You can start Medicare at 65, or earlier if you have a disability, end-stage renal disease, or ALS

Most people become may be able to access for Medicare when they turn 65, regardless of their health or work history. But you do not have to wait until 65. You can start Medicare earlier if you receive Social Security disability benefits for at least 24 months, if you have end-stage renal disease (permanent kidney failure requiring dialysis or transplant), or if you have been diagnosed with ALS (amyotrophic lateral sclerosis, also called Lou Gehrig's disease). The month you turn 65 is the month your coverage can begin — you do not have to wait for your birthday to pass.

Timing matters because Medicare has enrollment periods. If you miss the window to sign up when you first become may be able to access, you may pay a penalty for the rest of your life. The penalty is a percentage added to your monthly premium, and it does not go away even if you sign up years later.

Key Takeaways

  • You can start Medicare the month you turn 65, or earlier if you receive Social Security disability benefits, have end-stage renal disease, or have ALS.
  • Your Initial Enrollment Period is seven months long: three months before the month you turn 65, the month itself, and three months after.
  • If you miss your Initial Enrollment Period, you can sign up during the General Enrollment Period (January 1 to March 31 each year), but you will owe a lifetime penalty on Part B and Part D premiums.
  • You must sign up yourself — Social Security does not automatically enroll you in Medicare when you turn 65, even if you receive Social Security retirement benefits.
  • If you are still working and have health insurance through your employer, you may be able to delay Medicare without penalty under special rules.

may be able to access at 65: The Standard Route

The month you turn 65, you become may be able to access for Medicare Part A (hospital insurance) and Part B (medical insurance) if you are a U.S. citizen or permanent resident who has lived in the United States for at least five years. You do not need to have worked or paid taxes — some people become may be able to access through a spouse's work record. You do not need to be retired.

Your Initial Enrollment Period runs for seven months: the three months before you turn 65, the month you turn 65, and the three months after. This is your window to sign up without penalty. If you sign up during this period, your coverage can start on the first day of the month you turn 65 (or the first day of the month after you sign up, whichever is later).

If you do not sign up during your Initial Enrollment Period, you will have another chance during the General Enrollment Period, which runs January 1 to March 31 each year. But coverage does not start until July 1 of that year, and you will owe a penalty. For Part B, the penalty is 10 percent of the standard premium for each full year you were may be able to access but did not sign up. For Part D (prescription drug coverage), the penalty is 1 percent of the national average premium for each month you were may be able to access but did not sign up. These penalties are permanent — they do not expire.

Earlier may be able to access: Disability, Kidney Disease, and ALS

You can start Medicare before 65 if you receive Social Security Disability Insurance (SSDI) or Railroad Retirement Board disability benefits. You become may be able to access for Medicare after you have received disability benefits for 24 months. The 24 months do not have to be consecutive — they count from the date your disability began, not from the date you applied.

If you have end-stage renal disease (ESRD), you can start Medicare as soon as your condition is diagnosed, even if you are not yet on dialysis. You do not have to wait 24 months. Your coverage can begin the month your treatment starts, or the month you are diagnosed if you have not yet started treatment.

If you have been diagnosed with ALS, you can start Medicare when ready — there is no waiting period. Your coverage can begin the month after you explore.

If you become may be able to access before 65 through disability, ESRD, or ALS, you will automatically be enrolled in Medicare Part A and Part B once you meet the requirements. You do not have to sign up yourself. However, you still need to sign up for Part D (prescription drug coverage) if you want it, and you should do this during your Initial Enrollment Period to avoid a lifetime penalty.

What Happens If You Miss Your Enrollment Period

If you do not sign up during your Initial Enrollment Period and you do not have a may have access to reason to delay, you can still sign up during the General Enrollment Period (January 1 to March 31). Your coverage will start July 1 of that year. But you will owe a penalty on Part B premiums for as long as you have Medicare — typically 10 percent of the standard premium for each full year you were may be able to access but did not sign up.

