Medicare starts at 65, but you have to sign up

You do not get Medicare automatically when you turn 65. You must enroll during a specific window, or you will face late penalties that last for life. Most people sign up during their Initial Enrollment Period, which runs for seven months: three months before the month you turn 65, the month itself, and three months after.

If you are already getting Social Security benefits when you turn 65, Medicare will enroll you automatically in Parts A and B. You will receive your Medicare card in the mail about two weeks before your 65th birthday. If you are not yet taking Social Security, you must sign up for Medicare yourself, even if you do not plan to claim benefits yet.

The enrollment process is straightforward: you can sign up online at 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 legal residency, and information about your current health coverage if you have it.

Key Takeaways

  • You must enroll in Medicare during your Initial Enrollment Period — seven months centered on your 65th birthday — or face permanent penalties on your premiums.
  • If you are already receiving Social Security, Medicare will enroll you automatically in Parts A and B, but you still need to choose Part D coverage for prescriptions.
  • You can enroll online at Medicare.gov, by phone at 1-800-MEDICARE, or at your local Social Security office using your Social Security number and proof of citizenship.
  • Part A (hospital insurance) is usually free if you or your spouse paid Medicare taxes for at least 10 years; Part B (medical insurance) has a monthly premium that varies by income.
  • If you miss your Initial Enrollment Period, you can still sign up during the General Enrollment Period (January 1 to March 31 each year), but you will owe penalties.

What Medicare covers and what it costs

Part A covers hospital stays, skilled nursing care after hospitalization, hospice, and some home health services. There is no monthly premium for Part A if you or your spouse paid Medicare taxes for at least 10 years while working. If you do not meet that requirement, you can still purchase Part A, but the premium varies.

Part B covers doctor visits, outpatient care, medical equipment, and preventive services. Part B has a monthly premium that changes each year. In 2024, the standard premium is $174.70 per month, but higher-income beneficiaries pay more. You also pay a yearly deductible before Part B coverage begins, and you share the cost of most services after that.

Part D covers prescription drugs. It is optional, but if you do not enroll when you first become may be able to access and go without drug coverage, you will owe a penalty for every month you delay. Part D premiums and coverage vary by plan and by pharmacy, so comparing plans before you enroll saves money.

Part C, also called Medicare Advantage, is an alternative to Original Medicare (Parts A and B). It is offered by private insurance companies and usually includes Part D drug coverage. Part C plans often have lower out-of-pocket costs than Original Medicare, but they restrict you to a network of doctors and hospitals.

Signing up during your Initial Enrollment Period

Your Initial Enrollment Period is seven months long and is centered on your birth month. If you turn 65 in June, your period runs from March 1 through September 30. You can enroll at any point during this window without penalty, but the sooner you enroll, the sooner your coverage begins.

To enroll online, go to Medicare.gov, click "Sign Up for Medicare," and follow the prompts. You will need your Social Security number, date of birth, and citizenship information. The online process takes about 10 minutes. You can also call 1-800-MEDICARE and speak to a representative, or visit your local Social Security office in person.

When you enroll, you will choose whether to take Original Medicare (Parts A and B) or a Medicare Advantage plan (Part C). If you choose Original Medicare, you will also need to choose a Part D drug plan. If you choose Medicare Advantage, the plan usually includes drug coverage, but you should review the formulary to make sure your medications are covered.

After you enroll, your coverage begins on the first day of the month in which you sign up, or the first day of the following month if you enroll after the 15th. Your Medicare card will arrive in the mail within two weeks.

What to do if you miss your Initial Enrollment Period

If you do not enroll during your Initial Enrollment Period, you can still sign up during the General Enrollment Period, which runs from January 1 through March 31 each year. Coverage begins July 1 of that year. However, you will owe a late penalty on Part B and Part D for every month you delayed.

The Part B penalty is 10 percent of the standard premium for each full year you were late. If you were late by three years, you owe 30 percent more than the standard premium for the rest of your life. The Part D penalty works the same way: 1 percent of the national average premium for each month you were late.

