When You Can Start Medicare: Age Requirements and Exceptions

The Basic Age Requirement for Medicare

You become may be able to access for Medicare at age 65. This is the standard entry point, and it applies whether you are still working or retired. You do not have to stop working to sign up, and your income does not affect your age-based may be able to access.

If you were born on the first of the month, Medicare considers you that age starting the month before. If you were born on any other day, your coverage begins the first day of the month you turn 65. This matters for your enrollment important date — you have a seven-month window centered on your birthday month to sign up without penalty.

Key Takeaways

You are may be able to access for Medicare at age 65, regardless of whether you are still working or your income level.
You can sign up starting three months before your 65th birthday and must sign up by three months after, or face a permanent penalty on your premiums.
If you are already receiving Social Security before age 65, you will be enrolled automatically three months before you turn 65.
Some people under 65 can receive Medicare if they have been on Social Security disability for 24 months or have end-stage renal disease or ALS.
Delaying Medicare past 65 is only penalty-free if you have health coverage through a current job or a spouse's current job.

Who Can Get Medicare Before Age 65

Three groups of people under 65 are may be able to access for Medicare. The first is anyone who has been receiving Social Security Disability Insurance (SSDI) for 24 consecutive months. The 24-month waiting period starts from the month you were approved for disability, not from when you applied. Once you reach that mark, Medicare begins automatically — you do not need to sign up separately.

The second group includes people with end-stage renal disease (ESRD), meaning permanent kidney failure requiring dialysis or a transplant. You become may be able to access the first day of the month you start dialysis, or the month of your transplant, whichever comes first. You will need to provide medical documentation to Medicare showing your diagnosis.

The third group is anyone with amyotrophic lateral sclerosis (ALS), also called Lou Gehrig's disease. Unlike SSDI and ESRD, you do not have to wait — Medicare coverage begins the first month you are approved for SSDI due to ALS. This is the only condition with no waiting period.

What Happens If You Miss Your Enrollment Window

Your enrollment window is seven months long: three months before your 65th birthday, the month of your birthday, and three months after. If you do not sign up during this time and you do not have a valid reason to delay, you will pay a permanent late enrollment penalty for as long as you have Medicare Part B (medical insurance).

The penalty is 10 percent of the standard Part B premium for each full 12-month period you were may be able to access but not enrolled. If you wait two years to sign up, your premium goes up 20 percent permanently — even if you switch plans later. This penalty does not go away when you turn 70 or at any other age.

The main exception is if you had health coverage through a job or a spouse's job while you were 65 or older. This is called creditable coverage. If you had it, you have eight months after your coverage ends or your job ends — whichever comes first — to sign up for Medicare without penalty. You will need to show proof of that job coverage when you enroll.

Automatic Enrollment at 65

If you are already receiving Social Security retirement or disability benefits when you turn 65, Medicare will enroll you automatically. You will receive your Medicare card in the mail about three months before your 65th birthday. Part A (hospital insurance) and Part B (medical insurance) both start the first day of the month you turn 65.

You do not have to do anything to accept this automatic enrollment — it happens whether you want it or not. If you do not want Part B at that time because you have job-based coverage, you must contact Social Security or Medicare to decline it in writing. Keep a copy of your decline letter, because you will need it later to prove you had a valid reason to delay.

Delaying Medicare Past 65

You can delay Medicare past 65 without penalty only if you have health coverage through your own job or your spouse's current job. The coverage must be active — not COBRA, not retiree coverage, not coverage you are paying for yourself. It must be coverage provided by an employer where you or your spouse are actively working.

If you have this job-based coverage, you can wait to sign up for Medicare. When you or your spouse finally leaves that job, or when the coverage ends, you have eight months to enroll without penalty. You will need to show your employer's coverage letter or benefits document to prove you had creditable coverage.

If you do not have job-based coverage at 65, delaying Medicare is not recommended. You will face the permanent late enrollment penalty described above, and you will have a gap in coverage that could leave you responsible for large medical bills.

How to Sign Up for Medicare at 65

You can sign up for Medicare 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 option. You will need your Social Security number and proof of citizenship or legal residency.

If you are not yet receiving Social Security, you will need to explore for Social Security retirement benefits at the same time you explore for Medicare, or explore for Medicare separately. The two programs are linked but require separate applications. If you are already receiving SSDI, you do not need to do anything — Medicare will enroll you automatically when you hit the 24-month mark.

Plan to sign up at least one month before your coverage should start. Processing takes time, and you want your card to arrive before your 65th birthday so you can show it to doctors and hospitals right away.

Medicare Parts and What They Cover at 65

Part A covers hospital stays, skilled nursing facility care, hospice, and some home health services. There is no monthly premium for Part A if you or your spouse paid Medicare taxes for at least 10 years while working. If you did not, you may have to pay a premium.

Part B covers doctor visits, outpatient care, medical equipment, and preventive services. It has a monthly premium that changes each year. In 2024, the standard premium is $164.90 per month, but it is higher if your income is above certain thresholds. You pay this premium whether you use Medicare or not.

Part A and Part B together are called Original Medicare. Many people also choose Part D (prescription drug coverage) or a Medigap policy (supplemental insurance) to cover costs that Original Medicare does not pay. These are separate decisions you make when you turn 65.

Frequently Asked Questions

Can I sign up for Medicare before I turn 65?

Yes, you can sign up starting three months before your 65th birthday. You cannot sign up earlier than that unless you are under 65 and have SSDI, ESRD, or ALS. If you try to sign up more than three months early, your process will be rejected and you will have to reapply during your proper enrollment window.

What if I am still working at 65 and have health insurance through my job?

You can delay Medicare Part B without penalty as long as your job coverage continues and you are actively working. You must sign up within eight months after you leave the job or the coverage ends. Keep your employer's benefits letter to prove you had creditable coverage, because Medicare will ask for it.

Do I have to take Part B when I turn 65?

If you are automatically enrolled in Medicare through Social Security, Part B will be enrolled unless you decline it in writing. If you have job-based coverage, you can decline Part B and wait to enroll later without penalty. You must send your decline in writing to Social Security or Medicare and keep a copy.

What happens if I turn 65 outside the United States?

You can still sign up for Medicare at 65 even if you are living abroad. You will need to contact Social Security or Medicare by phone or mail to enroll. Some Medicare benefits do not work outside the U.S., so check what coverage applies in the country where you live before you sign up.

Can my spouse sign up for Medicare at 62 if I am 65?

No. Your spouse must wait until they turn 65 to sign up for Medicare based on age. The only exceptions are if your spouse is under 65 and has SSDI, ESRD, or ALS. Spousal benefits for Social Security retirement are different from Medicare may be able to access and do not lower the Medicare age requirement.

This guide is for general information only and is not medical, financial, legal, or other professional advice. For decisions specific to your situation, consult a qualified professional. See our Editorial Policy.