You can start Medicare at 65, but the exact month depends on when you were born

Medicare may be able to access begins the month you turn 65, regardless of whether you are still working. The Social Security Administration assigns you a specific enrollment month based on your birth date. If you were born between the 1st and 10th of any month, your enrollment month is the month you turn 65. If you were born between the 11th and 20th, enrollment happens the following month. If you were born between the 21st and 31st, enrollment happens two months after your birthday.

You do not have to wait until your 65th birthday to start the enrollment process. You can begin three months before you turn 65, and you should, because missing the enrollment window can cost you permanently in higher premiums. Medicare Part A (hospital insurance) is usually free if you or your spouse paid Medicare taxes for at least 10 years. Medicare Part B (medical insurance) costs a monthly premium that increases by 10 percent for each year you delay enrollment after you turn 65, and that penalty stays with you for life.

Key Takeaways

  • You become may be able to access for Medicare the month you turn 65, with the exact enrollment month determined by your birth date within that month.
  • You can enroll three months before your 65th birthday, and doing so avoids permanent premium penalties on Part B.
  • If you delay Part B enrollment past your 65th birthday without may have access to for an exception, you pay a 10 percent penalty for each year you wait, and this penalty is permanent.
  • You can enroll in Medicare even if you are still working and have employer health insurance, though your employer plan may affect when you should enroll in Part B.
  • The enrollment period lasts seven months total: three months before, the month you turn 65, and three months after.

When your enrollment period actually opens and closes

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 enroll in any of those seven months, but the month you choose affects when your coverage starts.

If you enroll during the three months before you turn 65, your coverage begins the month you turn 65. If you enroll in the month you turn 65, coverage starts the following month. If you enroll in the three months after you turn 65, coverage starts the month after you enroll. This timing matters if you have a gap in health insurance or if you are paying out of pocket for medical care.

After your Initial Enrollment Period ends, you can still enroll in Medicare during the General Enrollment Period, which runs January 1 through March 31 each year. However, coverage does not start until July 1 of that year, and you will owe the permanent Part B penalty if you did not have may have access to coverage in the years you delayed.

Exceptions that let you enroll after 65 without a penalty

If you are still working at 65 and your employer has 20 or more employees, you can delay Part B enrollment without penalty as long as you are covered by the employer plan. This is called the Special Enrollment Period. You must enroll in Part B within eight months of leaving the job or losing the employer coverage, whichever comes first. Bring documentation from your employer showing the number of employees and your coverage dates when you enroll.

If you are a federal employee or a railroad retiree, different rules may explore to your enrollment timing. Contact the Office of Personnel Management or the Railroad Retirement Board directly to confirm your dates. If you are a veteran, you may be covered by VA health benefits instead of Medicare, but you can still enroll in Medicare Part A and B at 65 if you choose.

If you missed your Initial Enrollment Period and did not have a may have access to exception, you can still enroll during General Enrollment, but you will owe the permanent penalty. There is no way to remove this penalty once it is applied, so the cost of delaying can add up significantly over time.

How to enroll before your 65th birthday

You can enroll online through Medicare.gov, by phone at 1-800-MEDICARE, or in person at your local Social Security office. Online enrollment is the fastest route and takes about 15 minutes. You will need your Social Security number, proof of citizenship or legal residency, and information about any current health insurance you have.

If you are explore for Social Security retirement benefits at the same time, you can enroll in Medicare during that process. If you are already receiving Social Security, you will be enrolled in Medicare Parts A and B automatically three months before you turn 65, and you will receive a Medicare card in the mail. You can decline Part B if you have employer coverage, but you must do so in writing before your coverage would start.

Start the enrollment process at least one month before your coverage date to allow time for your card to arrive. If you enroll close to your birthday, request expedited delivery or print a temporary notice to show your doctor while you wait for the physical card.

