You must be 65 or older to get Medicare, with rare exceptions

Medicare starts the month you turn 65. If your birthday is the first of the month, coverage begins that month. If your birthday is any other day, coverage begins the first day of the following month. You do not have to wait until your birthday itself — the program counts the month you reach 65 as your may be able to access month.

There are three exceptions to the age 65 rule. You can get Medicare before 65 if you have been receiving Social Security Disability Insurance (SSDI) for 24 months, if you have end-stage renal disease (ESRD) requiring dialysis or a transplant, or if you have amyotrophic lateral sclerosis (ALS). In each case, Medicare begins automatically — you do not need to take a separate step.

If you are not yet 65 and do not fall into one of these categories, you cannot get Medicare. You will need to find coverage through your employer, the individual market, Medicaid, or another source until you reach 65.

Key Takeaways

  • Medicare coverage begins the month you turn 65, regardless of the exact date within that month.
  • You can get Medicare before 65 if you have been on SSDI for 24 months, have end-stage renal disease, or have ALS.
  • If you work past 65, you can delay Medicare enrollment, but you must sign up during your initial enrollment window or face late penalties.
  • Your initial enrollment window is seven months long: three months before the month you turn 65, the month itself, and three months after.
  • If you miss your initial window and do not have may have access to coverage, you will pay a permanent surcharge on your Part B and Part D premiums.

When to sign up if you turn 65 this year

Your initial enrollment window is seven months: three months before you turn 65, the month you turn 65, and three months after. If you turn 65 in June, your window runs from March through September. You can sign up any time during this window, and coverage will begin the month you turn 65 — not the month you sign up.

You do not have to sign up in the month you turn 65. Many people sign up two or three months early to avoid a rush. The key is to sign up before the window closes, because missing it can cost you money for the rest of your life.

If you are still working and your employer offers health insurance, you may be able to delay Medicare without penalty. This is called creditable coverage. You must have written proof from your employer that their plan is creditable — ask your benefits department for this letter. Keep it, because you will need to show it when you do sign up for Medicare.

What happens if you miss your initial enrollment window

If you do not sign up during your seven-month window and you do not have creditable coverage from an employer, you will face a permanent surcharge on your Part B premium (the doctor and outpatient coverage) and your Part D premium (prescription drug coverage). This surcharge is called a late enrollment penalty.

The Part B penalty is 10 percent of the standard premium for each full year you were may be able to access but not enrolled. The Part D penalty is 1 percent of the national average Part D premium for each month you were may be able to access but not enrolled. Both penalties stay with you for as long as you have Medicare — they do not go away after a few years.

If you missed your window but now have a may have access to life event — such as losing employer coverage, moving to a new state, or turning 65 — you may be able to sign up during a special enrollment period. These windows are shorter than the initial window and have strict rules about what counts as a may have access to event. Contact Social Security or Medicare to ask whether your situation qualifies.

How to sign up for Medicare at 65

You have three ways to sign up: online through Medicare.gov, by phone with Social Security, or in person at a Social Security office. Most people sign up online because it is the fastest route and you can do it at any time of day.

To sign up online, go to Medicare.gov, click "Sign up for Medicare," and follow the steps. You will need your Social Security number and basic information about your health coverage history. The process takes about 15 minutes. You will get a confirmation number on screen and by email.

If you prefer to sign up by phone, call Social Security at 1-800-772-1213. Have your Social Security number and Medicare card (if you already have one) ready. If you sign up by phone, ask for a confirmation number before you hang up.

You can also walk into any Social Security office with your Social Security card and proof of citizenship or legal residency. Bring a photo ID and your birth certificate. Wait times at offices vary widely, so calling ahead to ask about current wait times is worth your time.

What happens after you turn 65 if you do not sign up

If you turn 65 and do not sign up for Medicare, you remain uninsured unless you have another source of coverage. You are still responsible for all medical costs out of pocket. You cannot get Medicare retroactively to cover bills you incurred while uninsured.

The exception is if you have creditable coverage from an employer or a spouse's employer. In that case, you can delay Medicare without penalty as long as you are still covered by that plan. Once you lose that coverage — because you or your spouse retires, leaves the job, or the employer stops offering it — you have a special enrollment period of up to eight months to sign up for Medicare without penalty.

If you are unsure whether your employer coverage is creditable, ask your benefits department in writing. They are required to tell you. Get the answer in writing and keep it, because you will need proof if you sign up for Medicare later.

Medicare for people under 65 with disabilities or specific conditions

If you are under 65 and have been receiving SSDI for 24 months, you become may be able to access for Medicare automatically. You do not need to do anything — Medicare will begin in the 25th month of your SSDI benefits. You will receive your Medicare card in the mail before coverage starts.

If you have end-stage renal disease (ESRD) and need dialysis or have had a kidney transplant, you can get Medicare regardless of age. Your nephrologist or dialysis center will help you sign up. Coverage usually begins the month your treatment starts, though the exact timing depends on your situation.

If you have been diagnosed with amyotrophic lateral sclerosis (ALS), you become may be able to access for Medicare when ready, with no waiting period. You will need to provide medical documentation of your diagnosis. Contact Social Security or Medicare to begin the process.

Delaying Medicare after 65 if you are still working

If you are working past 65 and your employer offers health insurance, you can delay Medicare Part B and Part D without penalty as long as you have creditable coverage. You must still enroll in Part A (hospital insurance) when you turn 65, even if you delay Part B, because Part A has no late penalty and covers hospital stays.

When you eventually leave your job or lose your employer coverage, you have eight months to sign up for Part B and Part D without penalty. This is called a special enrollment period for employer coverage. You must have written proof that your employer coverage was creditable — ask your benefits department for a letter before you leave the job.

If you do not sign up for Part B during this eight-month window, you will face the permanent late enrollment penalty described above. The penalty applies even if you had creditable coverage, because you did not sign up within eight months of losing it.

Frequently Asked Questions

Can I get Medicare before I turn 65?

Only if you have been on SSDI for 24 months, have end-stage renal disease requiring dialysis or a transplant, or have ALS. Otherwise, you must wait until 65. If you are under 65 and uninsured, you may be able to get Medicaid or coverage through the individual health insurance market, depending on your income and state.

What if I am still working when I turn 65?

You can delay Medicare Part B and Part D if your employer offers health insurance and it is creditable coverage. You must still sign up for Part A at 65. When you leave your job, you have eight months to sign up for Part B and Part D without penalty. Get written proof from your employer that your coverage is creditable before you leave.

Do I lose Medicare if I move to another state?

No. Medicare is federal and works in all 50 states, U.S. territories, and most foreign countries. Your coverage does not change when you move. You may want to review your Part D (prescription drug) plan and Part C (Medicare Advantage) plan, because some plans do not cover out-of-state care or have different networks in different states.

What if my birthday is on the first of the month?

Your Medicare coverage begins the month you turn 65, even though your birthday is the first day of that month. You do not have to wait until the next month. Your initial enrollment window still runs three months before, the month itself, and three months after.

Can I sign up for Medicare online?

Yes. Go to Medicare.gov, click "Sign up for Medicare," and follow the steps. You will need your Social Security number and information about your current health coverage. The process takes about 15 minutes and you will get a confirmation number on screen and by email.