You must sign up for Medicare at 65, but the exact important date depends on your work and insurance history

Most people become may be able to access for Medicare the month they turn 65. If you are still working and covered by your employer's health plan, you may not have to sign up right away — but you will eventually. If you are retired or not covered by an employer plan, you must sign up during your Initial Enrollment Period or face a permanent penalty on your premiums. The key is understanding which category you fall into and what your important date actually is.

The Social Security Administration handles Medicare enrollment. You do not sign up through your employer or your state. You sign up through Medicare directly, either online at Medicare.gov, by phone at 1-800-MEDICARE, or in person at your local Social Security office.

Key Takeaways

  • Your Initial Enrollment Period is the three months before you turn 65, the month you turn 65, and the three months after — seven months total to sign up without penalty.
  • If you are covered by an active employer health plan, you can delay Medicare Part B (medical insurance) without penalty, but you must still sign up for Part A (hospital insurance) at 65.
  • Missing your enrollment window costs you 10 percent more per month on Part B premiums for each year you delay, and the penalty is permanent.
  • Your employer must have 20 or more employees for you to legally delay Part B; if your employer is smaller, you must sign up at 65 or face the penalty.
  • When you leave your job or lose employer coverage, you have eight months to sign up for Part B without penalty.

Who must sign up at 65 and who can wait

If you are not working or your employer does not offer health insurance, you must sign up for Medicare during your Initial Enrollment Period. This period runs for seven months: the three months before the month you turn 65, the month you turn 65 itself, and the three months after. If you miss this window, you will owe a permanent increase on your Part B premium — 10 percent more for each full year you delayed.

If you are still working and your employer offers health insurance, the rules are different. You can delay Part B (which covers doctor visits and outpatient care) as long as you remain covered by that employer plan and the employer has 20 or more employees. However, you must still sign up for Part A (hospital insurance) at 65, even if you do not use it yet. Part A has no premium for most people, so there is no financial penalty for signing up early.

Self-employed people and those who own a business are treated as their own employer. If your business has fewer than 20 employees (including yourself), you cannot delay Part B — you must sign up at 65 or face the penalty.

What happens when you leave your job or lose coverage

When you stop working or lose your employer health plan, you enter a Special Enrollment Period. You have eight months from the date your coverage ends to sign up for Part B without penalty. This eight-month window is separate from your Initial Enrollment Period, so even if you missed your Initial Enrollment Period, you get a second chance when your employer coverage ends.

You must notify Medicare within 63 days of losing coverage. You can do this online at Medicare.gov, by calling 1-800-MEDICARE, or by visiting your local Social Security office. Bring documentation of when your coverage ended — your final pay stub, a letter from your employer, or your insurance termination notice.

If you wait longer than eight months after losing coverage, you will owe the permanent Part B penalty. There is no exception for people who did not realize they needed to sign up.

The permanent penalty for missing your important date

The Part B premium penalty is 10 percent of the standard Part B premium for each full 12-month period you were may be able to access but did not sign up. If the standard premium is $165 per month and you delayed for three years, you would pay an extra $49.50 per month for the rest of your life. This penalty does not go away if you eventually sign up.

Part D (prescription drug coverage) has a similar penalty: 1 percent of the national average premium for each month you delay. Like Part B, this penalty is permanent. The only way to avoid it is to sign up during your enrollment window or within 63 days of losing other drug coverage.

Part A (hospital insurance) does not have a penalty for most people because it is free. However, if you have worked long enough to may have access to for Social Security, you automatically get Part A at 65 whether you sign up or not. If you have not worked long enough, you can purchase Part A, and the premium is higher if you sign up late.

How to sign up during your enrollment period

You can sign up for Medicare online, by phone, or in person. Online enrollment through Medicare.gov is usually the fastest — you can complete it in about 10 minutes if you have your Social Security number and information about any current health coverage.

By phone, call 1-800-MEDICARE (1-800-633-4227). Representatives are available Monday through Friday, 8 a.m. to 8 p.m. Eastern time. Have your Social Security number, birth date, and current insurance information ready.

In person, visit your local Social Security office. 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 your current address.

What to ask your doctor and employer

Before you turn 65, ask your employer's benefits department whether your health plan will continue after you retire or turn 65. Ask specifically whether the plan will coordinate with Medicare or whether you will need to switch. Some employer plans end at 65; others continue and work alongside Medicare.

Ask your doctor whether they accept Medicare. Not all doctors do, and some accept only certain Medicare plans. If your current doctor does not accept Medicare, ask for a referral to someone who does, or plan to switch before your coverage changes.

Ask your employer whether they offer retiree health coverage. If they do, ask what it covers, what it costs, and whether you can keep it if you also enroll in Medicare. Some employers offer coverage that supplements Medicare; others offer coverage that replaces it until you turn 65.

When to contact Medicare if something changes

Contact Medicare within 30 days if your employment status changes, your employer coverage ends, or you move to a different state. You can report changes online at Medicare.gov, by phone at 1-800-MEDICARE, or in person at your local Social Security office.

If you are hospitalized or have a major health event before you sign up, contact Medicare when ready. Some situations may may have access to you for a Special Enrollment Period that extends your important date.

If you receive a notice that you owe a late enrollment penalty, do not ignore it. You can request a review if you believe the penalty was applied in error or if you have a valid reason for the delay. The important date to request a review is usually 60 days from the date on the notice.

Frequently Asked Questions

Can I sign up for Medicare before I turn 65?

No, you cannot sign up before the month you turn 65. Your enrollment period begins three months before that month. If you try to sign up early, your process will be rejected and you will have to reapply during your correct enrollment period.

What if I am still working past 65 and do not want Medicare?

You cannot refuse Medicare if you are may be able to access. However, you can delay Part B if you are covered by an employer plan with 20 or more employees. You must still sign up for Part A at 65. When you eventually retire or lose coverage, you will need to enroll in Part B within eight months to avoid the permanent penalty.

Do I have to take Part D prescription drug coverage?

You do not have to take Part D, but if you go without it and later sign up, you will owe a penalty for each month you were may be able to access but did not enroll. The only exception is if you had other drug coverage that was at least as good as Part D. If you do not take any prescription drugs, you can skip Part D without penalty, but you must sign up within 63 days of the day you first need it.

What if I missed my enrollment important date by a few weeks?

A few weeks past your important date still counts as missing it. The penalty applies starting the month after your Initial Enrollment Period ends. However, you can still sign up during the General Enrollment Period (January 1 to March 31 each year), though the penalty will explore. Contact Medicare to discuss your specific situation.

Can my spouse sign up for Medicare at a different time than me?

Yes. Each person has their own enrollment period based on their own birth month. Your spouse's Initial Enrollment Period is based on when they turn 65, not when you do. You can sign up at different times and have different coverage types.