The standard age to start Medicare is 65

You become may be able to access for Medicare at age 65, regardless of whether you are still working. This is the age when you can sign up for Part A (hospital insurance) and Part B (medical insurance). You do not have to retire or stop working to start Medicare — the two are separate decisions.

If you are already receiving Social Security benefits when you turn 65, Medicare enrollment happens automatically. If you are not yet on Social Security, you will need to sign up for Medicare yourself during your enrollment window, which begins three months before the month you turn 65.

Some people become may be able to access before 65 due to disability or end-stage renal disease. Those situations have different rules and timelines, covered in the sections below.

Key Takeaways

  • You can start Medicare at age 65, and you should sign up during the three-month window before your birthday month to avoid late penalties.
  • If you are still working at 65 and have health coverage through your job, you may be able to delay Part B without penalty under certain conditions.
  • People under 65 with disabilities or end-stage renal disease can start Medicare after receiving benefits for a set period or meeting specific medical criteria.
  • Missing your enrollment window can result in a permanent increase to your Part B and Part D premiums, so timing matters.

How to sign up during your enrollment window

Your Initial Enrollment Period runs for seven months: three months before the month you turn 65, the month you turn 65, and three months after. You can sign up online at Medicare.gov, by phone at 1-800-MEDICARE, or in person at your local Social Security office.

If you are already on Social Security, you do not need to do anything — Medicare will be mailed to you automatically about two weeks before your 65th birthday. If you are not on Social Security yet, you must contact Medicare or Social Security yourself during this seven-month window.

Signing up late — after your Initial Enrollment Period ends — can add a permanent 10 percent increase to your Part B premium for each full year you delayed. The same penalty applies to Part D (prescription drug coverage). These penalties stay with you for life, so enrolling on time matters financially.

Working past 65 and delaying Part B

If you are still working at 65 and your employer has 20 or more employees, you may have group health coverage that is primary to Medicare. In this case, you can delay Part B without penalty as long as you are covered by that employer plan and actively working.

You must still sign up for Part A (hospital insurance) at 65, even if you delay Part B. Part A has no premium for most people, and it covers hospital stays. Part B is the part you can delay if your job provides coverage.

When you leave your job or lose the employer coverage, you have eight months to sign up for Part B without penalty. This is called a Special Enrollment Period. You will need to show proof that you had employer coverage — usually a letter from your employer's benefits department stating the coverage dates and number of employees.

Medicare may be able to access before age 65

You can start Medicare before 65 if you have been receiving Social Security Disability Insurance (SSDI) for 24 months. The 24 months begins from the date your disability benefits started, not from the date you applied. Once you have been on SSDI for two years, you automatically move to Medicare.

If you have end-stage renal disease (ESRD) — permanent kidney failure requiring dialysis or a transplant — you can start Medicare regardless of age. You become may be able to access the first day of the month in which your dialysis treatment begins, or the month of your kidney transplant. You do not have to wait for any benefit period.

If you have amyotrophic lateral sclerosis (ALS), you can start Medicare when ready upon approval of your Social Security Disability claim, without waiting the usual 24 months. This is the only condition with this exception.

What happens if you miss your enrollment window

If you do not sign up for Part A or Part B during your Initial Enrollment Period, you can still sign up later during the General Enrollment Period, which runs January 1 through March 31 each year. Coverage would begin July 1 of that year.

However, late enrollment penalties explore. Your Part B premium increases by 10 percent for each full year you were may be able to access but not enrolled. If you missed enrollment by three years, your premium goes up 30 percent permanently. The same 10 percent annual penalty applies to Part D (prescription drug plans).

There are exceptions to late penalties in limited situations — for example, if you had employer coverage or if you were not a U.S. citizen and did not know you were may be able to access. These are called Special Enrollment Periods. If you think you have a reason for an exception, contact Social Security or Medicare to ask whether it applies to you.

Part A versus Part B: which starts at 65

Part A (hospital insurance) covers inpatient hospital stays, skilled nursing facility care, hospice, and home health services. Most people pay no monthly premium for Part A at 65 if they or their spouse paid Medicare taxes for at least 10 years while working.

Part B (medical insurance) covers doctor visits, outpatient care, lab tests, and preventive services. Part B has a monthly premium, which is income-based. In 2024, the standard Part B premium is $164.90 per month, but higher earners pay more. You should enroll in both Part A and Part B at 65 unless you have an exception for Part B based on employer coverage.

Part D (prescription drug coverage) is optional and sold by private insurers, not by Medicare directly. You can add Part D when you turn 65, or during the Annual Enrollment Period (October 15 through December 7 each year). If you go without Part D and later enroll, you may pay a penalty based on how long you went uncovered.

What to ask your doctor and when to seek help

Before you turn 65, ask your doctor or your current health plan whether there are any ongoing treatments or prescriptions you should know about before switching to Medicare. Some doctors do not accept Medicare, and some medications may be covered differently under Medicare Part D than under your current plan.

If you are still working at 65, ask your employer's benefits department whether your health plan is primary to Medicare and how many employees your company has. This determines whether you can delay Part B without penalty.

If you have a disability and are under 65, contact Social Security to confirm the date your disability benefits began — this is the date your 24-month countdown to Medicare starts. If you have ESRD or ALS, ask your nephrologist or neurologist to help you understand your Medicare start date.

Contact Medicare at 1-800-MEDICARE if you are unsure whether you have missed an enrollment important date or whether a Special Enrollment Period applies to you. They can review your situation and tell you what your options are.

Frequently Asked Questions

Do I have to sign up for Medicare at 65 if I am still working?

You must sign up for Part A at 65, even if you are working. You may be able to delay Part B if your employer has 20 or more employees and you are covered by their health plan. However, you still need to enroll in Part A during your Initial Enrollment Period to avoid penalties.

What if I turn 65 while I am traveling outside the United States?

You can still sign up for Medicare while abroad. You can enroll online at Medicare.gov, by phone at 1-800-MEDICARE, or by mail. Your coverage will begin on the first day of the month you turn 65 if you sign up during your Initial Enrollment Period.

Can I delay Medicare if I have private insurance?

Private insurance (not from an employer) does not allow you to delay Medicare without penalty. You must sign up for Part A and Part B at 65. Only group health coverage through an employer with 20 or more employees gives you the right to delay Part B.

What if I was not a U.S. citizen when I turned 65?

If you were not a U.S. citizen at 65 but became one later, you may have a Special Enrollment Period to sign up for Medicare without penalty. Contact Social Security with proof of your citizenship date to see whether this exception applies to you.

Do I lose Medicare if I move to another country?

You can keep Medicare Part A and Part B if you move abroad, but coverage is limited. Medicare generally does not pay for care outside the United States, except in rare cases near the border. Part D (prescription drugs) does not work outside the U.S. Talk to Medicare about your specific situation before moving.