctor visits, outpatient care, and preventive services. Part D covers prescription drugs. You do not have to take all three at once, but delaying Part D also triggers a surcharge if you do not have other drug coverage.

The start date of your coverage depends on when you enroll. If you enroll by the 15th of any month, coverage starts on the first day of that month. If you enroll after the 15th, coverage starts on the first day of the next month. To have coverage on your 65th birthday, you must enroll by the 15th of the month before you turn 65.

The exception: still working and covered by your employer

If you are still working at age 65 and your employer offers health insurance that covers you, you can delay Medicare enrollment without penalty. This is called creditable coverage. You do not have to enroll in Part B or Part D while you are covered by your employer's plan.

However, you must enroll within eight months of the date you leave that job or lose that coverage. If you wait longer, the late enrollment penalty applies. You also need to tell Medicare that you had creditable coverage when you do enroll, so keep a record of when your employer coverage ended.

Part A is different. Even if you have employer coverage, you can enroll in Part A at 65 without penalty, because Part A is usually free. Some people choose to do this and delay Part B and Part D. There is no downside to enrolling in Part A early.

What Part A costs and whether you have to pay for it

Part A is free if you or your spouse paid Medicare taxes (the 1.45 percent deduction from your paycheck) for at least 10 years. Most people who worked full-time for a decade or more may have access to for free Part A. You still have to enroll to receive it — it does not start automatically — but you will not pay a monthly premium.

If you do not have 10 years of Medicare tax history, you can still enroll in Part A, but you will pay a monthly premium. The amount depends on how many years of coverage you have. In 2024, the premium ranges from about $278 to $505 per month, but this amount changes each year. You can check the current premium on Medicare.gov.

Even if you have to pay for Part A, it is usually worth enrolling at 65, because the longer you wait, the higher your premium becomes. The surcharge for late enrollment in Part A is 10 percent per year, just like Part B.

Part B and Part D: the parts with monthly costs

Part B has a monthly premium that most people pay. In 2024, the standard premium is $164.90 per month, but the amount changes each year and is higher if your income is above a certain threshold. You pay this premium whether you use Medicare or not.

Part D (prescription drug coverage) also has a monthly premium that varies by plan. If you do not enroll in Part D when you first turn 65 and you do not have other drug coverage, you will owe a surcharge when you do enroll. The surcharge is 1 percent of the national average Part D premium for each month you were late — so if you delay two years, you owe 24 months of surcharge.

You can avoid the Part D surcharge by having other creditable drug coverage — through an employer plan, a union, or a veterans program. If you have that coverage, you can delay Part D without penalty. But you must tell Medicare within 63 days of losing that coverage, or the surcharge applies.

What to do if you missed your enrollment window

If you did not enroll during your seven-month window and you do not have other coverage, you can still enroll, but you will owe the late penalty. There is no way to avoid it. You can enroll during the next General Enrollment Period, which runs January 1 to March 31 each year. Coverage would start July 1 of that year.

If you have a may have access to life event — you lost employer coverage, you moved out of your plan's service area, or your plan was discontinued — you may be able to enroll outside the normal windows. These are called Special Enrollment Periods. You have 60 days from the event to enroll. Contact Medicare at 1-800-MEDICARE to ask whether your situation qualifies.

If you believe you have a good reason for missing your window — you were out of the country, you had a serious illness, or you received incorrect information — you can ask Medicare to waive the late penalty. This is rare and requires documentation, but it is worth trying if your circumstances were genuinely beyond your control.

Frequently Asked Questions

What happens if I turn 65 and do nothing?

You will not be on Medicare. You will have no coverage unless you have another plan through an employer, a spouse, or a private insurer. If you go without coverage and then enroll later, you will owe late penalties on Part B and Part D for the rest of your life.

Can I enroll in just Part A and skip Part B?

Yes. You can enroll in Part A only and delay Part B if you are still working and covered by your employer's plan. But if you are not working or do not have other coverage, skipping Part B means you have no doctor coverage, and you will owe a surcharge when you enroll later.

Do I have to enroll in Medicare if I have a private insurance plan?

No, if your private plan is creditable coverage — meaning it is as good as Medicare. But you should check with your plan's administrator. If your plan is not creditable and you do not enroll in Medicare during your window, you will owe late penalties when you do enroll.

What if I am still working at 65 — do I have to enroll?

Not if your employer covers you. You can delay enrollment without penalty as long as you enroll within eight months of leaving that job or losing that coverage. But if you want to enroll early, you can — there is no rule against it.

Can the late enrollment penalty be removed?

Very rarely. Medicare can waive the penalty only if you have a documented may have access to reason — you were out of the country, you received incorrect information from Medicare, or you had a serious medical condition. Most requests are denied. It is much better to enroll on time.