When You Can Start Collecting Medicare: Age Requirements and Your Options

You can start Medicare at 65, but you may be able to start earlier if you have a disability or end-stage renal disease

Medicare may be able to access is tied to age 65 for most people, but the program has routes in for people younger than that. If you are disabled and have been receiving Social Security Disability Insurance (SSDI) for 24 months, you become may be able to access at any age. If you have end-stage renal disease (ESRD) or amyotrophic lateral sclerosis (ALS), you can start Medicare right away, regardless of age. The month you turn 65 is the month your coverage can begin — you do not have to wait until your birthday passes.

Starting Medicare is not automatic. You have to take action during your enrollment window, or you may face a permanent penalty on your premiums. The enrollment window depends on which route you take: age-based, disability-based, or disease-based. Missing the window does not mean you lose coverage forever, but it does mean higher costs for as long as you have Medicare.

Key Takeaways

You become may be able to access for Medicare the month you turn 65, even if your birthday is on the last day of the month.
If you are receiving SSDI, you become may be able to access 24 months after your disability benefits start, regardless of your age.
People with end-stage renal disease or ALS can start Medicare when ready upon diagnosis, with no age or work history requirement.
Your enrollment window is usually seven months long and centered on your birthday month; missing it can add 10 percent to your Part B premium for life.

Medicare at 65: The standard age and your enrollment window

The month you turn 65, you enter your Initial Enrollment Period (IEP). This window runs for seven months: three months before the month you turn 65, the month you turn 65, and three months after. If your birthday is March 15, your window opens December 1 and closes June 30.

During this window, you can sign up for Medicare Part A (hospital insurance) and Part B (medical insurance) without penalty. Part A has no premium for most people who worked and paid Medicare taxes for at least 10 years. Part B has a monthly premium that changes each year; in 2024, the standard premium is $164.90 per month, but higher earners pay more.

If you do not sign up during your IEP, you can still sign up later, but you will face a permanent penalty. Part B premiums increase by 10 percent for each 12-month period you were may be able to access but did not sign up. That penalty stays with you for life. The only exception is if you were still working and covered by your employer's health plan when you turned 65 — in that case, you have eight months after your employment or coverage ends to sign up without penalty.

Starting Medicare before 65 if you receive disability benefits

If you receive Social Security Disability Insurance (SSDI), you become may be able to access for Medicare 24 months after your disability benefits begin. Your age does not matter. A 35-year-old on SSDI for two years can start Medicare; a 50-year-old on SSDI for two years can start Medicare.

Social Security will notify you by mail when you become may be able to access. You do not have to do anything to get Part A (hospital insurance) — it starts automatically. Part B (medical insurance) does not start automatically. You have to sign up for it during your enrollment window, which is the same seven-month window: three months before, the month you become may be able to access, and three months after. If you miss this window, the 10 percent penalty applies to Part B premiums.

If you are working while on SSDI and earning above the trial work period limit, tell Social Security before you turn 65. Your work situation may affect when Medicare starts or how much you pay. Social Security representatives can walk you through this by phone at 1-800-772-1213.

Medicare for people under 65 with end-stage renal disease or ALS

Two conditions let you start Medicare when ready, with no age requirement and no waiting period: end-stage renal disease (ESRD) and amyotrophic lateral sclerosis (ALS).

If you have ESRD and need dialysis or a kidney transplant, you become may be able to access for Medicare the month your dialysis or transplant treatment begins. If you have ALS, you become may be able to access for Medicare the month you are approved for SSDI benefits — you do not have to wait 24 months like other disability beneficiaries.

For ESRD, your dialysis center or transplant team will help you report your condition to Social Security. For ALS, Social Security approves you for SSDI benefits right away (no waiting period), and Medicare starts the same month. In both cases, Part A starts automatically and Part B requires you to sign up. Your enrollment window is still seven months, and the same 10 percent penalty applies if you miss it.

What happens if you delay Medicare past 65

You can delay Medicare past 65 if you are still working and covered by your employer's health plan. Your employer must have at least 20 employees. If this applies to you, you can wait to sign up for Part B without penalty, as long as you sign up within eight months of when your employment or employer coverage ends.

If you are not covered by an employer plan and you delay Medicare past 65, you will pay a permanent penalty. Part B premiums go up 10 percent for each year you were may be able to access but did not sign up. Part D (prescription drug coverage) has a similar penalty: 1 percent per month for each month you were may be able to access but did not sign up. These penalties are permanent and do not go away if you sign up later.

Part A (hospital insurance) does not have a penalty if you delay, but you should still sign up during your IEP to avoid gaps in coverage. If you end up in the hospital without Part A, you will owe the full cost.

How to sign up for Medicare

You can sign up for Medicare in three ways: online, by phone, or in person.

Online: Go to Medicare.gov and click "Sign Up for Medicare." You will need your Social Security number, birth date, and citizenship information. You can complete the process in one sitting or save it and come back.

By phone: Call Social Security at 1-800-772-1213 (TTY 1-800-325-0778). Have your Social Security number, birth date, and information about any current health coverage ready. The call usually takes 15 to 20 minutes.

In person: Visit your local Social Security office. You can find the nearest one at ssa.gov/locator. Bring your Social Security card, birth certificate, and proof of citizenship (passport, naturalization papers, or birth certificate on file with vital records).

You will receive your Medicare card in the mail within two to four weeks. Your coverage starts on the first day of the month you sign up, or the first day of the month you become may be able to access, whichever is later.

Frequently Asked Questions

Can I sign up for Medicare before I turn 65?

You can sign up three months before you turn 65. Your enrollment window opens three months before your birthday month. If you are on SSDI or have ESRD or ALS, you can sign up anytime during your seven-month enrollment window centered on the month you become may be able to access.

What if I miss my enrollment window?

You can still sign up later, but you will face a permanent premium penalty. Part B premiums increase 10 percent for each 12-month period you were may be able to access but did not sign up. The only exception is if you were covered by an employer health plan when you turned 65 — you then have eight months after that coverage ends to sign up without penalty.

Do I have to sign up for Part B if I sign up for Part A?

No. Part A and Part B are separate. Part A (hospital insurance) starts automatically for most people who sign up. Part B (medical insurance) requires a separate choice. However, if you do not sign up for Part B during your enrollment window and you are not covered by an employer plan, you will face a permanent penalty when you do sign up later.

What if I am still working at 65?

If your employer has at least 20 employees and covers you under their health plan, you can delay Part B without penalty. You have eight months after your employment or coverage ends to sign up for Part B. You should still sign up for Part A to avoid gaps in hospital coverage.

How do I know if I have been on SSDI for 24 months?

Social Security will send you a notice in the mail when you become may be able to access for Medicare. You can also call Social Security at 1-800-772-1213 and ask when your 24-month period ends. Have your Social Security number ready.

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.