Who Can Get Medicare and When

You become may be able to access for Medicare at age 65, regardless of income or health history. You do not have to retire. If you are under 65, you may be may be able to access if you have received Social Security Disability Insurance (SSDI) for 24 months, have end-stage renal disease (ESRD), or have amyotrophic lateral sclerosis (ALS). Your may be able to access does not depend on where you live or whether you have worked before — it depends on your age or disability status.

The enrollment window matters. You have a seven-month Initial Enrollment Period centered on the month you turn 65: three months before, the month itself, and three months after. If you miss this window, you will pay a permanent penalty on your Part B and Part D premiums for as long as you have Medicare. The penalty is roughly 10% per year you delayed, and it compounds.

If you are already receiving Social Security when you turn 65, Medicare will enroll you automatically. If you are not receiving Social Security, you must take action yourself — the government will not do it for you.

Key Takeaways

  • You must enroll during your seven-month Initial Enrollment Period (three months before, during, and three months after the month you turn 65) or pay a permanent penalty.
  • If you receive Social Security, Medicare enrolls you automatically; if you do not, you must enroll yourself through Social Security, Medicare.gov, or your local Social Security office.
  • You need a Social Security number and proof of citizenship or legal residency, but you do not need to be retired or have worked a certain number of years.
  • Part A (hospital insurance) is free for most people; Part B (doctor visits) costs a monthly premium that varies by income; Part D (prescription drugs) requires a separate enrollment step.
  • If you delay enrollment outside your Initial Enrollment Period, you can enroll during the General Enrollment Period (January 1 to March 31) but will face permanent penalties.

Enrolling If You Receive Social Security

If you already receive Social Security benefits, Medicare will enroll you automatically three months before the month you turn 65. You will receive a Medicare card in the mail about two weeks before your coverage starts. You do not need to do anything — the enrollment happens without your action.

Check the mail carefully. Your Medicare card will show your name, Medicare number, and the dates your coverage begins. Part A (hospital insurance) and Part B (doctor and outpatient services) will both start on the first day of the month you turn 65. If you do not receive your card by the expected date, call Social Security at 1-800-772-1213 to confirm your address is correct.

Even though you are enrolled automatically in Part A and Part B, you still must enroll in Part D (prescription drug coverage) separately if you want it. Missing the Part D enrollment important date also triggers a permanent penalty. You can enroll in Part D online at Medicare.gov, by phone, or through your local Social Security office during the same seven-month window.

Enrolling If You Do Not Receive Social Security

If you do not receive Social Security, you must enroll in Medicare yourself. You have three ways to do this: online at Medicare.gov, by phone at 1-800-MEDICARE (1-800-633-4227), or in person at your local Social Security office.

The online route is fastest. Go to Medicare.gov, click "Sign up for Medicare," and create or log into your account. You will need your Social Security number, proof of citizenship or legal residency, and information about any current health coverage. The system will walk you through Part A and Part B enrollment in one session. You can complete it in about 15 minutes.

By phone, call 1-800-MEDICARE during business hours (Monday through Friday, 8 a.m. to 8 p.m. your local time). A representative will ask the same questions and enroll you over the phone. This takes about 20 minutes. In person, visit your local Social Security office with your documents. Bring your Social Security card, proof of citizenship (passport, birth certificate, or naturalization papers), and proof of residency (utility bill or lease). Processing in person usually takes 30 to 45 minutes, and you will receive a temporary receipt on the spot.

Documents You Need to Enroll

Gather these documents before you start the enrollment process, whether online, by phone, or in person. You will need your Social Security number (or the number of the person whose work record you are using, if you are a spouse or widow). You will need proof of U.S. citizenship or legal residency — a passport, birth certificate, naturalization certificate, or permanent resident card (green card). You will need proof of your current address — a utility bill, lease, mortgage statement, or bank statement dated within the last two months.

If you are enrolling based on disability rather than age, you will need documentation of your SSDI award, ESRD diagnosis, or ALS diagnosis. If you have current health coverage through an employer or union, bring that information too — it may affect your Part B premium or whether you face a penalty for late enrollment.

If you are a non-citizen, bring your green card or visa. If you are a widow or widower, bring your marriage certificate and your spouse's death certificate. If you are divorced and using your ex-spouse's work record, bring the divorce decree. Having these documents ready prevents delays and reduces the chance you will be asked to resubmit something later.

