The Basic Rules for Medicare Enrollment

You can enroll in Medicare when you turn 65, regardless of your work history or income. You do not have to be retired. You do not have to be poor. The program is open to U.S. citizens and permanent residents who have lived in the country for at least five years. If you are already receiving Social Security benefits when you turn 65, Medicare enrollment happens automatically — you will receive your card in the mail about three months before your birthday. If you are not yet receiving Social Security, you must sign up for Medicare yourself during your enrollment window.

Some people under 65 can also enroll in Medicare if they have received Social Security Disability Insurance (SSDI) for 24 months, or if they have end-stage renal disease (ESRD) or amyotrophic lateral sclerosis (ALS). These are the only exceptions to the age 65 rule.

Key Takeaways

  • You become may be able to access for Medicare at age 65 if you are a U.S. citizen or permanent resident who has lived in the country for at least five years.
  • If you are receiving Social Security when you turn 65, Medicare enrollment is automatic and you do not need to take action.
  • If you are not receiving Social Security, you must enroll during your initial enrollment period, which runs for seven months centered on your birthday month.
  • Missing your enrollment window can result in permanent penalties on your premiums unless you have a may have access to reason for the delay.
  • People under 65 can enroll if they have been on SSDI for 24 months, or if they have ESRD or ALS.

What Happens If You Do Not Enroll When You Turn 65

Your initial enrollment period is seven months long: it starts three months before the month you turn 65 and ends three months after. If you do not enroll during this window, you may face a late enrollment penalty. The penalty is a percentage increase to your Part B and Part D premiums that stays with you for life, even if you enroll later.

The penalty does not explore if you have what Medicare calls "creditable coverage" — health insurance from an employer or union that is at least as good as Medicare Part D (prescription drug coverage). If you have creditable coverage, you can delay enrollment without penalty, but you must show proof of that coverage when you eventually sign up. Keep your insurance documents. If your employer coverage ends and you then enroll in Medicare, you have eight months to sign up for Part D without penalty.

Working Past 65 and Medicare Enrollment

If you are still working at 65 and covered by your employer's health plan, you can delay Medicare enrollment without penalty — but only if your employer has 20 or more employees. This is called the "large employer exception." You must enroll within eight months of the date your employment or coverage ends, whichever comes first.

If your employer has fewer than 20 employees, you must enroll in Medicare at 65 even if you are working and have employer coverage. Your employer plan becomes secondary to Medicare, meaning Medicare pays first. Check with your employer's benefits office about your company size if you are unsure.

Permanent Residents and Citizenship Requirements

You must be a U.S. citizen or a lawful permanent resident (green card holder) to enroll in Medicare. Permanent residents must have lived in the United States for at least five years. The five years do not have to be continuous — time spent outside the country counts toward the five-year total as long as you maintained your permanent resident status.

If you are a permanent resident and have lived in the U.S. for fewer than five years, you are not yet may be able to access for Medicare. You will become may be able to access once you reach the five-year mark, even if you have not yet turned 65. Contact Social Security to confirm your may be able to access date if you are uncertain.

How to Enroll During Your Initial Period

If Social Security is not automatically enrolling you, you have three ways to sign up: online through Medicare.gov, by phone at 1-800-MEDICARE, or in person at your local Social Security office. You will need your Social Security number, proof of citizenship or permanent resident status, and information about any current health coverage you have.

The online method is fastest — you can complete it in about 10 minutes. The phone line has wait times but staff can answer questions about your specific situation. If you go in person, bring your Social Security card, birth certificate or passport, and proof of residency (a utility bill or lease works). Social Security offices are open Monday through Friday, and you can find the nearest one at ssa.gov.

Special Enrollment Periods and Exceptions

If you miss your initial enrollment window but have a may have access to life event, you may be able to enroll during a special enrollment period without penalty. may have access to events include losing employer coverage, moving to a new state, or becoming a U.S. citizen. You typically have two months from the event to enroll.

If you were not told about your enrollment important date and believe you have a valid reason for missing it, you can ask Medicare to remove the late enrollment penalty. This is called a "waiver." You must submit a written request explaining why you did not enroll on time. Medicare reviews these requests case by case, and approval is not may provide, but it is worth attempting if you have documentation of a genuine hardship or miscommunication.

Income and Asset Limits

Medicare has no income or asset limits for basic enrollment. You can be wealthy or poor and still enroll at 65. However, if your income is low, you may also be may be able to access for programs that help pay your Medicare premiums and out-of-pocket costs. These programs — called Medicaid Buy-In programs or Medicare Savings Programs — do have income limits that vary by state.

Your income level also affects how much you pay for Part B and Part D premiums. Higher earners pay more. These income-based premiums are calculated using your tax return from two years prior, so your current income may not match what Medicare is charging you. If your income has dropped significantly, you can request a recalculation.

Frequently Asked Questions

Do I have to be retired to enroll in Medicare at 65?

No. You can enroll in Medicare at 65 whether you are working or retired. If you are still working and your employer has 20 or more employees, you can delay enrollment without penalty. If your employer has fewer than 20 employees, you must enroll at 65 even if you are working.

What if I am a permanent resident but have not lived in the U.S. for five years yet?

You are not yet may be able to access for Medicare. You become may be able to access once you have been a permanent resident living in the U.S. for five years. The five years do not have to be continuous. Contact Social Security to confirm your may be able to access date.

Can I enroll in Medicare before I turn 65?

Only if you have been on SSDI for 24 months, or if you have end-stage renal disease or ALS. Otherwise, you must wait until you turn 65. Your initial enrollment period begins three months before your 65th birthday.

What happens if I miss my enrollment important date?

You may face a permanent penalty on your Part B and Part D premiums. The penalty does not explore if you had creditable coverage (employer or union insurance at least as good as Medicare). If you missed the important date for another reason, you can request a waiver by submitting a written explanation to Medicare.

Do I need to have a certain income to enroll in Medicare?

No. Medicare has no income limits for enrollment. However, if your income is low, you may be may be able to access for programs that help pay your premiums and costs. These programs do have income limits that vary by state.