You can sign up for Medicare Part A at 65, but the exact timing matters for your wallet

Medicare Part A covers hospital stays, skilled nursing care, hospice, and home health services. You become may be able to access to sign up at age 65, but you do not have to wait until your birthday. You can start the process three months before you turn 65, and coverage can begin the month you turn 65. If you miss the initial window, you can still sign up later, but you may face a permanent penalty on your premiums.

Most people do not pay a monthly premium for Part A because they or their spouse paid Medicare taxes while working. If you did not work long enough to may have access to for premium-free Part A, you will pay a monthly amount that depends on how many quarters of work history you have. The longer you wait past 65 to sign up, the higher that premium becomes.

Key Takeaways

  • You can begin the sign-up process three months before your 65th birthday, and coverage typically starts the month you turn 65.
  • Most people pay no monthly premium for Part A if they or a spouse worked and paid Medicare taxes for at least 10 years.
  • If you delay signing up past your initial enrollment window, you will owe a 10 percent premium increase for each year you waited, and this penalty lasts for life.
  • You must sign up for Part A even if you plan to work past 65, unless you have employer coverage that meets Medicare's standards.

The three-month window before you turn 65

You can contact Social Security or Medicare three months before your 65th birthday to start the sign-up process. This is called your Initial Enrollment Period, and it runs from three months before your birthday through three months after. Starting early gives you time to gather documents, ask questions, and make sure coverage begins on time.

If your birthday is in June, for example, you can sign up starting in March. Coverage will begin July 1 (the first day of the month you turn 65). If you wait until after your birthday to sign up, coverage may not start until the following month, which means you could have a gap in hospital coverage.

What happens if you sign up after 65

If you do not sign up during your Initial Enrollment Period, you enter what Medicare calls a General Enrollment Period. You can sign up any time after your Initial Enrollment Period ends, but there is a cost: your Part A premium increases by 10 percent for each full year you delayed. This penalty is permanent — it does not go away after a certain number of years.

For example, if you turn 65 in 2024 but do not sign up until 2026, you delayed for two years. Your premium would be 20 percent higher than it would have been if you had signed up on time. That extra cost stays with you for life, even if you move to a different state or change plans.

When you can delay without a penalty

You do not have to sign up at 65 if you are still working and have health coverage through your employer or your spouse's employer. This coverage must meet Medicare's standards — most employer plans do. If you have this coverage, you can delay Part A sign-up without penalty as long as you are still employed and covered.

Once you leave that job or lose the employer coverage, you have an eight-month window to sign up for Medicare without owing a penalty. This is called a Special Enrollment Period. You will need to show proof that you had employer coverage and when it ended. Keep your final pay stub, insurance card, or a letter from your employer's benefits office as proof.

How to sign up for Part A

You can sign up through Social Security, Medicare, or your local Social Security office. If you are already receiving Social Security benefits, you are usually signed up for Part A automatically at 65 — you do not have to do anything. Check your Social Security statement or call Social Security to confirm.

If you are not yet receiving Social Security, you can sign up for Medicare online at Medicare.gov, by phone at 1-800-MEDICARE, or in person at your local Social Security office. You will need your Social Security number and proof of citizenship or legal residency. The process takes about 15 minutes online or by phone.

Part A premium costs if you did not work long enough

If you did not work or pay Medicare taxes for at least 10 years (40 quarters), you do not may have access to for premium-free Part A. Instead, you pay a monthly premium. The amount depends on how many quarters of work history you have. Someone with 30 quarters pays less than someone with no work history.

These premiums change each year. You can find the current amounts on Medicare.gov or by calling 1-800-MEDICARE. Even if you do not may have access to for premium-free Part A, signing up at 65 is still important — the penalty for delaying applies to you as well.

What to ask your doctor or Social Security

Before you turn 65, ask your current doctor whether they accept Medicare. Not all doctors do, and switching providers can be disruptive. If your doctor does not accept Medicare, ask for a referral to one who does in your area.

When you contact Social Security or Medicare to sign up, ask whether you may have access to for premium-free Part A based on your work history. If you do not, ask what your monthly premium will be. Also ask whether you need to sign up for Part B (doctor visits and outpatient care) at the same time, because the rules for Part B are different and missing that important date carries its own penalty.

Frequently Asked Questions

What if I turn 65 but am still working full-time?

You do not have to sign up for Part A if you have employer coverage that meets Medicare's standards. However, once you leave that job or lose the coverage, you have eight months to sign up without penalty. If you wait longer than eight months, you will owe a permanent 10 percent premium increase for each year you delayed.

Can I sign up for Part A without signing up for Part B?

Yes. Part A and Part B have separate enrollment periods and separate penalties. You can sign up for Part A at 65 and delay Part B if you have employer coverage. However, Part B has its own penalty rules, so contact Medicare to understand both before you decide.

What if I miss my Initial Enrollment Period?

You can still sign up during the General Enrollment Period (January 1 through March 31 each year), but you will owe a 10 percent premium increase for each year you delayed. This penalty is permanent. If you have a may have access to life event like losing employer coverage, you may have a Special Enrollment Period with no penalty.

Do I need to sign up if I have Veterans benefits?

You can have both Veterans benefits and Medicare. However, you should still sign up for Part A at 65 because it covers hospital care that Veterans benefits may not. Contact your VA office and Medicare separately to understand how both programs work together in your situation.

What documents do I need to sign up?

You will need your Social Security number and proof of citizenship or legal residency (a birth certificate, passport, or naturalization papers). If you are signing up by phone or online, have these ready but you do not need to mail them unless Medicare asks. If you are signing up in person at a Social Security office, bring the originals or certified copies.