You can start Medicare at 65, but you may be able to start earlier if you have a disability or end-stage renal disease

Medicare may be able to access is tied to age 65 for most people, but the program has other pathways in. If you are disabled and under 65, you may be covered after you have received Social Security Disability Insurance (SSDI) for 24 months. If you have end-stage renal disease (ESRD) — permanent kidney failure requiring dialysis or transplant — you may be covered regardless of age. If you are still working at 65, you do not have to sign up right away, but waiting past your initial enrollment window can cost you more in premiums later.

Your initial enrollment period is seven months long: three months before the month you turn 65, the month itself, and three months after. Missing this window triggers a permanent penalty on your Part B premium that stays with you for life. Understanding when you become may be able to access and when to sign up protects you from unexpected costs.

Key Takeaways

  • You become may be able to access for Medicare at age 65 if you have been a U.S. citizen or permanent resident for at least five years and have worked and paid Medicare taxes for at least 10 years (or are married to someone who has).
  • If you are under 65 and receiving SSDI, you become may be able to access for Medicare after 24 months of receiving disability benefits, regardless of your age.
  • People with end-stage renal disease can get Medicare at any age once their condition is diagnosed, even if they have not yet started dialysis.
  • Your initial enrollment period is the three months before the month you turn 65, the month itself, and the three months after — missing this window can result in a permanent penalty on your Part B premium.
  • If you are still working and covered by your employer's health plan at 65, you may be able to delay enrollment without penalty, but you must tell Medicare about your coverage.

Medicare at 65: Who qualifies and when to sign up

You are may be able to access for Medicare Part A (hospital insurance) at 65 if you are a U.S. citizen or permanent resident who has lived in the country for at least five years. You also need a work history: either you have paid Medicare taxes for at least 10 years (40 quarters), or you are married to someone who has and meet certain requirements. If you meet these conditions, Part A is free — you do not pay a monthly premium.

Part B (medical insurance) also starts at 65, but it costs a monthly premium that varies based on your income. Most people pay between $164 and $560 per month in 2024, depending on how much you earned in the past two years. If you wait to sign up for Part B after your initial enrollment period, you will pay a permanent 10 percent penalty on your premium for each year you delayed — that penalty stays with you for life.

Your initial enrollment period is seven months long: it begins three months before the month you turn 65 and ends three months after. During this window, you can sign up without penalty. If you are still working and covered by your employer's health plan, you may be able to delay Part B enrollment without penalty, but you must tell Medicare that you have other coverage. Ask your employer's benefits office whether your plan qualifies as "creditable coverage" before you decide to wait.

Getting Medicare before 65 if you have a disability

If you are under 65 and receiving SSDI, you become may be able to access for Medicare after you have been on disability for 24 months. This means if you are approved for SSDI today, you will be covered by Medicare two years from now, at whatever age you are then. You do not have to do anything — Social Security will enroll you automatically once the 24 months are up.

The same rule applies if you receive Supplemental Security Income (SSI) based on disability, though the timing can be different because SSI may be able to access rules differ from SSDI. Contact Social Security directly to confirm when your 24-month period ends, because the date depends on when your benefits officially began, not when you applied. Once you are on Medicare, you will receive the same Part A and Part B coverage as someone who turned 65.

You will still need to decide whether to add Part D (prescription drug coverage) or a Medigap or Medicare Advantage plan. If you miss the enrollment period tied to when you first become may be able to access, you may face a late-enrollment penalty on Part D or Part B, so mark your calendar when Social Security tells you your coverage will start.

Medicare for people with end-stage renal disease at any age

If you have end-stage renal disease (ESRD) — kidney failure that requires dialysis or a transplant — you can get Medicare regardless of your age. You become may be able to access once your condition is diagnosed by a doctor, even if you have not yet started treatment. You do not have to wait for dialysis to begin.

ESRD Medicare coverage includes Part A (hospital) and Part B (medical), and you will pay the standard Part B premium based on your income. You should also think about Part D (prescription drugs) and whether a Medigap or Medicare Advantage plan makes sense for you. Because ESRD often involves multiple medications and frequent medical visits, prescription coverage and supplemental insurance can reduce your out-of-pocket costs significantly.

What happens if you miss your enrollment window

If you do not sign up for Part B during your initial enrollment period and you do not have a may have access to reason to delay, you will pay a permanent penalty. 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 and did not sign up, your premium will be 30 percent higher than the standard rate — and that increase follows you for the rest of your life.

