Medicare eligibility typically begins at age 65, which is the standard age to qualify for this U.S. federal health insurance program. Medicare is a U.S. federal health insurance program specifically for people 65 and older as well as those under 65 who have received Social Security disability insurance income for 24 months. This means if you’re asking “How old to get Medicare?” the general answer is 65, but the answer to “Can I get Medicare under age 65?” is yes—if you qualify through disability or certain conditions like ALS or end-stage renal disease ESRD. Understanding these age and disability-related qualifications is key to knowing when you can enroll in Medicare.
What is Original Medicare?
Original Medicare consists of two parts: Part A hospital insurance, which covers inpatient and hospital services, and Part B medical insurance, which covers outpatient and physician services. Together, Medicare Part A hospital insurance and Part B medical insurance are referred to as Original Medicare. These are two of the main Medicare parts, and understanding the different Medicare parts is important for making informed enrollment and coverage decisions. Enrollment in Medicare is through the Social Security office or online at ssa.gov. However, there is no relationship between your social security retirement benefits and your Medicare. Social security benefits are a separate decision.
From this article, you will learn who qualifies for Original Medicare, when, and what healthcare insurance options you have if you are 65 and still working. This section will also help you understand how Medicare works in terms of eligibility, enrollment, and coverage.
Medigap Seminars Insurance Agency Reviews.
What Qualifies Me To Get Medicare Coverage?
For most people, this federal health plan insurance coverage starts no earlier than the month turn 65. Medicare coverage starts the first day of the month you turn 65. If your birthday falls on the first day of the month, then your coverage starts the first day of the month prior to turning 65. To be eligible for Medicare at age 65 you must:
Be a U.S. citizen or have been a legal U.S. resident for at least five years.
Either you or your spouse has paid Medicare taxes for at least 40-quarters during your lifetime.
If you haven’t paid Medicare taxes for the required time of at least 40 quarters, you may not qualify for Part A premium-free insurance. You might, however, be able to purchase this coverage. The amount you will need to pay in monthly premiums will depend on how long you have been paying Medicare payroll taxes.
These are the requirements for becoming eligible for Medicare by aging into Medicare, but there are situations when you may be eligible for Medicare prior to age 65. This includes:
you have been enrolled for Social Security disability benefits for at least twenty-four consecutive months;
you benefit from a disability pension from the railroad retirement board benefits and meet some special conditions;
you suffer from permanent kidney failure (ESRD), and your condition requires regular dialysis or a kidney transplant, under the assumption that you or your spouse have paid Social Security taxes for a required period;
you have Lou Gehrig’s disease, which has special eligibility rules allowing you to qualify for Medicare immediately upon diagnosis.
Some people can qualify for Medicare earlier than age 65 due to disability, ESRD, or Lou Gehrig’s disease.
If you find yourself in any of those situations, you should contact your local Social Security office or an insurance agent to talk about your options and the steps you need to take.
Losing Medicaid coverage can also trigger a special enrollment period for Medicare.
Disability Benefits: Qualifying for Medicare Before 65
If you’re under 65 and receiving disability benefits, you may be eligible for coverage before reaching the traditional age threshold. Individuals who receive disability benefits from Social Security or the Railroad Retirement Board for at least 24 consecutive months are automatically enrolled in Medicare. This includes people with End-Stage Renal Disease (ESRD), also known as permanent kidney failure, and those diagnosed with Amyotrophic Lateral Sclerosis (ALS), commonly called Lou Gehrig’s disease.
Your Initial Enrollment Period (IEP) for Medicare begins three months before your 25th month of receiving disability benefits and ends three months after. During this time, you can sign up for Medicare to ensure your coverage begins as soon as you’re eligible. If you miss your IEP, you can enroll during the General Enrollment Period (GEP), which runs from January 1 to March 31 each year, or during a Special Enrollment Period (SEP) if you experience a qualifying life event, such as losing other health coverage.
Whether you qualify due to social security disability benefits from Social Security, the Railroad Retirement Board, or because of a diagnosis like end stage renal disease or ALS, it’s important to understand your enrollment options and deadlines to avoid gaps in coverage. If you have questions about your eligibility or the enrollment process, contact Social Security or your local Social Security office for guidance.
Is It Mandatory to Sign Up for Medicare at Age 65?
It’s not mandatory to sign up for Medicare, as automatic enrollment may apply in certain situations lthough there are financial penalties for not enrolling in Medicare when you are supposed to.
