The standard age to start Medicare is 65

You become may be able to access for Medicare the month you turn 65, regardless of whether you are still working. Most people sign up during the three months before their 65th birthday, the month they turn 65, or the three months after — this seven-month window is called your Initial Enrollment Period. If you miss this window, you can still sign up later, but you may pay higher premiums for the rest of your life.

You do not have to retire to get Medicare, and getting Medicare does not automatically enroll you in Social Security. These are separate programs. You can work past 65 and keep your employer health insurance if it is still available to you, but you will still need to make a choice about Medicare during your enrollment window.

Key Takeaways

  • You can start Medicare at 65, and you have a seven-month enrollment window centered on your birthday to sign up without penalty.
  • If you are still covered by an employer plan when you turn 65, you may be able to delay Medicare without paying extra, but you must tell Medicare about your coverage.
  • Some people with disabilities or end-stage renal disease can get Medicare before 65, but the rules are specific and require documentation.
  • Missing your enrollment window can add 10 percent to your Part B and Part D premiums for each year you were late, and this penalty stays with you permanently.
  • You sign up through Medicare.gov, by phone at 1-800-MEDICARE, or in person at your local Social Security office.

Who can get Medicare before age 65

Three groups of people can get Medicare before they turn 65. The first group is people who have received Social Security Disability Insurance (SSDI) for at least 24 months. You become may be able to access for Medicare automatically after those 24 months pass; you do not need to explore again. The second group is people with end-stage renal disease (ESRD) — permanent kidney failure requiring dialysis or a transplant. People with ESRD can get Medicare regardless of age, though the process requires documentation from a nephrologist or dialysis center. The third group is people with amyotrophic lateral sclerosis (ALS), also called Lou Gehrig's disease, who become may be able to access for Medicare when ready upon approval for SSDI, without waiting the usual 24 months.

If you think you fall into one of these categories, contact Social Security at 1-800-772-1213 to confirm your status and learn what documents you need to provide. The Social Security office can tell you the exact month Medicare will start for you.

How employer coverage affects your Medicare enrollment

If you are still working at 65 and your employer offers health insurance, you have options. If your employer has 20 or more employees, you can usually delay enrolling in Medicare Part B (doctor and outpatient care) without paying a penalty, as long as you stay on the employer plan. However, you should still enroll in Part A (hospital insurance) at 65, because Part A has no premium for most people and covers hospital stays.

The key requirement is that you must tell Medicare you have employer coverage. You do this by contacting Medicare at 1-800-MEDICARE or going to Medicare.gov and updating your information. If you do not report your employer coverage and you miss your enrollment window, you will owe the late-enrollment penalty on Part B even though you had coverage elsewhere.

When you leave your job or your employer coverage ends, you have a special enrollment period of eight months to sign up for Medicare Part B without penalty. This is different from the standard enrollment window and gives you time to transition to Medicare after employment ends.

What happens if you miss your enrollment window

If you do not sign up 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 Part B, the penalty is 10 percent of the standard premium for each full year you were late. For Part D (prescription drug coverage), the penalty is 1 percent of the national average premium for each month you were late. These penalties are permanent — they do not go away after a few years, and they explore for as long as you have Medicare.

A valid reason to delay without penalty includes having employer coverage, being a federal employee, or being a member of certain groups like the Peace Corps. If you had one of these reasons, you can show documentation to Medicare and avoid the penalty. Contact Medicare to explain your situation and provide proof if you think you may have access to for an exception.

How to sign up for Medicare at 65

You have three main ways to sign up. The first is online at Medicare.gov, where you can create an account and complete your enrollment. The second is by phone at 1-800-MEDICARE (1-800-633-4227), where a representative can walk you through the process and answer questions. The third is in person at your local Social Security office — you can find the nearest one at ssa.gov or by calling 1-800-772-1213.