There are a few exceptions. If you had creditable coverage (health insurance that is at least as good as Medicare) through an employer or union when you turned 65, you may not owe a penalty if you enroll within eight months of losing that coverage. You will need to provide proof of that coverage when you enroll.

If you are still working at 65 and are covered by your employer's health plan, you may be able to delay Part B without penalty. You must enroll in Part A, but you can wait to enroll in Part B until you retire or lose the employer coverage. Contact Medicare to confirm your situation before you turn 65.

Choosing between Original Medicare and Medicare Advantage

Original Medicare (Parts A and B) is the federal program run by the Centers for Medicare and Medicaid Services. You can see any doctor or hospital that accepts Medicare, and there are no network restrictions. You pay a deductible and coinsurance for most services, and you are responsible for any costs above what Medicare allows.

Medicare Advantage (Part C) is a private insurance alternative. You must use doctors and hospitals in the plan's network, except in emergencies. Most plans have lower out-of-pocket maximums than Original Medicare, but you may pay higher copays for individual services. Many plans include dental, vision, and hearing coverage, which Original Medicare does not.

The choice depends on your health, your doctors, and your budget. If you have a preferred doctor or specialist, check whether they accept Medicare or are in your local Medicare Advantage plans before you decide. If you have low income, you may be able to get help paying Part B and Part D premiums through the Medicare Savings Program or the Low-Income Subsidy program.

Getting help with costs if you have low income

If your income is below a certain level, you may be able to get help paying Medicare premiums and out-of-pocket costs. The Medicare Savings Program helps pay Part B and Part D premiums, deductibles, and coinsurance. The Low-Income Subsidy program helps pay Part D premiums and cost-sharing.

Income limits vary by state and change each year. In 2024, you may be able to get help if your monthly income is below about $1,550 (for an individual) or $2,080 (for a couple), but these amounts are higher in some states. To find out whether you may have access to, contact your state Medicaid office or call 1-800-MEDICARE.

You can also explore for these programs at the same time you enroll in Medicare, or at any time after you are enrolled. The process process is the same whether you explore online, by phone, or in person.

After you enroll: what happens next

Once you are enrolled, your Medicare card will arrive in the mail. Keep it with you when you see a doctor or go to the hospital. When you visit a provider, give them your Medicare number so they can bill Medicare for the service.

Review your coverage each year during the Annual Enrollment Period, which runs from October 15 through December 7. This is when you can switch from Original Medicare to Medicare Advantage, or vice versa. You can also change your Part D drug plan if your medications or costs have changed.

If your income changes, your life situation changes, or you move to a new state, you may be able to make changes outside the Annual Enrollment Period. Contact Medicare to find out whether you may have access to for a Special Enrollment Period.

Frequently Asked Questions

What if I am still working at 65 and have health insurance through my job?

You must enroll in Part A when you turn 65, but you can delay Part B without penalty if your employer has 20 or more employees. You have eight months after you retire or lose the employer coverage to enroll in Part B without owing a penalty. Contact Medicare before you turn 65 to confirm your situation.

Do I need to enroll in Part D if I do not take any medications?

You should enroll in Part D even if you do not currently take medications. If you go without drug coverage and later need prescriptions, you will owe a penalty for every month you were not enrolled. The penalty is 1 percent of the national average Part D premium per month and lasts for life.

Can I change my mind after I enroll in Medicare?

Yes. You can switch between Original Medicare and Medicare Advantage, or change your Part D plan, during the Annual Enrollment Period (October 15 to December 7). If you have a may have access to life event, such as moving or losing other coverage, you may be able to make changes at other times.

What if I am not a U.S. citizen?

You must be a U.S. citizen or a lawful permanent resident who has lived in the United States for at least five years to be may be able to access for Medicare. If you are a lawful permanent resident, you will need to provide proof of your status when you enroll.

How do I know if my doctor accepts Medicare?

You can search for doctors and hospitals on Medicare.gov using the "Care Provider Search" tool. You can also call your doctor's office directly and ask whether they accept Medicare. If you are considering a Medicare Advantage plan, ask whether your doctor is in that plan's network.