Most people get Medicare Part A automatically at 65

If you are a U.S. citizen or permanent resident and you have worked and paid Medicare taxes for at least 10 years (40 quarters), Medicare Part A starts on the first day of the month you turn 65. You do not have to do anything — Social Security sends the enrollment to Medicare automatically. Your Part A coverage begins whether you ask for it or not.

The only time you need to take action is if you are still working at 65, do not want Part A yet, or you did not get your Medicare card in the mail. Even then, Part A has no monthly premium for most people, so there is rarely a reason to delay it.

Key Takeaways

  • You are enrolled in Medicare Part A automatically at 65 if you have paid Medicare taxes for at least 10 years, and it costs nothing if you meet that work history requirement.
  • Social Security handles the enrollment and sends your Medicare card to your address on file, usually two to three weeks before your 65th birthday.
  • If you do not receive your card, you can create a Medicare.gov account or call 1-800-MEDICARE to confirm your enrollment and request a replacement card.
  • Part A covers hospital stays, skilled nursing facility care, hospice, and some home health services, but not doctor visits or outpatient care.
  • If you are still working and have health coverage through your employer, you can delay Part A without penalty, but you must tell Social Security in writing.

What happens when you turn 65

About three weeks before your 65th birthday, Social Security mails your Medicare card to the address they have on file. The card shows your name, Medicare number, and the date your coverage begins. Check the address on your Social Security account now — if it is wrong, update it at ssa.gov or call Social Security at 1-800-772-1213 before your birthday month.

Your Part A coverage starts on the first day of the month you turn 65, even if your card arrives late. If you do not receive the card by the time you turn 65, you can still use your Medicare number to see doctors and go to hospitals. You can find your number by logging into Medicare.gov with your Social Security number and password, or by calling 1-800-MEDICARE.

If your card never arrives or gets lost, you can order a replacement at Medicare.gov under "Manage Your Health" or by calling 1-800-MEDICARE. There is no charge for a replacement card.

When you do not get Part A automatically

You will not be enrolled automatically if you have not worked 10 years in jobs where you paid Medicare taxes. This includes self-employment income — if you paid self-employment tax, those quarters count. If you fall short, you may still be able to purchase Part A at age 65, but the monthly premium is higher than for people who worked the required time.

You also will not be enrolled automatically if you are not a U.S. citizen or permanent resident. Permanent residents (green card holders) can enroll in Part A at 65 if they have lived in the United States for at least five years. Citizens and permanent residents who do not meet the work requirement can contact Social Security to find out whether they are may be able to access to purchase Part A.

If you think you should have been enrolled but were not, call Social Security at 1-800-772-1213 to check your work record. They can tell you how many quarters of coverage you have and whether you are may be able to access for Part A at no cost.

If you are still working at 65

You can delay Part A without any penalty if you are still working and covered by your employer's health plan. However, you must tell Social Security in writing that you want to delay. Without this written request, you will be enrolled automatically and may face complications with your employer coverage.

To delay Part A, contact Social Security before your 65th birthday or within three months after. You can call 1-800-772-1213, visit your local Social Security office, or mail a written request. Social Security will ask for proof that you are still working — usually a recent pay stub or a letter from your employer stating your employment status.

Once you stop working or lose your employer coverage, you can enroll in Part A without penalty during a special enrollment period. Social Security will guide you through this when you report the change.

What Part A covers and what it does not

Part A covers inpatient hospital stays, skilled nursing facility care (after a hospital stay), hospice services, and some home health services. It does not cover doctor visits, outpatient procedures, prescription drugs, or routine care in a doctor's office.

Part A has costs even though the premium is free for most people. You pay a deductible when you are admitted to the hospital (the amount changes each year), and you pay coinsurance for longer stays. Skilled nursing facility care is free for the first 20 days after a hospital stay, then you pay coinsurance for days 21 through 100.

To cover doctor visits and outpatient care, most people also enroll in Medicare Part B. Part B does have a monthly premium and is not automatic — you must choose to enroll during your initial enrollment period or face a penalty if you wait.

Your Medicare card and Medicare number

Your Medicare card shows your Medicare number, which is now the same as your Social Security number (this changed in 2018). Keep your card in a safe place. You will need the number when you see doctors, go to hospitals, or fill prescriptions.

If your card is lost or damaged, order a replacement at Medicare.gov or call 1-800-MEDICARE. You can also visit your local Social Security office. Replacement cards arrive in 7 to 10 business days.

Do not share your Medicare number with anyone except your doctor, hospital, pharmacy, or insurance company. Scammers sometimes call claiming to be from Medicare and ask for your number — Medicare will never call you first.

If you did not work 10 years but want Part A

If you have not worked the required 10 years but are 65 or older, you may be able to purchase Part A. The monthly premium varies based on how many quarters of coverage you have. You can contact Social Security to find out your work record and whether you are may be able to access to purchase Part A.

You can also be may be able to access for Part A based on your spouse's work record if you are 62 or older and married, or based on your ex-spouse's record if you are 62 or older and the marriage lasted at least 10 years. Social Security can tell you whether this applies to you.

To explore these options, call Social Security at 1-800-772-1213 or visit your local office. Bring your Social Security card and proof of age.

Frequently Asked Questions

What if I turn 65 but do not want Medicare yet?

If you are still working and have employer coverage, you can delay Part A by notifying Social Security in writing before or within three months after your 65th birthday. If you are not working, Part A has no premium, so there is usually no reason to delay it. However, you can contact Social Security to discuss your situation.

Can I enroll in Part A after I turn 65?

If you did not enroll when you turned 65 and you are no longer working or have lost your employer coverage, you can enroll during a special enrollment period without penalty. Contact Social Security or Medicare to report the change in your employment or coverage status.

Do I have to pay for Part A?

Most people pay no monthly premium for Part A because they worked and paid Medicare taxes for at least 10 years. You will pay a deductible and coinsurance when you use hospital or skilled nursing services. If you did not work 10 years, you may be able to purchase Part A, and the premium depends on your work record.

What is the difference between Part A and Part B?

Part A covers hospital stays and some skilled nursing and home health care. Part B covers doctor visits, outpatient services, and some preventive care. Part B has a monthly premium and requires you to enroll during your initial enrollment period.

What do I do if I never received my Medicare card?

Log into Medicare.gov to confirm your enrollment and find your Medicare number, or call 1-800-MEDICARE. You can order a replacement card at Medicare.gov or by phone. Your coverage is active even if your card has not arrived yet.