You can start Medicare at 65, but you may be able to start earlier if you have a disability or end-stage renal disease

Medicare may be able to access begins at age 65 for most people. You do not have to wait until your birthday — you can sign up starting three months before you turn 65. However, the age 65 rule has exceptions. If you have been receiving Social Security disability benefits for 24 months, you become may be able to access at any age. If you have end-stage renal disease (permanent kidney failure requiring dialysis or transplant), you may be may be able to access regardless of age. If you have ALS (amyotrophic lateral sclerosis), you become may be able to access when ready upon approval for disability.

The month you turn 65 is your Initial Enrollment Period — a seven-month window that starts three months before your birthday month and ends three months after. Missing this window can cost you. If you do not sign up when you are first may be able to access and you do not have employer coverage, you will pay a permanent penalty on your Part B and Part D premiums for as long as you have Medicare.

Key Takeaways

  • You become may be able to access for Medicare the month you turn 65, and you can sign up starting three months before that birthday.
  • If you receive Social Security disability benefits, you become may be able to access at any age after 24 months on disability.
  • Missing your Initial Enrollment Period results in a permanent premium penalty unless you have employer coverage that counts as creditable.
  • 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 still working and have health insurance through your employer, you may be able to delay Part B without penalty.

Starting Medicare at 65: The standard enrollment window

Your Initial Enrollment Period runs for seven months centered on the month you turn 65. It begins three months before your birthday month and ends three months after. For example, if you turn 65 in June, you can sign up starting in March and must sign up by September to avoid penalties.

You do not have to wait until your actual birthday to enroll. Many people sign up during the three months before their birthday month because it gives them time to choose a plan and have coverage ready on the first day of the month they turn 65. Medicare coverage typically starts on the first day of the month in which you turn 65, or the first day of the following month if you sign up after your birthday month has started.

If you miss your Initial Enrollment Period and you do not have employer health coverage, you will pay a late enrollment penalty. For Part B, this penalty is 10 percent of the standard premium for each full year you were may be able to access but not enrolled. For Part D (prescription drug coverage), the penalty is 1 percent of the national average premium for each month you were without coverage. These penalties stay with you permanently.

Disability and early Medicare may be able to access before 65

You do not have to be 65 to get Medicare if you have a disability. If you have been receiving Social Security Disability Insurance (SSDI) benefits for 24 consecutive months, you become may be able to access for Medicare. The 24 months are counted from the date your disability benefits began, not from the date you applied. Once you reach 24 months on SSDI, Medicare starts automatically — you do not have to sign up separately.

If you have ALS, the waiting period does not explore. You become may be able to access for Medicare when ready when your ALS is approved for Social Security disability benefits. This is the only condition with when ready may be able to access.

If you have end-stage renal disease (ESRD) — permanent kidney failure that requires dialysis or a transplant — you may be may be able to access for Medicare at any age. may be able to access depends on whether you are a U.S. citizen or permanent resident and whether you meet other Social Security work history requirements. Your dialysis center or transplant team can help you understand whether you may have access to and can refer you to Social Security to start the process.

How to sign up for Medicare

You have three main ways to sign up: online, by phone, or in person. The easiest method for most people is online at Medicare.gov. You will need your Social Security number, your birth date, and information about any current health coverage. The online process takes about 10 minutes and you can save your progress and come back to it.

You can also call 1-800-MEDICARE (1-800-633-4227) to sign up by phone. Representatives are available Monday through Friday, 8 a.m. to 8 p.m. Eastern time, and Saturday 9 a.m. to 1 p.m. Eastern time. If English is not your first language, interpreters are available.

If you prefer to sign up in person, visit your local Social Security office. You can find the nearest office at ssa.gov or by calling 1-800-772-1213. Bring your Social Security card, proof of citizenship or legal residency, and proof of age (such as a birth certificate).