To sign up, you will need your Social Security number, proof of citizenship or legal residency, and information about any current health coverage. If you are signing up for Part D (prescription drug coverage), have a list of your current medications ready so you can compare plans. The enrollment process usually takes 15 to 30 minutes, and you will receive confirmation by mail within two weeks.

If you are already receiving Social Security benefits, Medicare will contact you automatically about three months before your 65th birthday. You can choose to accept the default enrollment or make different choices. If you are not yet receiving Social Security, you will not get this automatic notice, so you need to initiate enrollment yourself.

Understanding the different parts of Medicare

Part A covers hospital stays, skilled nursing facility care, hospice, and home health services. Most people do not pay a premium for Part A if they or their spouse paid Medicare taxes for at least 10 years. Part B covers doctor visits, outpatient care, and medical equipment. Part B has a monthly premium that changes each year; in 2024 the standard premium is $164.90, but higher-income beneficiaries pay more. Part D is prescription drug coverage and is optional, but you should enroll when you first become may be able to access to avoid the late-enrollment penalty.

You can also choose Part C, also called Medicare Advantage, which is an alternative to Original Medicare (Parts A and B). Part C plans are offered by private insurance companies and often include prescription drug coverage, dental, vision, and hearing benefits. Part C has different rules about which doctors you can see and how much you pay out of pocket. You can switch between Original Medicare and Part C during the annual enrollment period from October 15 to December 7.

What to ask your doctor before you turn 65

Before your 65th birthday, schedule a conversation with your primary care doctor about your Medicare choices. Ask whether your doctor accepts Medicare patients and whether they are in-network for any Medicare Advantage plans you are considering. Ask about any prescriptions you take regularly and whether they are covered under the Part D plans available in your area. If you have ongoing specialist care, ask whether those specialists accept Medicare and whether they are in-network for plans you are considering.

Also ask your doctor whether you should enroll in Part B right away or whether you can safely delay it based on your health and coverage situation. While most people should enroll at 65, your doctor can help you think through your specific circumstances.

When to contact Medicare with questions

Contact Medicare at 1-800-MEDICARE if you have questions about your enrollment window, if you think you may have access to for an exception to the late-enrollment penalty, if you need help comparing plans, or if you are unsure which parts of Medicare you need. You can also visit Medicare.gov to use their plan comparison tool, read detailed information about each part, and find your local Social Security office.

If you are already on Social Security Disability Insurance and approaching 24 months of benefits, contact Social Security to confirm the exact month Medicare will start. If you have end-stage renal disease or ALS, work with your medical team to gather the documentation Medicare will need.

Frequently Asked Questions

Can I delay Medicare past 65 if I am still working?

You can delay Part B if your employer has 20 or more employees and you are still covered by their health plan. You must still enroll in Part A at 65. Report your employer coverage to Medicare so the delay is documented. When you leave your job, you have eight months to enroll in Part B without penalty.

What is the late-enrollment penalty and how long does it last?

The Part B penalty is 10 percent of the standard premium for each year you were late; the Part D penalty is 1 percent of the national average premium for each month you were late. These penalties are permanent and stay with you for as long as you have Medicare, even if you move to a different state or plan.

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

You should enroll in Part A at 65 because it has no premium for most people and covers hospital care. Part B and Part D are optional, but delaying them without a valid reason triggers permanent penalties. Part C is an alternative to Parts A and B, not an addition to them.

What if I turn 65 while I am still on my employer health plan?

Enroll in Part A at 65. You can delay Part B as long as your employer has 20 or more employees and you stay on their plan. Tell Medicare about your employer coverage. When your employment or coverage ends, you have eight months to enroll in Part B without penalty.

How do I know if I may have access to for Medicare before 65?

You may have access to if you have received SSDI for 24 months, if you have end-stage renal disease, or if you have ALS. Contact Social Security at 1-800-772-1213 with your situation. They can confirm whether you may have access to and tell you the month Medicare will start.