You can sign up for Medicare Part A starting three months before you turn 65

Medicare Part A covers hospital stays, skilled nursing care, hospice, and some home health services. You become may be able to access on the first day of the month you turn 65, but you do not have to wait until then to sign up. You can start the process three months before your 65th birthday and enroll anytime during that window.

Most people sign up during their initial enrollment period, which runs for seven months total: the three months before you turn 65, the month you turn 65, and the three months after. If you sign up during this window, your coverage starts on the first day of the month you turn 65, regardless of which month within the window you actually enroll.

Some people are already covered by Part A without signing up at all. If you have been receiving Social Security retirement benefits or Railroad Retirement Board benefits for at least four months before you turn 65, Medicare will enroll you automatically. You will receive your Medicare card in the mail about two weeks before your 65th birthday.

Key Takeaways

  • You can sign up for Medicare Part A starting three months before your 65th birthday, and coverage begins the first day of the month you turn 65.
  • If you are already receiving Social Security or Railroad Retirement Board benefits, you will be enrolled automatically and do not need to sign up yourself.
  • If you miss your initial enrollment period, you can still enroll later, but you may face a permanent penalty on your premiums if you wait.
  • You can sign up through Medicare.gov, by phone at 1-800-MEDICARE, or in person at your local Social Security office.
  • Part A is usually free for people who paid Medicare taxes while working, but some people without a work history may have to pay a monthly premium.

Who gets enrolled automatically and who needs to sign up

If you have been getting Social Security retirement benefits, Social Security disability benefits, or Railroad Retirement Board benefits for at least four months before you turn 65, Medicare will sign you up for Part A automatically. You do not need to do anything. Your Medicare card will arrive in the mail about two weeks before your birthday.

If you are not yet receiving any of these benefits when you turn 65, you will need to sign up yourself. This includes people who are still working and have delayed taking Social Security, people who are self-employed, and people who worked outside the United States. You have a seven-month window to enroll without penalty: three months before your birthday, the month of your birthday, and three months after.

If you are not sure whether you will be enrolled automatically, call Social Security at 1-800-772-1213 before your 65th birthday. They can tell you whether you are set up to receive automatic enrollment.

What happens if you sign up late

If you miss your initial enrollment period and do not sign up during those seven months, you can still enroll in Part A later. However, you will face a permanent penalty on your premiums. The penalty is 10 percent of the standard Part A premium for each full 12-month period you were may be able to access but not enrolled. This penalty stays with you for as long as you have Part A, even if you switch to a different plan later.

The only exception is if you had creditable coverage through an employer or union while you were working past 65. Creditable coverage means health insurance that is at least as good as Medicare Part A. If you had this coverage and did not enroll in Part A during your initial period, you can enroll later without penalty during an eight-month period after your coverage ends or your employment ends, whichever comes first.

Because the penalty is permanent, it is worth signing up during your initial enrollment period even if you do not think you need Part A right away. You can enroll and delay using the coverage if you have other insurance.

How to sign up for Part A

You have three main ways to sign up: online, by phone, or in person. The fastest way is usually online at Medicare.gov. Go to the "Sign Up for Medicare" section, create an account if you do not have one, and follow the steps. You will need your Social Security number and information about your citizenship or immigration status. The online process takes about 10 to 15 minutes.

You can also call 1-800-MEDICARE (1-800-633-4227). Representatives are available Monday through Friday from 8 a.m. to 8 p.m. Eastern time, and Saturday from 8 a.m. to 4 p.m. Eastern time. They can walk you through the enrollment over the phone and answer questions about your specific situation.

If you prefer to sign up in person, visit your local Social Security office. You can find the nearest office at ssa.gov or by calling 1-800-772-1213. Bring your Social Security card, proof of citizenship or immigration status, and proof of age (like a birth certificate or passport). Social Security offices are usually open Monday through Friday from 9 a.m. to 4 p.m., but hours vary by location.

Part A premiums and what they cover

Most people do not pay a monthly premium for Part A because they or their spouse paid Medicare taxes while working for at least 10 years. If you meet this requirement, Part A is free when you turn 65.

If you do not have 10 years of Medicare tax history, you will pay a monthly premium. The amount depends on how many quarters of Medicare tax you paid. Someone with 30 to 39 quarters of coverage pays less than someone with fewer than 30 quarters. The exact premium amount changes each year. You can find the current premium on Medicare.gov or by calling 1-800-MEDICARE.

Part A covers the costs of hospital inpatient stays, skilled nursing facility care after a hospital stay, hospice care, and some home health services. It does not cover outpatient doctor visits, prescription drugs, or routine preventive care — those are covered by Part B and Part D. Part A does have a deductible and copayments that you pay out of pocket.

Special situations: working past 65 and coverage outside the United States

If you are still working and have health insurance through your employer or union, you may not need to sign up for Part A right away. However, the rules are different depending on the size of your employer. If your employer has 20 or more employees, your employer's health plan is primary and Medicare is secondary. You can delay enrolling in Part A without penalty as long as you have this coverage and are still working.

If your employer has fewer than 20 employees, Medicare is primary. In this case, you should enroll in Part A during your initial enrollment period to avoid the late penalty, even if you do not use it right away.

If you are living or working outside the United States when you turn 65, you can still sign up for Part A online or by phone. Part A does not cover care received outside the United States, with rare exceptions for emergency care in Canada or Mexico. If you are living abroad and do not think you will need Part A coverage, you can delay enrollment, but you will need to show that you had creditable coverage to avoid the penalty when you return.

Frequently Asked Questions

Can I sign up for Part A before I turn 65?

Yes. You can start the enrollment process three months before your 65th birthday. Your coverage will begin on the first day of the month you turn 65, regardless of when during those three months you enroll. If you are already receiving Social Security benefits, you will be enrolled automatically.

What if I am still working at 65 and have employer health insurance?

If your employer has 20 or more employees, you can delay Part A enrollment without penalty as long as you are working and covered by the employer plan. If your employer has fewer than 20 employees, you should enroll in Part A during your initial enrollment period to avoid a permanent penalty, even if you do not use it right away.

How much does Part A cost?

Part A is free for most people who paid Medicare taxes for at least 10 years while working. If you do not have 10 years of Medicare tax history, you will pay a monthly premium that varies based on how many quarters of coverage you have. The exact amount changes each year.

What is the penalty for signing up late?

If you miss your initial enrollment period, you pay a permanent 10 percent penalty on your Part A premium for each full 12-month period you were may be able to access but not enrolled. This penalty stays with you for life. The only exception is if you had creditable employer coverage while working past 65.

Will I be automatically enrolled in Part A?

You will be automatically enrolled if you have been receiving Social Security retirement benefits, Social Security disability benefits, or Railroad Retirement Board benefits for at least four months before you turn 65. If you are not receiving these benefits, you will need to sign up yourself during your seven-month initial enrollment period.