Those who are eligible for premium free Part A and are receiving Social Security income for at least four months prior to the month they turn 65 will be automatically enrolled in Medicare, the federal health insurance program. This process is known as automatic enrollment. In your welcome kit, you will have instructions for opting out of Medicare Part B, if you so choose. If you are not automatically enrolled, you must actively enroll in Medicare during your enrollment period. You may need to sign up for Part A and/or Part B if you are not automatically enrolled.
You should receive instructions on how to enroll in Medicare at least three months prior to your 65th birthday month.
What If You Haven’t Retired at the Age of 65?
For those still working past the age of 65, the standard enrollment procedure may not apply. Usually, there are three routes one can take when choosing insurance coverage, provided their company has more than 19 employees and offers employer health plans.
The first option would be to stay on the employer’s health plan and delay enrolling for Medicare. If you are considering this option, please compare the cost and benefits of Medicare compared to the employer plan. When comparing Original Medicare, it is important to check if your healthcare providers accept Medicare, as this affects your coverage and flexibility. In the overwhelming majority of cases, Medicare plus a supplement is better health insurance coverage at a lower cost.
The second scenario includes resignation from the group health plan coverage and enrollment for coverage. You can also add a Medicare supplement to enhance your health plan insurance and cap your annual out-of-pocket costs.
The third route some choose is to stay on the employer’s health plan insurance and enroll for Medicare at the same time. Doing this will render your Medicare to secondary insurance. That means the employer plan will control your health coverage. While enrolling in Medicare Part A can be useful because it you do not pay a premium for Part A, enrolling in Part B while keeping your employer coverage is not advisable. Please see my video on Medicare Explained for more information on this topic.
My advice is that a person should never enroll in Medicare Part B until and unless you are prepared for Medicare to be your primary health coverage. Enrolling in Medicare as secondary coverage can paint yourself into a corner and reduce your options when you choose to move to Medicare as primary coverage.
The two crucial points to keep in mind are:
When you or your spouse benefit both from group health coverage and Medicare coverage, and your company has more than twenty employees, the employer group insurance is considered to be your primary insurance;
If your company hires less than twenty employees, you must enroll in Medicare or you will be penalized. Your Medicare will be your primary insurance. You will not need your employer insurance because you can improve your Medicare with a supplement.
Small Employer Rules
If you your employer has fewer than 20-employees and you don’t sign up for Medicare during your initial enrollment period, you will be at risk of coverage gaps, as well as late enrollment penalties. In addition, even if you worked with a large employer, cobra coverage is not considered creditable and cannot be used as a substitute for Medicare.
What Is the Earliest Age for Medicare?
The earliest you can receive Medicare benefits is at the age of 65, even if you retire early. You may be able to receive Social Security retirement benefits if you retire before turning 65, but this does not entitle you to benefit from Medicare.
However, some individuals may qualify for Medicare earlier than age 65 if they have a disability, End-Stage Renal Disease (ESRD), or Amyotrophic Lateral Sclerosis (ALS).
In a situation when you start your retirement earlier, you can purchase insurance coverage on your own until you’re eligible for Medicare.
The Exception to the Rule
The only exception to this rule applies to people with disabilities who receive Social Security disability income for at least 24-months. They will automatically be enrolled in Original Medicare on their 25th consecutive month of disability income.
How Soon Before My 65th Birthday Should I Apply for Medicare?
Your Initial Enrollment Period starts three months before your 65th birthday and ends three months after the month in which you turned 65. This is the time during which you can enroll for Medicare Part A and Part B as well as Part D prescription drug coverage. You should expect your Medicare card about 30-days after you enroll.
You can enroll online at the Social Security website. This article and video walk you through the process of enrolling in Medicare.
It’s worth mentioning that people who are enrolled automatically don’t have to go through any additional enrollment process. However, if you are not automatically enrolled, you must actively enroll in Medicare during your Initial Enrollment Period to ensure you receive coverage. Still, because Medicare Part B coverage requires paying monthly premiums, you will have the chance to opt-out from health insurance.
Coverage Start Date: When Does Medicare Begin?
The date your Medicare coverage begins depends on how and when you enroll. If you are automatically enrolled in Medicare—such as when you’re already receiving Social Security benefits—your coverage starts on the first day of the month you turn 65. For those who sign up during their Initial Enrollment Period, coverage typically begins on the first day of the month after you enroll.
If you miss your Initial Enrollment Period and enroll during the General Enrollment Period (January 1 to March 31), your Medicare coverage will begin on July 1 of that year. In certain situations, you may qualify for retroactive coverage, which can start up to six months before your application date, especially if you delayed enrollment due to specific circumstances.
