You can enroll in Medicare when you turn 65, regardless of your work history or health status

Medicare may be able to access begins the month you turn 65. You do not need to have worked a certain number of years, and you do not need to be retired. If you are already receiving Social Security or Railroad Retirement Board benefits, Medicare will start automatically three months before your 65th birthday. If you are not yet receiving those benefits, you will need to sign up for Medicare yourself during your enrollment window.

The only exception is if you are still working and covered by your employer's health plan. In that case, you can delay Medicare without penalty, but you must tell Medicare you are doing so. If you miss your enrollment window and do not have employer coverage, you will pay a permanent penalty on your premiums for as long as you have Medicare.

Key Takeaways

  • Medicare begins the month you turn 65, and you are automatically enrolled if you receive Social Security or Railroad Retirement Board benefits.
  • If you are not receiving those benefits, you must sign up during your Initial Enrollment Period, which runs from three months before to three months after your 65th birthday.
  • Missing your enrollment window results in a permanent late penalty on your Part B and Part D premiums unless you have employer coverage.
  • You can delay Medicare past 65 only if you are still working and covered by your employer's health plan.
  • Some people under 65 may be may be able to access for Medicare if they receive Social Security Disability Insurance (SSDI) or have end-stage renal disease or ALS.

When to sign up if you are not automatically enrolled

Your Initial Enrollment Period is seven months long: it starts three months before the month you turn 65 and ends three months after. For example, if you turn 65 in June, your enrollment period runs from March through September. You can sign up online at Medicare.gov, by phone at 1-800-MEDICARE, or in person at your local Social Security office.

You should sign up even if you plan to delay Medicare. Telling Medicare you are still covered by an employer plan protects you from the late penalty. This protection is called creditable coverage. Without it, you will owe an extra 10 percent on your Part B premium for each year you were may be able to access but did not sign up — and that penalty stays with you permanently.

People under 65 who may be may be able to access for Medicare

Three groups of people younger than 65 can enroll in Medicare. The first is people who have received Social Security Disability Insurance (SSDI) for 24 months. The second is people with end-stage renal disease (permanent kidney failure requiring dialysis or a transplant). The third is people with ALS (amyotrophic lateral sclerosis, also called Lou Gehrig's disease) — they become may be able to access when ready, without waiting.

If you are in one of these groups, you will be contacted by Social Security or your dialysis center about Medicare enrollment. You do not need to do anything to start the process, but you should still review your enrollment options and choose your coverage before your coverage date arrives.

How your work history affects Medicare

You do not need to have worked to turn 65 and enroll in Medicare. However, your work history does affect whether you pay a premium for Part A (hospital insurance). If you or your spouse worked and paid Medicare taxes for at least 10 years, you will not pay a monthly premium for Part A. If neither of you meets that requirement, you will pay a premium that varies based on how many years you or your spouse did work.

Part B (medical insurance) and Part D (prescription drug coverage) require a monthly premium regardless of your work history. The amount you pay for Part B may be higher if your income is above a certain level — this is called an Income-Related Monthly Adjustment Amount (IRMAA). Part D premiums vary by plan.

What happens if you miss your enrollment window

If you do not sign up during your Initial Enrollment Period and you do not have employer coverage, you will have to wait until the next General Enrollment Period, which runs January 1 through March 31 each year. Your coverage will not start until July 1 of that year. During the months you are uninsured, you are responsible for all medical costs.

You will also owe a late penalty. Your Part B premium will be 10 percent higher for each full year you were may be able to access but not enrolled. Your Part D premium will be 1 percent higher for each month you were may be able to access but not enrolled. These penalties are permanent — they do not go away even after you finally sign up.

Delaying Medicare if you are still working

If you are still working at 65 and covered by your employer's health plan, you can delay Medicare without penalty. Your employer plan will be your primary insurance, and Medicare will be secondary. You must tell Medicare you are delaying by contacting Social Security or calling 1-800-MEDICARE. Do this even if you do not sign up for any part of Medicare — it protects you from the late penalty.

Once you leave your job or lose your employer coverage, you will have an 8-month Special Enrollment Period to sign up for Medicare without penalty. This period starts the month your employment or coverage ends. After that window closes, the late penalty applies again.

Medicare enrollment and retirement timing

You do not have to retire to enroll in Medicare at 65. Many people continue working past 65 while also using Medicare. If you are still working and have employer coverage, you can keep that coverage and delay Medicare. If you are working but do not have employer coverage, you should sign up for Medicare at 65 to avoid the late penalty.

Some people choose to retire before 65 and pay for private insurance until Medicare starts. Others work past 65 specifically to keep employer coverage. There is no single right choice — it depends on your job, your health, and your finances. A Social Security representative or your employer's benefits office can walk you through your options.

Frequently Asked Questions

What if I turn 65 but do not feel ready to retire?

You can enroll in Medicare and keep working. Medicare does not require you to retire. If you have employer coverage through your job, you can delay Medicare and keep your employer plan as primary. Just tell Social Security or Medicare that you are still covered so you do not get a late penalty.

Can I sign up for Medicare before I turn 65?

You can sign up starting three months before your 65th birthday. Your coverage will begin the month you turn 65. If you wait until after your Initial Enrollment Period ends, you will have to wait until the next General Enrollment Period (January through March), and your coverage will not start until July.

Do I have to sign up for all parts of Medicare at once?

No. You can sign up for Part A (hospital insurance) and Part B (medical insurance) separately. Part D (prescription drug coverage) has its own enrollment rules. However, if you delay Part B or Part D without a valid reason, you will owe a late penalty. Talk to Medicare about your situation before you decide to delay.

What if I am not a U.S. citizen?

You must be a U.S. citizen or a lawful permanent resident who has lived in the United States for at least five consecutive years to enroll in Medicare. If you are not sure about your status, contact Social Security or call 1-800-MEDICARE to find out whether you are may be able to access.

Does Medicare start right away when I turn 65?

If you are already receiving Social Security or Railroad Retirement Board benefits, Medicare starts automatically the month you turn 65. If you sign up during your enrollment period, coverage starts the month you turn 65. If you sign up during the General Enrollment Period, coverage starts July 1 of that year.