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 set by federal law, and it applies to almost everyone. You do not have to retire to sign up — you can keep working and have Medicare at the same time.

Medicare may be able to access at 65 is automatic if you have already been receiving Social Security benefits. If you have not yet claimed Social Security, you will need to sign up for Medicare separately during your enrollment window, which opens three months before the month you turn 65.

The enrollment window stays open for seven months total: three months before you turn 65, the month you turn 65, and three months after. If you miss this window and do not have other coverage, you may face a permanent penalty on your premiums.

Key Takeaways

  • You can start Medicare the month you turn 65, even if you are still working or have not yet claimed Social Security.
  • Your enrollment window is seven months long: three months before you turn 65, the month of your birthday, and three months after.
  • Some people under 65 may be covered by Medicare if they receive disability benefits or have end-stage renal disease or ALS.
  • If you delay signing up past your enrollment window without other coverage, you will pay a higher premium for as long as you have Medicare.
  • You can sign up online at Medicare.gov, by phone at 1-800-MEDICARE, or in person at your local Social Security office.

Who can get Medicare before age 65

Three groups of people under 65 may be covered by Medicare. The largest group is people who have been receiving Social Security Disability Insurance (SSDI) for 24 months. After two years on SSDI, you automatically become covered by Medicare, even though you are not yet 65. You do not need to do anything — Medicare starts on its own.

The second group is people with end-stage renal disease (ESRD), which means permanent kidney failure requiring dialysis or a transplant. People with ESRD can start Medicare as soon as the month their kidney disease is diagnosed, regardless of age. You will need to sign up yourself; it does not happen automatically.

The third group is people with amyotrophic lateral sclerosis (ALS), also called Lou Gehrig's disease. Unlike SSDI, you do not have to wait 24 months — Medicare coverage begins the same month you are approved for SSDI because of ALS.

How to sign up during your enrollment window

You have three ways to sign up for Medicare when you turn 65. The easiest is online at Medicare.gov. You will need your Social Security number, proof of citizenship or legal residency, and information about any current health coverage. The online process takes about 10 minutes and you get a confirmation number right away.

You can also call 1-800-MEDICARE (1-800-633-4227) and speak to someone who will walk you through the questions. This line is open 24 hours a day, seven days a week. Have your Social Security number and insurance information ready.

A third option is to visit your local Social Security office in person. You can find the nearest office at ssa.gov or by calling 1-800-772-1213. Bring your Social Security card, proof of citizenship, and any current insurance documents. Many people prefer this route because they can ask questions face-to-face.

What happens if you miss your enrollment window

If you do not sign up during your seven-month window and you do not have other may have access to coverage, you will pay a late enrollment penalty for as long as you have Medicare. The penalty is 10 percent of the standard Part B premium for each full 12 months you were not covered. This penalty does not go away — it stays on your premium for life.

For example, if you miss your window by two years and the standard Part B premium is $165 per month, your penalty would be 20 percent of that amount, or about $33 extra per month, added to every premium payment you make going forward.

There are a few situations where you can sign up late without a penalty. If you or your spouse were still working and covered by an employer health plan when you turned 65, you have an eight-month window after that coverage ends to sign up without penalty. You will need to show proof that you had employer coverage — usually a letter from your employer or a copy of your insurance card.

Employer coverage and Medicare at 65

If you are still working at 65 and your employer offers health insurance, you can keep that coverage instead of signing up for Medicare — but only if your employer has 20 or more employees. Once you or your spouse stops working, or your employer coverage ends, you have eight months to sign up for Medicare without a late penalty.

If your employer has fewer than 20 employees, Medicare becomes your primary insurance when you turn 65, and you should sign up during your regular enrollment window. Your employer coverage becomes secondary, meaning Medicare pays first.

Tell your employer's benefits department that you are turning 65. They can tell you whether your plan qualifies as "creditable coverage" under Medicare rules. This matters because it affects whether you can delay signing up without a penalty.

Medicare coverage for non-citizens and recent immigrants

To sign up for Medicare at 65, you must be a U.S. citizen or a lawful permanent resident (green card holder) who has lived in the United States for at least five years. If you are a green card holder but have not yet lived here five years, you cannot sign up for Medicare at 65, even if you meet all other requirements.

Some people with temporary visas or work permits are not covered by Medicare at any age. If you are not a citizen or permanent resident, contact Medicare directly at 1-800-MEDICARE to find out whether you can sign up. Have your visa or immigration documents ready when you call.

Questions to ask your doctor or Social Security office

Before you turn 65, schedule a conversation with your doctor or your Social Security office about Medicare. Here are the questions that matter most:

  • Do I need to sign up for Medicare Part B, or can I delay because I have employer coverage?
  • What is my enrollment window, and what is the exact important date?
  • If I have a disability or chronic condition, should I choose Original Medicare or a Medicare Advantage plan?
  • What documents do I need to bring when I sign up?
  • Does my current doctor accept Medicare, and will my prescriptions be covered?

Frequently Asked Questions

Can I start Medicare before I turn 65 if I am still working?

No, unless you receive disability benefits or have end-stage renal disease or ALS. If you are working and do not fall into one of those categories, you must wait until the month you turn 65. You can keep working after you turn 65 and have Medicare at the same time.

What if I turn 65 in the middle of the month?

Medicare coverage begins on the first day of the month you turn 65, regardless of which day in that month your birthday falls. If your birthday is January 15, your Medicare coverage starts January 1. You still have the full seven-month enrollment window: three months before, the month of your birthday, and three months after.

Do I have to sign up for Part B at 65, or can I wait?

You can delay Part B if you or your spouse have employer coverage with 20 or more employees. Once that coverage ends, you have eight months to sign up without a penalty. If you do not have employer coverage at 65, you should sign up for Part B during your regular window to avoid a permanent penalty.

What if I am not a U.S. citizen?

You must be a U.S. citizen or a lawful permanent resident who has lived in the United States for at least five years. If you are a green card holder with fewer than five years in the country, you cannot sign up for Medicare at 65. Call 1-800-MEDICARE to discuss your specific immigration status.

Can I sign up for Medicare online if I do not have a computer?

Yes. You can call 1-800-MEDICARE and sign up over the phone, or visit your local Social Security office in person. Both options are free and do not require a computer. Social Security offices are open Monday through Friday, and some locations offer evening or Saturday hours.