Understanding when your coverage begins is crucial to avoid any gaps in your health plan insurance. Be sure to review your enrollment period and sign up for Medicare at the right time to ensure your coverage starts when you need it.
What Are My Other Options?
Because not everyone can afford Medicare, each state has options available to low income individuals that provide quality healthcare at no or a very low cost. This program is called Medicaid in most states, Medi-Cal in California.
If you lose Medicaid coverage, you may become eligible for a special enrollment period to sign up for Medicare.
What is Medicaid?
Medicaid is a combination of federal and state assistance program for people who need financial aid to fund their health insurance. Through it, people are able to reduce their health insurance premiums to zero or pay just a small co-payment for various medical services.
Whether or not you are eligible for Medicaid will depend on the state you live in. You must be a U.S. citizen or have sufficient immigration status to be able to participate in the program. You can find all the essential information regarding Medicaid and if you qualify for Medicaid services by contacting your state Department of Insurance.
When Should I Sign Up for Medicare?
There are several ways through which you can enroll for Medicare. The most optimal situation is when you sign up for the insurance as soon as you are eligible for it unless you wish to stay on your employer’s health plan.
You need to sign up for Part A and/or Part B during your Enrollment Period unless you are automatically enrolled.
The most favorable time to enroll for Medicare is during your Initial Enrollment Period
What is My Initial Enrollment Period
As we mentioned in this article, the Enrollment Period lasts seven months. Part A can start no earlier than the month you turn 65. If you enroll after turning 65, Part A coverage will start retroactively, either 6-months prior to your enrollment application of the date of your initial enrollment, whichever is sooner.
General Enrollment Period
If for whatever reason, you didn’t enroll during your Enrollment Period and did not have creditable coverage, you can enroll during the General Enrollment Period. This window of time spreads from January 1 to March 31 each year.
Starting in 2023 your Medicare the first day of the following month after you enroll. This means if you sign up in January, your Medicare will start in February 01.
It’s significant to mention that you might be forced to pay a monthly late enrollment penalty, which is why if you’re planning to enroll for this insurance it makes the most sense to sign up for Medicare as soon as you’re eligible.
What is a Special Enrollment Period
Special Enrollment Period is for those individuals who either:
are working past the Medicare enrollment period and you or your spouse have creditable coverage;
or are within their eight-month period after losing creditable employer coverage.
Special Enrollment Periods may also be available if you experience issues with employer or group health plans, such as misrepresentation or administrative errors.
In the case of the last situation, the eight-month period starts when an individual stops working, whether they choose COBRA or another insurance plan or not.
In those instances, you can apply for Medicare Part A and B at any time.
You can’t enroll within this period:
Once your other insurance plan, for example, COBRA, ends. You have to enroll within the eight-month period after you’ve stopped working. Otherwise, you will be forced to enroll within the next General Enrollment Period.
When you have or lose your Marketplace coverage.
When you suffer from End-Stage Renal Disease (ESRD).
Medicare Advantage Plans Explained
For some people, a Medicare Advantage plan may be a better option than Original Medicare.
A Medicare Advantage Plan replaces your Original Medicare Part A and Part B with a similar coverage administered by a private insurance company.
If you want to learn more about how to sign up and switch Medicare Advantage plans please see my Medicare Advantage Plans Explained article and video.
Premium-Free Part A: Who Qualifies and What Does It Cover?
Many people qualify for premium-free Part A, which is Medicare’s hospital insurance, if they or their spouse have worked and paid Medicare taxes for at least 10 years (40 quarters). You’re also eligible if you’re 65 or older and have received Social Security benefits for at least four months before turning 65. Premium-free Part A covers hospital insurance, including inpatient hospital stays, skilled nursing facility care, hospice care, and some home health services.
It’s important to note that while Part A may be premium-free, it does not include medical insurance for outpatient care or doctor visits—that’s covered under Part B, which usually requires a monthly premium. You can sign up for Medicare and premium-free Part A during your Initial Enrollment Period or any time after you become eligible. If you haven’t paid enough Medicare taxes, you may still be able to purchase Part A by paying a monthly premium.
Be sure to review your work history and Social Security benefits to determine if you qualify for premium-free Part A, and sign up for Medicare during your enrollment period to maximize your hospital insurance benefits.
Costs and Budgeting: What Will You Pay for Medicare?