Part D (prescription drug coverage) has a similar penalty: if you go 63 days or more without coverage and later sign up, you will pay a permanent surcharge on your premium. The penalty is 1 percent of the national average Part D premium for each month you were without coverage. These penalties do not go away, so it is worth signing up on time even if you do not think you need the coverage yet.

If you have a may have access to life event — such as losing employer coverage, moving out of your plan's service area, or becoming newly may be able to access for Medicaid — you may be able to sign up outside your initial window without penalty. These are called Special Enrollment Periods, and they last 60 days from the date of the event. You will need to report the event to Medicare and provide proof, such as a letter from your employer saying your coverage ended.

How to sign up for Medicare

You can sign up for Medicare through Social Security, either online at ssa.gov, by phone at 1-800-772-1213, or in person at your local Social Security office. You will need your Social Security number, proof of citizenship or permanent residency, and proof of age (such as a birth certificate). If you are signing up for Part B, you may also need to provide income information.

You can also sign up through Medicare directly at Medicare.gov, by phone at 1-800-MEDICARE (1-800-633-4227), or by visiting your local Social Security office. If you are already receiving SSDI or SSI, Social Security will contact you before your coverage begins and walk you through your options for supplemental coverage. Sign up during your initial enrollment period — the three months before you turn 65, the month of your birthday, and the three months after.

If you are still working and have employer coverage, contact your employer's benefits office to confirm whether you can delay Part B without penalty before you decide to wait. Waiting to sign up without permission from Medicare can trigger a penalty, so it is safer to sign up and then decide whether to use your Medicare coverage.

Deciding between Original Medicare and Medicare Advantage

Once you are may be able to access for Medicare, you will choose between Original Medicare (Part A and Part B) or a Medicare Advantage plan (Part C). Original Medicare is run by the federal government and covers hospital stays, doctor visits, and some preventive care. You can see any doctor or hospital that accepts Medicare, and you pay a deductible and coinsurance for most services.

Medicare Advantage plans are run by private insurance companies and bundle Part A, Part B, and usually Part D into one plan. They often have lower out-of-pocket costs and may include dental, vision, or hearing coverage, but they typically require you to use doctors and hospitals in their network. If you choose Original Medicare, you will need to add Part D for prescription drugs and may want to add a Medigap plan to cover costs that Medicare does not pay.

You can change your choice during the Annual Enrollment Period (October 15 to December 7 each year), so if you pick one and later decide it is not working for you, you have a chance to switch. Your first chance to enroll in a plan is during your initial enrollment period, which is the same seven-month window you use to sign up for Medicare itself.

Frequently Asked Questions

Can I get Medicare before 65 if I am not disabled?

No, unless you have end-stage renal disease. If you are under 65 and do not have ESRD or a disability that qualifies you for SSDI or SSI, you will need to wait until 65 or find coverage through your employer, the Affordable Care Act marketplace, or Medicaid. Some states have expanded Medicaid to cover more working-age adults, so check your state's rules.

What if I am still working at 65 — do I have to sign up for Medicare?

You do not have to sign up for Part B if you are covered by your employer's health plan and your employer has 20 or more employees. You must tell Medicare about your coverage so you do not face a late-enrollment penalty later. When you do retire or lose coverage, you will have eight months to sign up for Part B without penalty. Part A is usually free, so most people sign up for it even if they delay Part B.

How much does Medicare cost?

Part A is free for most people. Part B costs between $164 and $560 per month in 2024, depending on your income from two years ago. Part D (prescription drugs) costs between $7 and $100 per month depending on the plan. If you choose a Medigap plan, that costs $100 to $300 per month. Medicare Advantage plans often have no monthly premium but charge copays when you use services.

What if I was not born in the United States — can I still get Medicare?

Yes, if you are a permanent resident (green card holder) and have lived in the United States for at least five years. You will also need the standard work history: 10 years of paying Medicare taxes, or being married to someone who has. Bring your green card and proof of residency when you sign up.

Can I sign up for Medicare online?

Yes. You can create an account at ssa.gov and sign up for Medicare through Social Security, or go to Medicare.gov to sign up directly with Medicare. You can also call 1-800-772-1213 (Social Security) or 1-800-MEDICARE (1-800-633-4227) to sign up by phone, or visit your local Social Security office in person.