When You Become Eligible for Medicare: Age and Other Pathways

The Standard Age for Medicare may be able to access

You become may be able to access for Medicare at age 65, regardless of your work history or income. This is the primary pathway to coverage, and it applies to U.S. citizens and permanent residents who have lived in the country for at least five years.

You do not have to wait until your 65th birthday to sign up. You can enroll starting three months before the month you turn 65, during the month you turn 65, and for three months after. This seven-month window is called your Initial Enrollment Period. If you miss this window, you may face permanent penalties on your premiums, so timing matters.

Turning 65 does not automatically enroll you. You must take action yourself through Medicare.gov, by phone, or in person at a Social Security office. Many people assume they are automatically signed up and discover too late that they are not covered.

Key Takeaways

You are may be able to access for Medicare when you turn 65, and you have a seven-month enrollment window centered on your birthday to sign up without penalties.
You can enroll before your 65th birthday, which is often the best time to do so to avoid coverage gaps.
Some people under 65 may have access to for Medicare if they receive Social Security Disability Insurance (SSDI) for at least 24 months, or if they have end-stage renal disease or ALS.
Missing your Initial Enrollment Period can result in permanent premium increases, so it is important to sign up during your window even if you do not plan to use Medicare right away.
If you are still working and have employer coverage at 65, you may be able to delay enrollment without penalty, but you must meet specific conditions.

Who Qualifies Before Age 65

Three groups of people under 65 can enroll in Medicare. The first is people who have received Social Security Disability Insurance (SSDI) for at least 24 consecutive months. Once you have been on SSDI for two years, you automatically become may be able to access for Medicare, even if you are in your 30s or 40s. You do not need to explore separately; Social Security will notify you when you become may be able to access.

The second group includes people with end-stage renal disease (ESRD), which means permanent kidney failure requiring dialysis or a transplant. People with ESRD can enroll in Medicare regardless of age, though the process requires documentation from a nephrologist or dialysis center. Coverage typically begins the month dialysis starts or the month of a transplant.

The third group is people with amyotrophic lateral sclerosis (ALS), also called Lou Gehrig's disease. Unlike SSDI, which requires a 24-month waiting period, people with ALS become may be able to access for Medicare when ready upon approval of their SSDI claim. This is the only condition with this expedited pathway.

How Working Past 65 Affects Your Enrollment

If you are still working at 65 and your employer has 20 or more employees, you may be able to delay Medicare enrollment without facing penalties. This is called the Special Enrollment Period for those with group health coverage. Your employer's health insurance is considered primary, and Medicare becomes secondary. You can enroll in Medicare later without the usual late-enrollment penalties, as long as you sign up within eight months of leaving your job or losing your employer coverage.

If your employer has fewer than 20 employees, Medicare becomes your primary insurance at 65, and you should enroll during your Initial Enrollment Period. Delaying enrollment in this situation will result in permanent premium penalties.

Self-employed people and those with individual health insurance do not may have access to for this exception. You should enroll in Medicare at 65 even if you have other coverage.

What Happens If You Miss Your Enrollment Window

If you do not enroll during your seven-month Initial Enrollment Period and you do not have a may have access to reason to delay, you will face a permanent increase to your Part B premium. The penalty is 10 percent of the standard Part B premium for each full year you were may be able to access but not enrolled. If you were may be able to access for three years without signing up, your premium increases by 30 percent for as long as you have Medicare.

There is no way to remove this penalty once it is applied. You can only enroll during the General Enrollment Period, which runs from January 1 to March 31 each year, with coverage starting July 1. This means if you miss your Initial Enrollment Period and enroll during General Enrollment, you will have a gap in coverage and will pay the penalty indefinitely.

The only exceptions to this penalty are if you had may have access to coverage through an employer or union, or if you were receiving benefits from the Veterans Administration. If either applies to you, you will need to provide documentation when you enroll.

Part A and Part B: What You Need to Know About Enrollment

Part A covers hospital stays, skilled nursing care, hospice, and some home health services. Most people do not pay a monthly premium for Part A if they or their spouse paid Medicare taxes while working. If you do not have enough work history to may have access to for premium-free Part A, you can purchase it.

Part B covers doctor visits, outpatient care, and medical equipment. Part B requires a monthly premium, which changes each year. The standard premium for 2024 is higher for people with higher incomes, so your actual cost depends on your Modified Adjusted Gross Income from two years prior.

You enroll in both Part A and Part B during your Initial Enrollment Period. If you delay Part B and do not have a may have access to reason, you will owe the permanent penalty described above. Part A does not have the same penalty, but you should still enroll to avoid coverage gaps.

Enrollment Steps and Timing

You can enroll in Medicare three ways: online at Medicare.gov, by calling Social Security at 1-800-772-1213, or by visiting a local Social Security office in person. Online enrollment is usually the fastest option and lets you complete the process from home.

Start the process at least one month before your Initial Enrollment Period begins. This gives you time to gather documents (your birth certificate, proof of citizenship or permanent residency, and your Social Security number) and ask questions if you need to.

After you enroll, Medicare will mail you your Medicare card within two weeks. Your coverage typically starts on the first day of the month you turn 65, or the first day of the month after you enroll, whichever is later. If you enroll during your Initial Enrollment Period, coverage usually begins on the first of the month you turn 65, even if you enroll before that month arrives.

Frequently Asked Questions

Can I enroll in Medicare before I turn 65?

Yes, you can enroll starting three months before the month you turn 65. For example, if you turn 65 in June, you can enroll starting in March. This is often the best time to enroll because it ensures your coverage starts on your 65th birthday without gaps.

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

If your employer has 20 or more employees, you can delay Medicare Part B without penalty as long as you enroll within eight months of leaving your job or losing coverage. Part A has no penalty for delay. If your employer has fewer than 20 employees, you should enroll in Medicare at 65 even if you have employer coverage, because Medicare will be primary.

Do I automatically get Medicare when I turn 65?

No. You must enroll yourself. If you receive Social Security benefits, you may be automatically enrolled in Part A and Part B, but you should verify this by checking your Social Security account online or calling Social Security to confirm. Do not assume you are enrolled.

What is the penalty for enrolling late?

If you miss your Initial Enrollment Period and do not have a may have access to reason to delay, your Part B premium increases by 10 percent for each full year you were may be able to access but not enrolled. This penalty is permanent and applies for as long as you have Medicare. Part A does not have a late-enrollment penalty, but you should still enroll to avoid coverage gaps.

Can I get Medicare if I am under 65?

Yes, if you have received SSDI for 24 months, if you have end-stage renal disease, or if you have ALS. People with ALS become may be able to access when ready upon SSDI approval, while others must meet the 24-month requirement. You will need medical documentation from your doctor or treatment center to enroll.

This guide is for general information only and is not medical, financial, legal, or other professional advice. For decisions specific to your situation, consult a qualified professional. See our Editorial Policy.