Understanding the costs associated with Medicare is essential for effective budgeting and planning. While most people receive premium-free Part A, Medicare Part B—which covers medical insurance like doctor visits and outpatient care—requires a monthly premium. In 2022, Part B premiums range from $148 to $504 per month, depending on your income. You may also be responsible for deductibles, copays, and coinsurance for certain services.
If you choose a Medicare Advantage plan or add Part D prescription drug coverage, there may be additional monthly premiums and out-of-pocket costs. Medicare Advantage plans often bundle hospital, medical, and drug coverage, but costs and coverage details can vary by plan and provider.
When selecting your Medicare plan coverage, consider your health needs, lifestyle, and budget. It’s a good idea to explore options like a Health Savings Account (HSA) to help cover out-of-pocket expenses. Comparing different Medicare Advantage plans and drug coverage options can also help you find the best fit for your needs and financial situation.
Medicare Resources: Where to Get Help and More Information
Navigating Medicare can be complex, but there are many resources available to help you make informed decisions about your health plan insurance. The official government website, Medicare.gov, offers comprehensive information on Medicare eligibility, enrollment periods, and coverage options. You can also contact the Social Security Administration (SSA) or visit your local Social Security office for assistance with enrollment and questions about your benefits.
For those considering Medicare Advantage plans, the Medicare Advantage plan finder tool on Medicare.gov can help you compare plans in your area. If you are interested in Medigap or Medicare supplement plans, learn more about how to research a Medicare supplement insurance company to make informed decisions. Additional support is available through the State Health Insurance Assistance Program (SHIP), which provides free, unbiased counseling on Medicare-related issues, and the Medicare Rights Center, a non-profit organization dedicated to helping Medicare beneficiaries.
For more information on federal health insurance programs, visit official government websites such as SSA.gov and USA.gov. These secure websites offer up-to-date details on Medicare eligibility, coverage, and enrollment, ensuring you have the resources you need to make the best choices for your health coverage.
Final Thoughts
Getting your health insurance in order is incredibly important. Medicare starts to cover from the age of 65, leading many to wonder how old do you have to be to get a medicare plan so if your birthday is approaching it is a good time to start researching your options.
If you want to educate yourself more on the topics regarding Medicare, its costs, and benefits, we invite you to check our Medicare-related materials. We will gladly assist you in selecting the right solutions for your needs. Contact us to receive the answers to your questions.
Don’t wait up with signing up for health coverage. Do it as soon as possible and enjoy the benefits at the earliest time.
Frequently Asked Questions (FAQ)
Most people become eligible for Medicare at age 65, often in conjunction with their social security benefits . However, individuals under 65 who have received Social Security disability benefits for at least 24 months, or those with certain conditions like End-Stage Renal Disease (ESRD) or Amyotrophic Lateral Sclerosis (ALS), may qualify earlier.
It is not mandatory to sign up for Medicare at age 65, but if you do not enroll when eligible, you may face late enrollment penalties. Some individuals are automatically enrolled if they are receiving Social Security benefits prior to turning 65.
Yes, if you have health coverage through your employer and the company has 20 or more employees, you may delay enrolling in Medicare without penalty. You can sign up during a Special Enrollment Period after your employment or group health coverage ends.
The Initial Enrollment Period is a 7-month window that starts three months before your 65th birthday month and ends three months after. This is the time to sign up for Medicare Parts A and B to avoid gaps in coverage or penalties.
If you miss your IEP, you can enroll during the General Enrollment Period from January 1 to March 31 each year. Coverage will begin July 1 of that year, but you may have to pay a late enrollment penalty.
Yes, individuals receiving Social Security disability insurance or Railroad Retirement Board disability benefits for 24 months are eligible for Medicare before age 65. Those with ESRD or ALS qualify immediately upon diagnosis or after specific waiting periods.
Medicare Part A provides hospital insurance including, inpatient hospital stays, skilled nursing facility care, hospice, and some home health services. For information about Durable Medical Equipment coverage under Medicare, see how Part B provides these benefits. Many people qualify for premium-free Medicare Part A based on their work history or their spouse’s.
While many people receive premium-free Part A, Medicare Part B requires monthly premiums. Additional costs may include deductibles, copayments, and coinsurance. Medicare Advantage and Part D plans may have separate premiums and out-of-pocket expenses.
You can sign up online at the Social Security Administration website, by phone, or in person at your local Social Security office. If you are automatically enrolled, you will receive your Medicare card before your coverage starts.
Losing Medicaid coverage may qualify you for a Special Enrollment Period to sign up for Medicare without penalty. It’s important to act promptly to maintain continuous health insurance coverage.
