You can start Medicare at 65, no matter your work history

Medicare begins the month you turn 65, as long as you or your spouse paid Medicare taxes while working. You do not have to retire to sign up — you can keep working and have Medicare at the same time. If you were born on the first of the month, your coverage starts the month before.

The month you turn 65, you become may be able to access for all four parts of Medicare: Part A (hospital insurance), Part B (medical insurance), Part D (prescription drug coverage), and the option to choose Part C (Medicare Advantage) instead of Parts A and B. You can also buy a Medigap policy to cover costs that Medicare does not pay.

Key Takeaways

  • Medicare starts the month you turn 65 if you or your spouse paid Medicare taxes for at least 10 years of work.
  • You must sign up during your Initial Enrollment Period, which runs three months before your 65th birthday through three months after, or face a permanent penalty on Part B premiums.
  • If you are still working and have health insurance through your job, you may be able to delay Part B without penalty, but you must sign up for Part A.
  • You can sign up online at Medicare.gov, by phone at 1-800-MEDICARE, or in person at your local Social Security office.
  • People under 65 with End-Stage Renal Disease, ALS, or who have received Social Security Disability Insurance for 24 months can start Medicare earlier.

Who qualifies for Medicare at 65

You may have access to if you are a U.S. citizen or permanent resident who has lived in the country for at least five years, and you or your spouse paid Medicare taxes for at least 10 years (40 quarters) of work. You do not have to be retired. You do not have to be a certain income level. Age 65 is the standard starting point for almost everyone.

If you were born outside the United States, you still may have access to at 65 as long as you are a permanent resident and meet the work history requirement. If you are not yet a permanent resident, contact Social Security to learn what documents you will need.

When to sign up during your Initial Enrollment Period

Your Initial Enrollment Period is a seven-month window: three months before the month you turn 65, the month you turn 65, and three months after. For example, if you turn 65 in June, your enrollment period runs from March through September.

Sign up during this window to avoid a permanent penalty on your Part B premium. If you miss this period and do not have a valid reason (called a "may have access to event"), your Part B premium will be 10 percent higher for each year you were may be able to access but did not sign up. This penalty stays with you for life.

Part A (hospital insurance) does not have a penalty if you miss the important date, but you should still sign up as soon as you turn 65 because coverage is retroactive three months. If you sign up late, you may lose that back coverage.

Signing up before you turn 65

You can sign up starting three months before your birthday. The Social Security Administration recommends signing up about three months early so your coverage starts smoothly on your 65th birthday month. If you wait until after your birthday, there may be a gap in coverage.

You can sign up online at Medicare.gov, by calling 1-800-MEDICARE (1-800-633-4227), or by visiting your local Social Security office in person. Online signup is usually the fastest route. Have your Social Security number, birth certificate, and proof of citizenship or permanent residency ready.

If you are still working at 65

You can delay Part B (medical insurance) without penalty if you have health insurance through your current job and your employer has 20 or more employees. This is called creditable coverage. You must still sign up for Part A (hospital insurance) at 65, but you can wait to sign up for Part B until you retire or lose your job coverage.

When you do sign up for Part B later, you have eight months from the date your job coverage ends to sign up without penalty. If you miss this window, the 10 percent penalty applies for each year you were may be able to access but did not sign up.

If your employer has fewer than 20 employees, you should sign up for Part B at 65 even if you have job coverage, because the job coverage may not count as creditable. Contact Medicare to confirm your situation before you decide to delay.

Medicare before age 65 for certain conditions

You can start Medicare before 65 if you have been receiving Social Security Disability Insurance (SSDI) for 24 months. Your Medicare coverage begins automatically — you do not have to sign up. You will receive your Medicare card in the mail about a month before your coverage starts.

You can also start Medicare before 65 if you have End-Stage Renal Disease (permanent kidney failure requiring dialysis or transplant) or ALS (amyotrophic lateral sclerosis, also called Lou Gehrig's disease). For these conditions, you can sign up as soon as you are diagnosed. Contact Social Security or call 1-800-MEDICARE to begin the process.

What happens after you turn 65

Once your Medicare coverage starts, you will receive a red, white, and blue Medicare card in the mail. Use this card at doctors' offices, hospitals, and pharmacies. You will also receive information about your coverage options and any costs you are responsible for.

After you sign up, you can make changes to your coverage during the Annual Enrollment Period, which runs October 15 through December 7 each year. During this time, you can switch between Original Medicare and Medicare Advantage, add or drop prescription drug coverage, or buy a Medigap policy. Outside this window, you can only make changes if you have a may have access to life event, such as moving, losing other insurance, or getting married.

Frequently Asked Questions

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

Your Medicare coverage starts the month before you turn 65. For example, if you were born on June 1, your coverage begins May 1. Your Initial Enrollment Period also shifts back one month, so it would run from February through August.

Can I sign up for Medicare online?

Yes. Go to Medicare.gov and click "Sign Up for Medicare." You will need your Social Security number, birth certificate, and proof of citizenship or permanent residency. The online process usually takes 15 to 20 minutes. You can also call 1-800-MEDICARE or visit a Social Security office.

What if I do not have 10 years of work history?

If you do not have 10 years of work history yourself, you may still may have access to based on your spouse's work history if you are married, or your ex-spouse's history if you were married for at least 10 years. Contact Social Security to learn about you may have access to this way.

Do I have to retire to sign up for Medicare?

No. You can sign up for Medicare and keep working. If you have health insurance through your job, you may be able to delay Part B without penalty, but you must still sign up for Part A at 65.

What if I miss my Initial Enrollment Period?

You can still sign up, but you may face a permanent 10 percent penalty on your Part B premium for each year you were may be able to access but did not sign up. The penalty lasts for life. Sign up as soon as you realize you missed the important date to stop the penalty from growing.