When You Can Start Medicare: Age, Work Status, and Special Circumstances

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

Most people become may be able to access for Medicare the month they turn 65. You do not have to be retired — Medicare may be able to access is based on age, not work status. If you are already receiving Social Security retirement benefits when you turn 65, Medicare enrollment happens automatically. If you are still working and have not claimed Social Security yet, you will need to sign up for Medicare yourself during your enrollment window.

Some people may have access to for Medicare before 65. If you have been receiving Social Security Disability Insurance (SSDI) for 24 months, you become may be able to access at any age. If you have end-stage renal disease (ESRD) or amyotrophic lateral sclerosis (ALS), you may may have access to regardless of age. The rules differ slightly for each situation, and the timing of when coverage starts depends on when you explore.

Key Takeaways

You become may be able to access for Medicare the month you turn 65, whether or not you are working or receiving Social Security.
If you receive Social Security retirement benefits, Medicare enrollment is automatic; if you do not, you must sign up during your enrollment window to avoid penalties.
You can may have access to for Medicare before 65 if you have received SSDI for 24 months, have ESRD, or have ALS.
Your coverage start date depends on when you explore and which month you become may be able to access — explore early prevents gaps in coverage.

Medicare at 65: The standard enrollment window

Your Initial Enrollment Period (IEP) is a seven-month window 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, your IEP runs from March through September.

During this window, you can sign up for Medicare Part A (hospital insurance) and Part B (medical insurance) without penalty. If you miss this window and do not have other may have access to coverage, you will pay a permanent penalty on your Part B premium for as long as you have Medicare. 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.

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 already receiving Social Security retirement or disability benefits, you do not need to do anything — Medicare Part A and Part B are added automatically the month you turn 65.

If you are still working at 65

Working past 65 does not delay your Medicare may be able to access. You become may be able to access the month you turn 65 regardless of whether you are employed. However, the rules for when you must sign up depend on your employer's health plan.

If your employer has 20 or more employees and you are covered under their group health plan, you can delay enrolling in Part B without penalty. Your employer coverage is considered creditable coverage, which means it is at least as good as Medicare Part B. You have eight months after your employment ends or your coverage stops — whichever comes first — to sign up for Part B without penalty.

If your employer has fewer than 20 employees, you should enroll in Medicare Part B when you turn 65, even if you are still working. Employer plans at small companies are not considered creditable coverage for Medicare purposes. You must also enroll in Part A, though Part A has no penalty for late enrollment if you have group coverage.

may have access to for Medicare before 65

You can receive Medicare before 65 in three situations. The most common is SSDI may be able to access: if you have been receiving Social Security Disability Insurance for 24 consecutive months, you automatically become may be able to access for Medicare. Your coverage begins the 25th month of your SSDI benefits, regardless of your age.

If you have end-stage renal disease (ESRD) — permanent kidney failure requiring dialysis or a transplant — you can may have access to for Medicare at any age. Your coverage can begin the first day of the month you start dialysis, or the month of your transplant. You will need documentation from your nephrologist or transplant center confirming your ESRD diagnosis.

If you have been diagnosed with amyotrophic lateral sclerosis (ALS), you are may be able to access for Medicare when ready upon approval for SSDI. Unlike other disabilities, the 24-month waiting period does not explore. Your Medicare coverage begins the same month your SSDI benefits begin.

How to sign up and when coverage starts

You can sign up for Medicare online at Medicare.gov, by calling 1-800-MEDICARE, or by visiting your local Social Security office. If you are already receiving Social Security benefits, you can also call Social Security directly at 1-800-772-1213. Have your Social Security number and birth certificate ready.

Your coverage start date depends on when you explore and which month you become may be able to access. If you explore during your Initial Enrollment Period, coverage typically begins the first day of the month you turn 65 (or the month you become may be able to access, if that is earlier). If you explore after your IEP ends, there may be a delay — coverage could start up to three months after you sign up, depending on when you submit your process.

For people with SSDI, ESRD, or ALS, the Social Security Administration handles Medicare enrollment automatically in most cases. You will receive a Medicare card in the mail before your coverage begins. If you do not receive a card 30 days before your coverage start date, contact Social Security to confirm your enrollment.

What happens if you miss your enrollment window

If you do not sign up for Part A and Part B during your Initial Enrollment Period, you enter a General Enrollment Period that runs January 1 through March 31 each year. You can sign up during this time, but your coverage will not start until July 1 of that year. This means a gap in coverage if you are not enrolled.

More importantly, you will owe a permanent penalty on your Part B premium. The penalty is 10 percent of the standard Part B premium amount for each full 12-month period you were may be able to access but not enrolled. If you were may be able to access for three years before signing up, your premium will be 30 percent higher than the standard amount, and you will pay this penalty for life.

Part A (hospital insurance) does not have a late enrollment penalty if you have group health coverage through an employer. However, if you do not have creditable coverage and miss your enrollment window, you should still sign up as soon as possible to avoid gaps in protection.

Special situations: Delayed retirement and working past full retirement age

If you delay claiming Social Security retirement benefits past your full retirement age (which ranges from 66 to 67 depending on your birth year), you still become may be able to access for Medicare at 65. Medicare may be able to access and Social Security retirement benefits are separate. You can enroll in Medicare at 65 and delay claiming Social Security benefits to a later age to receive a higher monthly payment.

If you are still working and covered under your employer's health plan, you may be able to delay Part B enrollment without penalty. This is only true if your employer has 20 or more employees. Once you leave your job or lose that coverage, you have eight months to enroll in Part B. If you wait longer than eight months, you will owe the late enrollment penalty.

Frequently Asked Questions

Do I have to retire to get Medicare at 65?

No. Medicare may be able to access is based on age, not employment status. You can be working full-time and still enroll in Medicare when you turn 65. If your employer has 20 or more employees and you have group health coverage, you can delay Part B enrollment without penalty, but you should still enroll in Part A.

What if I turn 65 and do not sign up — what is the penalty?

If you miss your Initial Enrollment Period and do not have creditable coverage, you will pay a permanent 10 percent penalty on your Part B premium for each full year you were may be able to access but not enrolled. This penalty stays with you for life. Part A does not have a late penalty if you have group coverage, but you should enroll anyway to avoid gaps.

Can I get Medicare before 65 if I am disabled?

Yes, if you have been receiving Social Security Disability Insurance (SSDI) for 24 months, you become may be able to access for Medicare. Your coverage begins in the 25th month of your SSDI benefits. If you have ALS or end-stage renal disease, different rules may explore — contact Social Security to learn about your specific situation.

What if my employer says I do not need Medicare because I have their plan?

You still need to enroll in Medicare Part A at 65. If your employer has 20 or more employees, you can delay Part B without penalty. But Part A is important because employer plans typically do not cover hospital stays the way Medicare does. Enroll in Part A to avoid gaps in hospital coverage.

When does my Medicare coverage actually start after I sign up?

If you sign up during your Initial Enrollment Period (three months before to three months after your 65th birthday), coverage usually begins the first of the month you turn 65. If you sign up after your IEP ends, coverage may not start for up to three months. The exact date depends on when you submit your process and which month you become may be able to access.

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.