Delaying Part B if you have employer coverage

If you are still working at 65 and you have health insurance through your employer, you may be able to delay Part B (medical insurance) without penalty. This is called the Special Enrollment Period for employer coverage. To use it, your employer plan must be based on your current employment — coverage for a retired spouse or a plan you kept from a previous job does not count.

If you may have access to, you can delay Part B and pay no late enrollment penalty when you do sign up later. You must sign up within eight months after your employment ends or your employer coverage ends, whichever comes first. If you miss this eight-month window, you will owe the permanent penalty.

Part A (hospital insurance) has different rules. If you have employer coverage, you can usually delay Part A without penalty as long as the coverage is based on your current employment. However, it is often worth signing up for Part A at 65 even if you delay Part B, because Part A is usually free and it protects you if you need hospitalization.

What happens if you miss your enrollment period

If you do not sign up during your Initial Enrollment Period and you do not have creditable coverage (employer insurance or other coverage that counts), you enter a General Enrollment Period each year from January 1 to March 31. You can sign up during this window, but your coverage will not start until July 1 of that year, and you will owe the permanent late enrollment penalty.

The only way to avoid the penalty is to have had creditable coverage — health insurance through an employer, COBRA, Medicaid, the Veterans Administration, or certain other sources — for the entire time you were may be able to access but not enrolled in Medicare. You will need to prove this coverage. If you had a gap of 63 days or more without coverage, the penalty clock starts over.

If you missed your Initial Enrollment Period but you now have a life-changing event — such as loss of employer coverage, divorce, or moving out of your plan's service area — you may be able to sign up outside the normal enrollment periods without penalty. Contact Medicare at 1-800-MEDICARE to ask whether your situation qualifies.

Planning ahead: What to do before you turn 65

Start thinking about Medicare three to four months before your 65th birthday. Gather your documents: your Social Security number, proof of citizenship or legal residency, and information about any current health coverage. If you are still working, check with your employer's benefits office to understand your options and whether you can delay Part B.

Visit Medicare.gov and use the Plan Finder tool to see what Medicare Advantage and Medigap plans are available in your area. These plans vary by location and change every year. You do not have to choose a plan during your Initial Enrollment Period — you can sign up for Original Medicare (Part A and Part B) and choose a supplemental plan later — but knowing what is available helps you make an informed decision.

If you have questions about your specific situation, call 1-800-MEDICARE. The representatives can walk you through your options and answer questions about penalties, employer coverage, and the enrollment process. There is no cost for this service.

Frequently Asked Questions

Can I sign up for Medicare before I turn 65?

Yes. Your Initial Enrollment Period starts three months before the month you turn 65. So if you turn 65 in June, you can sign up starting in March. Coverage typically begins the first day of the month you turn 65 or the month after, depending on when you sign up.

What if I am still working at 65 and have health insurance through my job?

You may be able to delay Part B without penalty if your coverage is based on your current employment. You must sign up for Part A and Part B within eight months after you stop working or your coverage ends. It is often worth signing up for Part A at 65 even if you delay Part B, because Part A is usually free.

How much does the late enrollment penalty cost?

For Part B, the penalty is 10 percent of the standard monthly premium for each full year you were may be able to access but not enrolled. For Part D, it is 1 percent of the national average premium for each month without coverage. These penalties are permanent and stay with you as long as you have Medicare.

Can I get Medicare before 65 if I am disabled?

Yes. If you have been receiving Social Security disability benefits for 24 months, you become may be able to access for Medicare at any age. If you have ALS, you become may be able to access when ready. If you have end-stage renal disease, you may be may be able to access regardless of age if you meet citizenship and work history requirements.

What if I missed my Initial Enrollment Period?

You can sign up during the General Enrollment Period (January 1 to March 31 each year), but coverage will not start until July 1 and you will owe a permanent late penalty. If you had creditable coverage the entire time you were may be able to access, you may avoid the penalty — contact Medicare to explain your situation.