Medicare is health insurance for people 65 or older. You may be eligible to get Medicare earlier if you have a disability, End-Stage Renal Disease (ESRD), or ALS (also called Lou Gehrig’s disease). 

Some people get Medicare automatically, others have to actively sign up -- it depends if you start getting retirement or disability benefits from Social Security before you turn 65. 

  • Before you turn 65:

    • If you apply to start getting retirement benefits from Social Security (or the Railroad Retirement Board) at least 4 months before you turn 65, you’ll automatically get Part A (Hospital Insurance) and Part B (Medical Insurance) when you turn 65.

    • You’ll still need to make important decisions about how you get your coverage, including adding drug coverage.

    If you want to get Medicare when you turn 65, but aren’t planning to take retirement benefits at that time, you’ll need to sign up for Medicare.

    After you turn 65:

    • You’ll have to contact Social Security when you’re ready to sign up for Medicare.

    • Depending on your work situation and if you have health coverage through your employer, you may want to wait to sign up for Medicare.

Which path is right for me?

Medicare is personal, and everyone’s journey is unique. Factors like your age, if you’re still working, and when you get retirement or disability benefits from Social Security, all impact when and how you sign up for Medicare. 

I’m getting Social Security benefits before 65

  • If you're going to get retirement or disability benefits from Social Security at least 4 months before you turn 65. You’ll get Medicare Part A (Hospital Insurance) and Part B (Medical Insurance) automatically when you turn 65. You’ll still need to make important decisions about your coverage, like whether you need to add drug coverage.

I’m getting Social Security benefits after 65

  • When you’re ready, you’ll have to contact Social Security to sign up for Medicare. Depending on whether you’re working and if you have health coverage through your employer, you might not want to sign up for Medicare as soon as you become eligible.

  • Get disability benefits

    • If you’re under 65 and getting disability benefits from Social Security, you get Medicare automatically after getting disability benefits for 24 months or when you turn 65 – whichever comes first. We’ll mail you a welcome package with your Medicare card 3 months before your Medicare coverage starts. Keep that timing in mind. 

    Are working past 65

    • If you (or your spouse) are still working when you turn 65, enrolling in Medicare works a little differently. Find out when you need to sign up. Then when you’re ready, you can follow the “Getting Social Security benefits after 65” path to get all the information you need. 

    Have End-Stage Renal Disease (ESRD) 

    • End-Stage Renal Disease (ESRD) is permanent kidney failure that requires a regular course of dialysis or a kidney transplant. 

    Have coverage from the Marketplace

    • You should generally sign up for Medicare when you’re first eligible (usually when you turn 65) to avoid a delay in Medicare coverage and the possibility of a Medicare late enrollment penalty. You don’t need to join the Marketplace if you have Medicare. The Marketplace doesn’t affect your Medicare choices or benefits.

    Have ALS (Lou Gehrig’s disease) 

    • You get Medicare automatically the same month that you start to get Social Security benefits. If you haven’t done it yet, your first step is to apply for disability benefits at Social Security. Then you can follow the “Getting Social Security benefits before 65” path to get all the information you need.

    Need a Special Enrollment Period (SEP)

    After you’re first eligible to sign up for Medicare, you may have other opportunities to enroll. Learning about these situations can help you avoid gaps in coverage and late enrollment penalties. 

    Have to pay for Part A

    If you don’t qualify for a premium-free Part A, you might be able to buy it. In 2023, the premium is either $278 or $506 each month, depending on how long you or your spouse worked and paid Medicare taxes. Who qualifies for Part A without paying a monthly premium?

  • You usually don't pay a monthly premium for Part A if you (or another qualifying person, like your current or former spouse) paid Medicare taxes while working for a certain amount of time. (If you're 65 or older, usually this is 10 years of work. If you get Medicare earlier than age 65, you won't pay a Part A premium.)

    If you qualify, you can sign up for Part A coverage starting 3 months before you turn 65 and any time after you turn 65. 
    Part A coverage starts up to 6 months back from when you sign up or apply to get benefits from Social Security (or the Railroad Retirement Board).

    If you’re not sure if you qualify, you can:
    ⦁    Log into (or create) your secure my Social Security account to find out if you paid Medicare taxes long enough. 
    ⦁     Ask your employer.

    If you or your spouse worked for a railroad, you can call the Railroad Retirement Board at 1-877-772-5772.

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