The Basic Age Rule 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 enroll, and your employer coverage does not prevent you from signing up at 65.

The month you turn 65, you enter a seven-month window called your Initial Enrollment Period. This window starts three months before your 65th birthday month and ends three months after. During this time, you can enroll in Medicare Part A (hospital insurance) and Part B (medical insurance) without penalties. If you miss this window, you may pay higher premiums for the rest of your life.

You do not have to enroll the moment you turn 65 if you have coverage through a current employer and meet certain conditions. However, the rules are strict, and mistakes are costly. If you are unsure whether you can delay, contact Social Security or Medicare directly before your 65th birthday.

Key Takeaways

  • Medicare may be able to access begins at age 65 for most people, and you have a seven-month enrollment window centered on your 65th birthday month.
  • If you miss your Initial Enrollment Period, you will pay a permanent penalty on your Part B and Part D premiums unless you have a valid reason for the delay.
  • You may be able to delay enrollment past 65 if you have health insurance through a current employer, but you must meet specific conditions and notify Medicare.
  • Some people under 65 can get Medicare if they receive Social Security disability benefits for at least 24 months, have end-stage renal disease, or have ALS.

Who Can Get Medicare Before Age 65

Three groups of people under 65 are may be able to access for Medicare. The first group is people who have received Social Security Disability Insurance (SSDI) for at least 24 months. Once you have been on SSDI for two years, Medicare Part A and Part B start automatically. You do not have to be any particular age.

The second group is people with end-stage renal disease (ESRD), which means permanent kidney failure requiring dialysis or a transplant. You can enroll in Medicare as soon as you start dialysis treatment or are scheduled for a kidney transplant, regardless of age. You will have a three-month enrollment window starting the month your treatment begins.

The third group is people with ALS (amyotrophic lateral sclerosis), also called Lou Gehrig's disease. You become may be able to access for Medicare the month you are approved for SSDI, without waiting the usual 24-month period. You do not have to wait two years.

How to Enroll During Your Initial Enrollment Period

You can enroll in Medicare three ways: online through Medicare.gov, by phone at 1-800-MEDICARE, or in person at your local Social Security office. The online method is fastest — you can complete it in about 10 minutes if you have your Social Security number and information about any current health coverage.

You will need to provide your name, date of birth, Social Security number, and citizenship or immigration status. If you are enrolling in Part B, Medicare will ask whether you have other health insurance through an employer or a spouse's employer. Answer honestly, because this affects whether you can delay Part B without penalty.

After you enroll, Medicare will mail you a Medicare card within two weeks. Your coverage typically starts the first day of the month in which you turn 65, or the first day of the month after you enroll, whichever is later. Keep your Medicare card in a safe place — you will need it at every doctor visit and hospital stay.

What Happens If You Miss Your Enrollment Window

If you do not enroll during your seven-month Initial Enrollment Period and you do not have a valid reason for the delay, you will pay a late enrollment penalty for the rest of your life. For Part B, the penalty is 10 percent of the standard premium for each full year you were may be able to access but not enrolled. If you were may be able to access for three years and did not enroll, your Part B premium will be 30 percent higher than the standard amount.

The same penalty applies to Part D (prescription drug coverage). If you go 63 days or longer without Part D coverage and later enroll, you will pay a penalty based on how long you went without it. These penalties do not expire — they stay on your premiums permanently.

The only way to avoid a late enrollment penalty is to have a valid reason, called a may have access to event. The most common reason is having health insurance through a current employer or a spouse's current employer. Other reasons include losing employer coverage, moving out of your plan's service area, or having your plan end. You must enroll within 63 days of losing coverage. If you believe you have a may have access to event, contact Medicare to explain your situation.

Delaying Medicare If You Have Employer Coverage

If you or your spouse are still working and have health insurance through that job, you may be able to delay Part B without penalty. The rule is that your employer must have 20 or more employees. If it does, you can stay on the employer plan and delay Medicare Part B until you or your spouse stops working or lose the coverage.

You must enroll in Part A (hospital insurance) at 65 even if you delay Part B, unless you are still covered by an employer plan with 20 or more employees. Part A has no monthly premium if you or your spouse paid Medicare taxes for at least 10 years, so there is no financial reason to delay it.

To delay Part B without penalty, you must tell Medicare in writing that you are delaying because of employer coverage. You can do this by contacting Social Security or Medicare and stating that you have group health plan coverage through your employer. Keep a record of when you notified them. When you do enroll in Part B later, your coverage will start the first day of the month after you enroll or lose your employer coverage.

Special Situations: Government Employees and Railroad Workers

If you worked for the federal government and are covered by the Federal Employees Health Benefits Program (FEHB), you must enroll in Medicare Part A at 65 but can delay Part B if you are still employed. When you retire or lose FEHB coverage, you have 63 days to enroll in Part B without penalty.

If you are a retired railroad worker covered by Railroad Retirement benefits, you are may be able to access for Medicare at 65 just like other workers. Your railroad retirement benefits do not change when you enroll in Medicare. You will receive both payments separately.

If you worked for a state or local government and did not pay Social Security taxes, you may have limited Medicare coverage. Contact Social Security to find out what you are may be able to access for, because the rules vary by state and by when you worked.

Frequently Asked Questions

Can I enroll in Medicare before I turn 65?

Only if you meet one of three conditions: you have been on Social Security disability for 24 months, you have end-stage renal disease, or you have ALS. Otherwise, you must wait until age 65. You can contact Medicare three months before your 65th birthday to start the enrollment process.

What if I turn 65 while I'm still working?

You can enroll in Medicare at 65 even if you are still working. If your employer has 20 or more employees and offers health insurance, you can delay Part B without penalty, but you should still enroll in Part A. Tell Medicare in writing that you are delaying Part B due to employer coverage.

Do I lose my Medicare if I go back to work after 65?

No. Once you are enrolled in Medicare, you keep it for life. Working does not affect your Medicare coverage. If you have both Medicare and employer coverage, Medicare is usually the secondary payer, meaning the employer plan pays first.

What if I was born on the first of the month?

If you were born on the first of the month, Social Security considers you to have been born the day before. Your Initial Enrollment Period starts three months before the month before your birth month. Contact Social Security to confirm your exact enrollment dates.

Can I change my mind after I enroll?

Yes, but only during certain times. You have a General Enrollment Period from January 1 to March 31 each year, when you can enroll in or change Medicare plans. Changes made during this period take effect July 1. Outside these windows, you can only make changes if you have a may have access to event like losing employer coverage.