Medicare Options when Turning 65

Do I Have to Sign Up for Medicare at Age 65?

Age 65 is usually the right time to sign up for Medicare or confirm whether you can delay without a penalty. If you do not have group health plan coverage through your or your spouse’s current employer, signing up during your first Medicare enrollment window can help your coverage start on time, avoid gaps in coverage, and reduce the risk of late enrollment penalties.

If you do have group health plan coverage through a current employer, your next steps may be different. You may be able to delay Part B and sign up later during a Special Enrollment Period. Before you wait, ask your employer’s benefits administrator how your coverage works with Medicare.

Start looking at Medicare about three months before your 65th birthday month. This gives you time to apply for Original Medicare and compare other coverage options if you want more than Part A and Part B. for a railroad.

Begin with these steps:

1. Check if you can get Medicare. Review age, residency, and other eligibility rules. 
2. Decide if you need Part A, Part B, or both. Your current health coverage may affect this decision. 
3. Apply during your first enrollment window. This can help your coverage start on time. 
4. Compare other coverage options. Decide if you want more coverage than Original Medicare. 
5. Watch your timing. Missing the right enrollment window can lead to gaps in coverage or late enrollment penalties.

Can I Get Medicare at 65?

Yes. Most people can get Medicare at age 65. In general, you may be eligible if you are 65 or older and meet U.S. citizenship or residency rules.

Lawful permanent residents generally must have lived in the U.S. continuously for at least  five years before the month they apply for Medicare.

Many people get Part A with no monthly premium if they or their spouse paid Medicare taxes for at least 10 years. If you do not qualify for premium-free Part A, you may still be able to buy Part A.

When Is My First Sign-Up Window?

Your first sign-up window is called your Initial Enrollment Period, or IEP. It lasts seven months, and it:

• Starts three months before your birthday month.
• Includes your birthday month.
• Ends three months after your birthday month.

Applying during this time can help your coverage start on time and may help you avoid late penalties.

Some people do not enroll during this time because of employer coverage or other reasons. They may still be able to sign up later without a penalty if they qualify for a Special Enrollment Period.

When Should I Start the Sign-Up Process?

Many people start about three months before their 65th birthday month. This gives you time to apply for Original Medicare and choose any extra coverage you want.

If you are not enrolled automatically, you can apply for Medicare through Social Security, including online at SSA.gov.

Starting early can help your coverage begin on time. Coverage starts only after Medicare accepts your application. In many cases, if you apply during the three months before your birthday month, coverage can start on the first day of your birthday month. If your birthday is on the first day of a month, coverage can start on the first day of the month before.

What Coverage Options Can I Choose After Original Medicare?

Original Medicare is a good start, but it does not cover everything. You may still have out-of-pocket costs for doctor visits and hospital stays. Original Medicare also does not cover most outpatient prescription drugs and does not set a yearly cap on what you pay out of pocket. Many people choose extra coverage for these reasons.

Here are the main choices:

• Medicare Advantage (Part C): A Medicare Advantage plan is an all-in-one alternative to Original Medicare from a private company approved by Medicare. These plans cover Part A and Part B and usually include prescription drug coverage. Some plans also include extra benefits like routine dental, vision, and hearing care.

• Medicare Supplement (Medigap): Medigap is extra insurance you can buy from a private company. It helps pay your share of costs that Original Medicare does not fully cover, like copayments, coinsurance, and deductibles.

• Medicare drug plan (Part D): A Part D plan helps cover the cost of prescription drugs. You can get drug coverage through a standalone drug plan or through many Medicare Advantage plans.

If you want Medigap, your federal six-month open enrollment period starts when you are 65 or older and have Part B. During that time, insurers generally cannot use your health history to deny you a Medigap policy.

Learn more about Medicare eligibility and enrollment 

Learn more about Medicare 

Can I Delay Medicare If I'm Still Working?

Yes, you may be able to delay Medicare Part B if you have group health plan coverage through your or your spouse's current employer. If you qualify, you can usually sign up later during a Special Enrollment Period without a Part B late enrollment penalty.

Many people still sign up for Part A at 65 if they qualify for premium-free Part A. If you have a Health Savings Account, or HSA, check with your employer or tax advisor before signing up for any part of Medicare.

Who Should Enroll or Wait at 65?

Your next step may depend on employer size and your type of coverage:

• 20 or more employees: You may be able to delay Part B without a penalty while you have current job-based group health coverage.

• Fewer than 20 employees: Medicare may pay first, so signing up for Medicare at 65 may be important.

Before you decide, check with your employer's benefits administrator so you know how your job-based coverage and Medicare work together. COBRA, retiree coverage, and Marketplace plans work differently from coverage from a current job. If you have one of these types of coverage, do not guess. Check whether you need Part B at 65, whether your drug coverage is creditable, and whether signing up for Medicare could change or end your current benefits.

Will I Pay a Late Penalty If I Wait Too Long?

Yes, you may have to pay a late enrollment penalty if you miss your first sign-up window and do not qualify for a Special Enrollment Period or another exception. Different parts of Medicare have different penalty rules.

• Part A: A penalty may apply only if you have to buy Part A and wait to apply.

• Part B: Your premium usually goes up 10% for each full 12-month period you could have had Part B but did not apply.

• Part D: A penalty may apply if you go 63 days or more without drug coverage Medicare counts as creditable.

You may be able to avoid these penalties if you qualify for a Special Enrollment Period, or SEP. An SEP is extra time to sign up for Medicare after certain life events. For example, if you have health insurance from a current job, you may be able to apply later without a penalty after that job or coverage ends.

Learn more about Medicare eligibility and enrollment 

Learn more about Medicare