When You Turn 65: Understanding Medicare Age Requirements

You become may be able to access for Medicare the month you turn 65

Medicare may be able to access begins the first day of the month in which you turn 65, regardless of the exact date of your birthday. If you turn 65 on any day in March, your coverage can start March 1. If you turn 65 on March 31, your coverage still starts March 1 of that month.

You do not have to wait until your birthday passes. You can sign up starting three months before the month you turn 65. This three-month window is important because missing it can cost you in penalties later, even if you have other health coverage through work.

There are narrow exceptions to the age 65 rule. People under 65 with end-stage renal disease (permanent kidney failure requiring dialysis or transplant) or amyotrophic lateral sclerosis (ALS) can become may be able to access at any age. People who have received Social Security Disability Insurance (SSDI) for 24 months also become may be able to access before 65, regardless of their age.

Key Takeaways

Medicare begins the first day of the month you turn 65, and you can start the sign-up process three months before that month arrives.
If you are still working and have health insurance through your employer, you can delay Part B enrollment without penalty if your employer has 20 or more employees.
Waiting past your initial enrollment window to sign up for Part B or Part D (prescription drug coverage) triggers a permanent penalty on your monthly premium.
You must actively sign up for Medicare; it does not happen automatically unless you are already receiving Social Security benefits.
People under 65 with end-stage renal disease, ALS, or 24 months of SSDI can become may be able to access before their 65th birthday.

How to sign up during your initial enrollment window

Your Initial Enrollment Period runs for seven months: three months before the month you turn 65, the month you turn 65, and three months after. During this window, you can sign up for Medicare Part A (hospital insurance) and Part B (medical insurance) without waiting periods or penalties.

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 already receiving Social Security benefits, you will be enrolled in Part A and Part B automatically unless you decline Part B in writing.

If you miss your Initial Enrollment Period, you can still sign up during the General Enrollment Period, which runs January 1 through March 31 each year. However, coverage does not start until July 1 of that year, and you will owe a permanent 10 percent increase to your Part B premium for each full year you delayed enrollment.

Working past 65 and delaying Part B enrollment

If you are still working and covered by your employer's health plan, you may be able to delay Part B enrollment without penalty. This is called the Special Enrollment Period for people with group health plan coverage. The rule applies only if your employer has 20 or more employees.

To use this exception, you must sign up for Part A when you turn 65, but you can delay Part B until you leave your job or lose your employer coverage. You then have eight months to sign up for Part B without the late-enrollment penalty. You will need to show proof that you had employer coverage — usually a letter from your employer's benefits department stating the number of employees and your coverage dates.

If your employer has fewer than 20 employees, Medicare is your primary insurance when you turn 65, and you should sign up for Part B during your Initial Enrollment Period to avoid penalties.

Prescription drug coverage and Part D enrollment

Part D (prescription drug coverage) has its own enrollment rules tied to age 65. You can sign up for Part D during your Initial Enrollment Period, which includes the same seven-month window as Part A and Part B. If you have employer coverage that includes prescription drugs, you may be able to delay Part D enrollment without penalty, similar to the Part B rule.

If you go without Part D coverage and do not have other creditable prescription drug coverage (such as through an employer or union), you will owe a permanent penalty when you eventually sign up. The penalty is roughly 1 percent of the national average Part D premium for each month you were without coverage. This penalty stays on your premium for as long as you have Part D.

To avoid the penalty, you must sign up for Part D during your Initial Enrollment Period or show proof of creditable coverage from another source. Your employer or union plan administrator can provide a letter stating whether your coverage is creditable.

What happens if you miss your enrollment window

Missing your Initial Enrollment Period does not prevent you from getting Medicare, but it creates lasting financial consequences. Late-enrollment penalties explore to Part B and Part D and are permanent — they do not go away even if you sign up years later.

The Part B penalty is 10 percent of the standard premium for each full year you delayed. If the standard premium is $175 per month and you delayed for three years, your penalty would be 30 percent, raising your monthly cost to $227.50 for life. The penalty applies only to you, not to your spouse.

You can appeal a late-enrollment penalty if you had good cause for missing the important date — for example, if you were out of the country, had a serious illness, or received incorrect information from Medicare or Social Security. You must submit your appeal within the timeframe Medicare specifies, usually within 60 days of receiving your notice.

Coordinating Medicare with other coverage

If you have retiree health coverage from a former employer, union, or veteran's benefits, you should understand how it coordinates with Medicare. Some retiree plans are designed to work alongside Medicare and will become secondary coverage once you enroll. Others may end when you turn 65. Contact your retiree plan administrator before you turn 65 to learn what happens to your coverage.

If you have Medicaid (state health insurance for low-income people), you can have both Medicaid and Medicare at the same time. Medicaid will help pay some of your Medicare premiums and cost-sharing. Contact your state Medicaid office to report that you have become may be able to access for Medicare, as this may change your Medicaid benefits.

If you are a veteran, you may have coverage through the VA in addition to Medicare. You do not have to choose between them — you can use both. However, the VA and Medicare do not coordinate payments, so you will need to tell each provider about the other coverage you have.

Special situations: Disability, end-stage renal disease, and ALS

If you have been receiving SSDI for 24 months, you become may be able to access for Medicare at that point, regardless of your age. Your coverage begins the 25th month of your SSDI benefits. You will be enrolled automatically in Part A and Part B unless you decline Part B in writing.

If you have end-stage renal disease requiring dialysis or a kidney transplant, you can become may be able to access for Medicare as early as the first month of dialysis treatment or the month of your transplant, even if you are under 65. You will be enrolled in Part A automatically. You should sign up for Part B during your Initial Enrollment Period to avoid late-enrollment penalties.

If you have ALS (Lou Gehrig's disease), you become may be able to access for Medicare when ready upon diagnosis, without waiting for SSDI benefits to begin. You will be enrolled in Part A automatically. Like other groups, you should sign up for Part B and Part D during your Initial Enrollment Period.

Frequently Asked Questions

What if I turn 65 on the first day of the month?

Your Medicare coverage still begins on the first day of that month. The rule is the same whether you turn 65 on the 1st or the 31st — coverage starts the first day of the month in which you turn 65.

Do I have to sign up for Medicare if I am still working and have employer coverage?

You must sign up for Part A at age 65, even if you are working. You can delay Part B if your employer has 20 or more employees and you are covered by their health plan. However, you should sign up for Part B within eight months of leaving your job to avoid late-enrollment penalties.

What is the penalty for signing up late for Part B?

The penalty is 10 percent of the standard Part B premium for each full year you delayed enrollment. This penalty is permanent and added to your monthly premium for life. You can appeal the penalty if you had good cause for the delay, such as incorrect information from Medicare.

Can I sign up for Medicare before I turn 65?

You can begin the sign-up process three months before the month you turn 65. Your coverage will not start until the first day of the month you turn 65, but signing up early ensures you do not miss your Initial Enrollment Period.

What happens to my employer health insurance when I turn 65?

Your employer coverage does not automatically end. However, once you have Medicare, your employer plan usually becomes secondary coverage. Contact your employer's benefits department before you turn 65 to learn whether your coverage continues, ends, or changes after you enroll in Medicare.

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.