What happens if you miss your enrollment window

If you do not enroll during your Initial Enrollment Period and you do not have a may have access to exception, you can enroll during General Enrollment (January 1 through March 31), but coverage will not start until July 1. You will also owe the permanent Part B penalty, which is 10 percent of the standard premium for each full year you were may be able to access but not enrolled.

The penalty applies to your Part B premium for as long as you have Medicare. If the standard Part B premium is $165 per month and you delayed two years, you would pay an extra $33 per month for life. This penalty cannot be waived or removed, even if you later face financial hardship.

If you have a gap in coverage between when you turn 65 and when you eventually enroll, you are responsible for all medical bills during that time. Medicare does not cover retroactively, so any hospital stays, doctor visits, or prescriptions you paid for out of pocket cannot be reimbursed once you enroll.

Part A versus Part B: different age rules

Part A (hospital insurance) and Part B (medical insurance) have the same age requirement — 65 — but different enrollment rules. Part A is usually free if you paid Medicare taxes while working, and you should enroll even if you are still working and have employer coverage. There is no penalty for delaying Part A enrollment if you have employer coverage, but enrolling early protects you if your employment ends unexpectedly.

Part B has the premium penalty for delay, so the decision to enroll depends on your work status. If you are still working and covered by an employer plan with 20 or more employees, you can delay Part B without penalty. If you are self-employed or work for a small employer, you should enroll in Part B at 65 to avoid the penalty, even if you also have a private plan.

Part D (prescription drug coverage) also has a penalty for delay if you go 63 or more days without creditable coverage. If your employer or retiree plan covers drugs at least as well as Medicare Part D, you can delay without penalty. If not, enroll in Part D when you turn 65 or lose the employer coverage, whichever comes first.

Special situations: still working, self-employed, or on disability

If you are still working full-time at 65, you can enroll in Medicare and keep your job. Your employer plan and Medicare will coordinate, with Medicare typically paying second. You do not have to choose between them. However, if your employer has fewer than 20 employees, Medicare becomes your primary payer, so enrolling in Part B is important to avoid gaps in coverage.

If you are self-employed, you cannot use the employer exception to delay Part B. You should enroll in Part B at 65 unless you have other creditable coverage, such as a spouse's employer plan or a private plan that meets Medicare standards. Confirm with your insurance broker that your current plan qualifies before you decide to delay.

If you are receiving Social Security Disability Insurance (SSDI) before age 65, you will be automatically enrolled in Medicare Part A and Part B 24 months after your disability began. You do not need to do anything — your Medicare card will arrive in the mail. If you want to decline Part B because you have employer coverage, you must notify Social Security in writing before your coverage starts.

Frequently Asked Questions

Can I enroll in Medicare before I turn 65?

You can start the enrollment process three months before you turn 65, and your coverage will begin the month you turn 65 if you enroll during that three-month window. You cannot enroll earlier than three months before your birthday.

What if I am still working and have health insurance through my job?

You can enroll in Medicare at 65 even if you are still working. If your employer has 20 or more employees, you can delay Part B without penalty as long as you are covered by the employer plan. Part A has no penalty for delay, so you can enroll in Part A only if you prefer.

Do I have to enroll in Medicare at 65 if I do not want it?

You do not have to enroll, but if you delay past your Initial Enrollment Period without a may have access to exception, you will owe a permanent penalty on Part B. The penalty is 10 percent of the standard premium for each year you delayed, and it stays on your premium for life.

What if I miss the enrollment important date?

You can enroll during General Enrollment (January 1 through March 31), but coverage will not start until July 1, and you will owe the permanent Part B penalty unless you have a may have access to exception. The penalty cannot be removed once applied.

Does my birth date affect when I can enroll?

Your birth date determines which month you are may be able to access to enroll, but not whether you can enroll. If you were born on the 15th, your enrollment month is the month after you turn 65. If you were born on the 5th, your enrollment month is the month you turn 65. You can enroll anytime during your seven-month Initial Enrollment Period regardless of the exact date.