You become may be able to access for Medicare at 65, regardless of your income or work history

Medicare may be able to access begins the month you turn 65. You do not have to be retired, and you do not have to have worked a certain number of years — though most people do may have access to based on their own work record or their spouse's. If you were born on the first of the month, your coverage starts the month before. Otherwise it starts the month of your birthday.

There are a few exceptions. If you are under 65, you may be able to enroll in Medicare if you have received Social Security Disability Insurance (SSDI) for 24 months, or if you have end-stage renal disease (ESRD) or amyotrophic lateral sclerosis (ALS). But for most people, 65 is the magic number.

Key Takeaways

  • Medicare coverage starts the month you turn 65, and you must enroll during your Initial Enrollment Period to avoid paying higher premiums for the rest of your life.
  • Your Initial Enrollment Period is seven months long: three months before your 65th birthday, the month you turn 65, and three months after.
  • If you are still working and covered by your employer's health plan at 65, you may be able to delay enrollment without penalty, but you must tell Social Security.
  • You can enroll online at Medicare.gov, by phone at 1-800-MEDICARE, or in person at your local Social Security office.
  • Missing your enrollment window can cost you 10 percent more per month on Part B premiums for each year you delay, for as long as you have Medicare.

When your Initial Enrollment Period begins and ends

Your Initial Enrollment Period is a seven-month window that centers on your 65th birthday. It starts three months before the month you turn 65 and ends three months after. For example, if you turn 65 in June, your period runs from March through September.

You should enroll during this window, even if you do not plan to use Medicare right away. Waiting until after this period closes can trigger a late enrollment penalty — a permanent increase to your Part B premium. The penalty is 10 percent of the standard Part B premium for each 12-month period you were may be able to access but did not enroll. That penalty stays with you for life.

The only way to avoid this penalty is to have creditable coverage — health insurance through your employer or your spouse's employer that is at least as good as Medicare Part B. If you have that coverage, you can enroll in Medicare later without penalty, but you must enroll within eight months of losing that job-based coverage.

How to enroll in Medicare at 65

You have three main ways to enroll. The easiest is online at Medicare.gov. You will need your Social Security number, birth date, and citizenship or immigration status. The process takes about 10 minutes.

You can also call 1-800-MEDICARE (1-800-633-4227) and speak to a representative. They can answer questions about your specific situation and enroll you over the phone. The line is open 24 hours a day, seven days a week.

A third option is to visit your local Social Security office in person. You will need to bring your Social Security card, proof of citizenship or legal residency (such as a passport or birth certificate), and proof of age. You can find your nearest office at ssa.gov/locator.

What happens if you are still working at 65

If you are still employed and covered by your employer's health plan, you may not need to enroll in Medicare right away. However, the rules depend on the size of your employer. If your employer has 20 or more employees, your employer's plan is the primary payer, and you can delay Medicare enrollment without penalty. You must enroll within eight months of leaving that job.

If your employer has fewer than 20 employees, Medicare becomes primary, and you should enroll in Medicare Part A and Part B when you turn 65. Delaying can result in a late enrollment penalty on Part B.

In either case, tell Social Security that you are still working and covered by an employer plan. You can do this when you enroll, or you can contact Social Security separately. This protects you from penalties and ensures your records are correct.

Late enrollment penalties and how they work

A late enrollment penalty applies only to Part B (medical insurance) and Part D (prescription drug coverage). It does not explore to Part A (hospital insurance), which most people do not pay a premium for.

The Part B penalty is 10 percent of the standard monthly premium for each 12-month period you were may be able to access but did not enroll. If the standard Part B premium is $175 per month and you wait two years to enroll, your penalty would be 20 percent, or $35 per month, added to your premium for life. The same logic applies to Part D: 1 percent of the national average Part D premium per month of delay.

These penalties are permanent. Even if you enroll later and pay them for years, they do not go away. The only exception is if you had creditable coverage through an employer or union, in which case the penalty clock does not start until you lose that coverage.

Special situations: disability, ESRD, and ALS

If you are under 65 and receiving Social Security Disability Insurance (SSDI), you become may be able to access for Medicare after you have been on SSDI for 24 months. Your coverage begins in the 25th month of your disability benefits.

If you have end-stage renal disease (ESRD) — permanent kidney failure requiring dialysis or a transplant — you may be may be able to access for Medicare regardless of age. You can enroll in Medicare as soon as you start dialysis or receive a transplant, or three months before if you know you will need dialysis. Your coverage can begin as early as the first day of the month you start treatment.

If you have been diagnosed with amyotrophic lateral sclerosis (ALS), you are may be able to access for Medicare when ready, with no waiting period. Your coverage begins the month your Social Security disability benefits begin.

Frequently Asked Questions

What if I turn 65 and I am not a U.S. citizen?

You can enroll in Medicare if you are a lawful permanent resident (green card holder) and have lived in the United States for at least five years. You will need to provide proof of your immigration status when you enroll. Undocumented immigrants are not may be able to access for Medicare.

Can I enroll in Medicare before I turn 65?

You can enroll starting three months before the month you turn 65. This is part of your Initial Enrollment Period. Enrolling early ensures your coverage starts on time and helps you avoid late penalties.

What if I miss my Initial Enrollment Period?

You can still enroll, but you will likely owe a late enrollment penalty on Part B and Part D for as long as you have Medicare. The only way to avoid the penalty is if you had creditable coverage through an employer. Contact Medicare or Social Security to enroll as soon as possible to limit the penalty.

Do I have to enroll in all four parts of Medicare at 65?

No. Part A (hospital insurance) is automatic for most people at 65 and has no premium. You must actively enroll in Part B (medical insurance). Part D (prescription drugs) and Medigap or Medicare Advantage are optional. However, delaying Part B or Part D enrollment can result in penalties.

What if I am still working and my employer offers retiree health coverage?

Retiree health coverage from a former employer counts as creditable coverage. You can delay Medicare enrollment without penalty as long as you are covered. When you retire and lose that coverage, you have eight months to enroll in Medicare without penalty.