The penalty applies only if you did not have a valid reason to delay. If you were covered by an employer health plan while you were still working, or if your spouse was still working and you were covered under their plan, you may have had a valid reason to delay. This is called the Special Enrollment Period. You can sign up without penalty during the eight months after your employment (or your spouse's employment) ends or your employer coverage ends, whichever comes first.

To avoid penalty, you must sign up during one of these windows. There is no way to remove a penalty once it has been applied, even if you sign up later.

You Must Sign Up Yourself — It Is Not Automatic

Even if you receive Social Security retirement benefits, you are not automatically enrolled in Medicare when you turn 65. You must sign up yourself, or ask someone to help you. Social Security does not assume you want Medicare just because you are receiving retirement checks.

You can sign up online at Medicare.gov, by phone at 1-800-MEDICARE (1-800-633-4227), or in person at your local Social Security office. If you are deaf or hard of hearing, you can use the TTY number 1-877-486-2048. You will need your Social Security number, proof of citizenship or permanent residency, and information about any current health coverage you have.

If you are already receiving Social Security benefits (retirement, disability, or survivor benefits), the process is faster because Social Security already has your information. If you are not yet receiving Social Security benefits, you will need to provide proof of age, citizenship, and residency.

Special Rules If You Are Still Working

If you are still working at 65 and your employer offers health insurance, you may be able to delay Medicare Part B without penalty. This is called creditable coverage. Your employer's plan must cover you (not just your dependents), and it must be based on your current employment.

If you have creditable coverage through your employer, you can delay Part B and avoid the 10 percent penalty. You have eight months after your employment ends or your employer coverage ends to sign up for Part B without penalty. You must still sign up for Part A at 65 — there is no penalty for delaying Part A, but you should enroll to avoid gaps in coverage.

If you are self-employed or your employer does not offer health insurance, you cannot delay Part B. You must sign up during your Initial Enrollment Period or pay a penalty.

Timing Your Coverage Start Date

The month your coverage starts depends on when you sign up. If you sign up during your Initial Enrollment Period (three months before to three months after the month you turn 65), your coverage can start on the first day of the month you turn 65. If you sign up after your Initial Enrollment Period ends, your coverage will start on the first day of the month after you sign up, or later, depending on when the Social Security Administration processes your process.

If you are may be able to access before 65 through disability, ESRD, or ALS, your coverage start date is determined by your condition, not by when you sign up. For disability, coverage starts the month after you have received benefits for 24 months. For ESRD, coverage starts the month your treatment begins. For ALS, coverage starts the month after you explore.

Frequently Asked Questions

Do I have to sign up for Medicare at 65 if I am still working?

You do not have to sign up for Part B if you have creditable coverage through your employer. But you should sign up for Part A at 65, even if you are still working, because there is no penalty for delaying Part A and you want to avoid gaps in coverage. If you do not have employer coverage, you must sign up for both Part A and Part B during your Initial Enrollment Period or pay a lifetime penalty on Part B.

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

Your Initial Enrollment Period is still seven months: three months before the month you turn 65, the month you turn 65, and three months after. Your coverage can start on the first day of the month you turn 65, regardless of which day of the month your birthday falls on.

Can I sign up for Medicare online?

Yes. You can create an account at Medicare.gov and sign up for Part A and Part B online. You can also call 1-800-MEDICARE or visit your local Social Security office. Online signup is usually the fastest option.

If I delay Part B because I am still working, when do I need to sign up?

You have eight months after your employment ends or your employer coverage ends to sign up for Part B without penalty. If you miss this window, you will owe a 10 percent penalty on your Part B premium for as long as you have Medicare.

What if I moved to another country after I turned 65?

You can keep Medicare Part A and Part B if you move outside the United States, but coverage is limited. Medicare generally does not cover care outside the U.S., except in limited situations (like if you are in Canada or Mexico and close to the U.S. border). Contact Medicare at 1-800-MEDICARE to discuss your specific situation before you move.