Understanding Part A, Part B, and Part D

Medicare has four parts, but enrollment focuses on three. Part A covers hospital stays, skilled nursing facility care, hospice, and home health services. Part A is free for most people because you or your spouse paid Medicare taxes while working. You do not choose to enroll or not enroll in Part A — it is automatic when you turn 65 and meet the work history requirement (usually 40 quarters of Medicare-taxed work, or about 10 years).

Part B covers doctor visits, outpatient services, lab tests, and preventive care. Part B requires a monthly premium. The standard premium in 2024 is $174.70 per month, but it varies by income. If your income is higher, you will pay an Income-Related Monthly Adjustment Amount (IRMAA) on top of the base premium. You must actively choose to enroll in Part B during your Initial Enrollment Period. If you delay and do not have a valid reason (such as current employer coverage), you will pay a 10% penalty for each year you delayed.

Part D covers prescription drugs. Part D is not automatic — you must choose a plan and enroll during your Initial Enrollment Period or during the annual open enrollment period (October 15 to December 7). If you go without Part D coverage and later enroll, you will pay a penalty of roughly 1% of the national average Part D premium for each month you were without coverage. This penalty is permanent and compounds each year.

Part C (Medicare Advantage) is an alternative to Part A and Part B offered by private insurers. You do not enroll in Part C during the initial enrollment process — you choose it separately if you want it, and you can switch back to Original Medicare (Part A and Part B) during the annual open enrollment period.

What Happens After You Enroll

After you enroll, your Medicare coverage begins on the first day of the month you turn 65 (or the month your disability is approved). You will receive your Medicare card in the mail within two to four weeks. Your card shows your Medicare number, which is unique to you and different from your Social Security number. Keep this card with you when you see a doctor or go to the hospital.

Once you have your card, you can start using your benefits when ready. Show your card to your doctor's office, hospital, or pharmacy. They will verify your coverage and bill Medicare directly. You will be responsible for any copayments, coinsurance, or deductibles outlined in your plan.

If you enrolled in Part D, you will need to choose a specific drug plan. You can do this on Medicare.gov, by phone, or through an insurance agent. Different plans cover different drugs and have different costs. Use the Medicare Plan Finder tool on Medicare.gov to compare plans based on the medications you take. Your Part D coverage will start on January 1 of the year after you enroll, or when ready if you enroll during the annual open enrollment period.

If You Miss Your Enrollment important date

If you miss your Initial Enrollment Period, you can still enroll, but you will face consequences. The General Enrollment Period runs from January 1 to March 31 each year. During this window, you can enroll in Part B and Part D without a penalty if you have a valid reason for missing the initial important date — such as current employer coverage, coverage through a spouse's employer, or coverage through TRICARE or the Veterans Administration.

If you do not have a valid reason, you will pay a permanent penalty. Your Part B premium will increase by 10% for each year you delayed. Your Part D premium will increase by roughly 1% for each month you were without coverage. These penalties stay with you for life, even if you later switch plans or move to a different state.

If you miss the General Enrollment Period entirely, you must wait until the next General Enrollment Period (January 1 to March 31 of the following year) to enroll. Your coverage will not start until July 1 of that year. During the months you are not covered, you are responsible for all medical costs.

Frequently Asked Questions

Do I have to retire to get Medicare at 65?

No. Medicare may be able to access at 65 is based on age alone, not on whether you work or retire. You can continue working and earning income while receiving Medicare. If you are still working and have health coverage through your employer, you may want to delay Part B enrollment to avoid paying both premiums, but you must still enroll in Part A.

What if I am still working and have employer health coverage?

If your employer has 20 or more employees, your employer coverage is primary and Medicare is secondary. You can delay Part B enrollment without penalty as long as you are actively employed and covered. When you leave your job or lose coverage, you have eight months to enroll in Part B without penalty. Enroll as soon as you lose coverage to avoid gaps.

Can my spouse enroll at the same time I do?

Yes, if your spouse is also 65 or older. Each person has their own seven-month enrollment window based on their own birth month. You can enroll together online or by phone, but each person must have their own Medicare number and card. If your spouse is under 65, they cannot enroll until they turn 65 or become may be able to access through disability.

What if I am a non-citizen or immigrant?

You must be a U.S. citizen or have been a lawful permanent resident for at least five years to be may be able to access for Medicare. Bring your green card or visa documentation when you enroll. If you do not meet these requirements, you may not be may be able to access for Medicare, though you may be able to purchase private health insurance.

How much does Medicare cost?

Part A is free for most people. Part B costs a monthly premium (the standard amount is $174.70 in 2024, but varies by income). Part D costs vary by plan, typically $5 to $100 per month. You also pay copayments and deductibles when you use services. The exact costs depend on which plan you choose and your income level.