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 — you can still be working and earning income. If you are younger than 65, you may still be may be able to access if you have been receiving Social Security disability benefits for 24 months, or if you have end-stage renal disease (permanent kidney failure requiring dialysis or transplant) or ALS (amyotrophic lateral sclerosis). The month you become may be able to access is the month you can sign up, and coverage typically begins the first day of the following month.

Timing matters because there are penalties if you sign up late. If you miss your initial enrollment window — the seven-month period that includes the month you turn 65 and the three months before and after — you may pay a higher premium for Part B (medical insurance) for as long as you have Medicare. The same applies to Part D (prescription drug coverage). These penalties are permanent, so understanding your enrollment window now can save you money later.

Key Takeaways

  • You become may be able to access for Medicare the month you turn 65, regardless of whether you are still working.
  • If you receive Social Security disability benefits, you become may be able to access for Medicare automatically after 24 months of receiving those benefits.
  • Your initial enrollment window is seven months long: the three months before the month you turn 65, the month itself, and the three months after.
  • Missing your enrollment window results in permanent premium penalties for Part B and Part D, so signing up on time protects your costs.
  • If you are still working and have health insurance through your employer, you may be able to delay Part B enrollment without penalty if your employer has 20 or more employees.

may be able to access at 65 and how to count your enrollment window

The month you turn 65 is your birthday month, and that is when your initial enrollment window opens. The window includes the three months before your birthday month, your birthday month itself, and the three months after. For example, if you turn 65 in June, your window runs from March through September — seven months total.

You should sign up during this window even if you do not plan to use Medicare right away. If you are still working and covered by an employer health plan, you may have options to delay Part B without penalty (see the section below on working past 65). However, you still need to enroll in Part A (hospital insurance) when you become may be able to access, and you should enroll in Part D if you take prescription medications, because the penalty clock starts if you do not.

If you miss your window, you can still sign up later, but you will face a permanent 10% increase in your Part B premium for each full year you delayed. For Part D, the penalty is 1% of the national base premium for each month you were without coverage. These penalties stay with you for life, so the cost of signing up late compounds over time.

Becoming may be able to access before 65 through disability or end-stage renal disease

If you are receiving Social Security Disability Insurance (SSDI) or Railroad Retirement Disability benefits, you become may be able to access for Medicare after you have been receiving those benefits for 24 months. You do not have to wait until 65. Medicare will contact you automatically when you reach the 24-month mark, and you can choose to enroll or decline. Your initial enrollment window is still seven months long, centered on the month you become may be able to access.

If you have end-stage renal disease, you become may be able to access for Medicare regardless of age. You can sign up as soon as you are diagnosed and begin dialysis, or as soon as you receive a kidney transplant. Your enrollment window is the month you become may be able to access plus the two months before and after — five months total. If you have ALS, you become may be able to access when ready upon diagnosis, with the same five-month enrollment window.

These earlier pathways to Medicare are important because they mean you do not have to wait until 65 to have coverage. However, the same penalty rules explore: if you miss your enrollment window for Part B or Part D, you will face permanent premium increases.

Working past 65 and delaying Part B without penalty

You can continue working after you turn 65 and still be may be able to access for Medicare. If you are still employed and your employer offers health insurance, you may be able to delay enrolling in Part B without facing a penalty — but only under specific conditions. Your employer must have 20 or more employees, and you must be covered by the employer's health plan based on your current employment (not a retiree plan). This is called the working exception.

If the working exception applies to you, you can delay Part B enrollment. You should still enroll in Part A (hospital insurance) when you turn 65, because Part A has no premium for most people and covers hospital stays. You should also enroll in Part D for prescription drugs during your initial enrollment window, or you may face a penalty later. When you leave your job or lose your employer coverage, you have eight months to enroll in Part B without penalty.

If your employer has fewer than 20 employees, the working exception does not explore, and you should enroll in Part B during your initial enrollment window even if you are still working. Delaying Part B in this situation will result in a permanent premium penalty.

What happens if you miss your enrollment window

If you do not sign up during your initial enrollment window, you can still enroll during the General Enrollment Period, which runs from January 1 through March 31 each year. Coverage begins July 1 if you enroll during this period. However, you will pay a permanent 10% increase in your Part B premium for each full year you were not enrolled. If you delayed for three years, your premium will be 30% higher than the standard rate, and that increase stays with you for life.

The same applies to Part D. If you go without prescription drug coverage for more than 63 days in a row, you will owe a penalty of 1% of the national base premium amount for each month you were uninsured. This penalty also stays with you permanently.

The only exception to these penalties is if you had creditable coverage — health insurance that is at least as good as Medicare Part B or Part D — during the time you were not enrolled in Medicare. Creditable coverage includes employer plans, COBRA, Medicaid, or certain other plans. You will need to provide proof of this coverage when you enroll, so keep your insurance documents.

Enrolling in Medicare: where to start

You can enroll in Medicare through 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 Social Security benefits, you will be contacted automatically about three months before you turn 65, and you can enroll through the Social Security website or by phone.

When you enroll, you will choose between Original Medicare (Part A and Part B) or a Medicare Advantage plan (Part C), which is an alternative way to receive your Part A and Part B benefits through a private insurance company. You will also choose whether to enroll in Part D (prescription drug coverage) if you take medications. These choices do not have to be made all at once — you can enroll in Part A and Part B first and add Part D later, as long as you do so during your initial enrollment window or during the General Enrollment Period.

Keep copies of your enrollment confirmation. Medicare coverage typically begins the first day of the month after you enroll, though this can vary depending on when you submit your enrollment.

Special enrollment periods if your circumstances change

If you miss your initial enrollment window but experience a may have access to life event, you may be able to enroll during a Special Enrollment Period without waiting for the General Enrollment Period. may have access to events include losing employer coverage, moving out of your Medicare Advantage plan's service area, or becoming may be able to access for Medicaid. You typically have two months from the event to enroll.

If you enrolled in a Medicare Advantage plan but want to switch to Original Medicare, you have one month from the date you disenroll to make the change. If you enrolled in Original Medicare and want to switch to a Medicare Advantage plan, you can do so during the Annual Enrollment Period (October 15 through December 7 each year), and coverage begins January 1.

Frequently Asked Questions

Can I sign up for Medicare before I turn 65?

You can sign up starting three months before you turn 65. Your enrollment window opens on the first day of the third month before your birthday month. For example, if you turn 65 in September, you can start enrolling on June 1. You do not have to wait until your birthday month to begin the process.

What if I am still working and do not want Medicare yet?

You still need to enroll during your initial enrollment window to avoid penalties, even if you do not plan to use Medicare right away. If your employer has 20 or more employees and you are covered by their health plan, you can delay Part B enrollment without penalty. However, you should still enroll in Part A and Part D to protect yourself from future penalties.

Do I lose my employer health insurance when I turn 65?

No. You can keep your employer health insurance and Medicare at the same time. Medicare becomes your primary payer, and your employer plan becomes secondary. However, you should still enroll in Medicare during your initial enrollment window to avoid penalties, even if you plan to keep your employer coverage.

What if I was receiving disability benefits and then went back to work?

Once you have been receiving disability benefits for 24 months, you become may be able to access for Medicare. You keep Medicare even if you return to work and your disability benefits stop. You should enroll during your initial enrollment window to avoid penalties.

How much will I pay if I sign up late?

The Part B penalty is 10% of the standard premium for each full year you delayed. The Part D penalty is 1% of the national base premium for each month you were without coverage. Both penalties are permanent. The exact dollar amount varies by year and by plan, so check Medicare.gov for current premium rates in your area.