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Does Medicare Automatically Start at Age 65?

Published March 1, 2023

For some, approaching their mid-sixties means they're close to starting their much-anticipated retirement, but for others, it means finally getting access to Medicare. This can be the case if you’re approaching 65 and your existing health insurance is either not robust enough or too expensive. Today, Medicare covers 65 million people — nearly 20% of the U.S. population.

As age 65 approaches, you may ask: Do you automatically get Medicare when you turn 65? In some cases, enrollment in Medicare’s Part A (Hospital Insurance) and Part B (Medical Insurance) will be automatic, but not in all cases. And since penalties result from not being enrolled promptly, you’ll want to know your situation in advance.

What Are the Cases When Medicare Automatically Starts?

Social Security becomes available at age 62 to those who have worked long enough to qualify. Your benefits will be larger the longer you wait to claim your benefits, so many don’t claim them right away. By age 64, about 44% of women and 39% of men will have claimed their Social Security benefits, and by age 65, the figures will be 54% and 49%, respectively.

So, do you automatically get Medicare with Social Security? Only if you’ve received Social Security or Railroad Retirement benefits for at least four months before your 65th birthday will Medicare enroll you automatically, and your coverage will start the month you turn 65. Based on the percentages above, this is the case for about half of Medicare enrollees.

For those wondering: how old do you have to be to get Medicare? — the short answer is typically 65 years old. But Medicare is also accessible before age 65, and enrollment will be automatic in the following circumstances:

  • You have a disability and have received Social Security Disability Insurance (SDI) benefits for 24 months
  • You have end-stage renal disease (ESRD) and either started dialysis or had a kidney transplant at least three months ago
  • You receive SSDI benefits because you have amyotrophic lateral sclerosis (ASL or Lou Gehrig’s Disease)

To qualify for Medicare, you must also be a U.S. citizen or have been a legal U.S. resident for at least five years.

Do I Need to Apply For Medicare?

You don’t have to apply for Medicare if you meet the abovementioned criteria. Three months before your 65th birthday, you’ll automatically be enrolled in premium-free Medicare Part A and Part B, then receive an enrollment package with your Medicare card.

But do you have to get Medicare at 65? Ultimately, it’s up to you. Medicare Part A is premium-free for those who have worked a minimum of 40 quarters — or a total of 10 years — but you will pay a premium for Medicare Part B, so you may decide to turn down Part B coverage. Regardless, you’ll have to notify Medicare of your decision. If you live in Puerto Rico or a foreign country, you won’t get Part B automatically; you’ll have to sign up for it.

However, if you do have to apply, the Department of Health and Human Services (HHS) recommends signing up when you are first eligible, which is within the three months leading up to your 65th birthday. This will ensure you won’t have a coverage gap or face any late enrollment penalties.

Here are some ways to sign up:

  • Online at the Social Security website, you’ll have to create your “my Social Security” account to sign up for Medicare or apply for benefits
  • Call Social Security at (800) 772-1213, or call (800) 325-0778 if you’re a TTY user
  • Contact your local Social Security office
  • Call the Railroad Retirement Board at (877) 772-5772 if you or your spouse worked for a railroad

If you prefer more assistance, you can call OpenMedicare at (844) 910-2061 directly to be connected with a licensed agent who can help you through the enrollment process.

People often have questions about Medicare Part A (Hospital Insurance), including: is Medicare Part A automatic at age 65? If Part A is premium-free for you because you or your spouse worked long enough, it makes sense to accept it if it comes automatically or to sign up for it at 65, regardless of whether you have health insurance through an employer. It can sit quietly in the background until you lose your employer insurance.

Medicare Enrollment Periods

With Medicare, coverage always starts on the first of the month, but which month it goes into effect depends on when you sign up. You have several Medicare enrollment periods available to you.

Initial Enrollment Period

The first enrollment period — also known as your Initial Enrollment Period (IEP) — includes the three months before your 65th birthday, the month of your birth, and the three months after your birth month. If you enroll at any time during the first three months, coverage will start on the 1st day of your birthday month, but coverage will be delayed if you wait until your birth month or after. An exception to this occurs when your birthday falls on the first day of a month. If your birthday is August 1, your “birth month” will fall on July instead of August. Three months before and after the month of your birth means your IEP runs from April through October, and your Medicare coverage begins July 1 instead of August 1.

Medicare Supplement Open Enrollment Period

If you’re covered by Medicare Part A and Part B, your Part B coverage pays 80% of covered medical costs after you meet the annual deductible. You’re responsible for the remaining 20%. You may add an optional, private Medicare Supplement Insurance (Medigap) plan to help pay for some or all of the gaps in the coverage. Once you’re 65 and are enrolled in Part B for the first time, you have a six-month period known as the Medicare Supplement Open Enrollment Period to buy any Medigap policy without medical underwriting by the issuing private insurance company. After that, your application may result in higher premiums or be turned down for health reasons.

Annual Enrollment Period

The Annual Enrollment Period is also commonly referred to as the Medicare Open Enrollment or the Medicare Annual Election Period. It runs from October 15 through December 7 annually. During this window, you can:

  • Sign up for or change Medicare Part D prescription drug coverage
  • Change an existing Medicare Advantage plan
  • Switch from Original Medicare to Medicare Advantage

The new coverage begins January 1 of the following year.

Special Enrollment Period

If you’re 65 and have creditable medical benefits through your employer or your spouse’s job, you may be able to delay signing up for Medicare without facing a penalty. Check with your insurer or HR department to be sure your coverage is creditable. The sponsoring employer must have at least 20 employees, but retiree and COBRA health plans do not qualify. If your coverage qualifies, you’ll be eligible for a Special Enrollment Period (SEP) that gives you eight months after coverage ends to enroll in Part A and Part B without any penalty. You may also be eligible as a result of specific life events.

General Enrollment Period

Suppose you didn’t apply for Medicare during your IEP and don’t qualify for a SEP. In that case, the Medicare application window opens again at the start of each year, from January 1 through March 31, during the General Enrollment Period (GEP). Your coverage starts the month after you sign up. Because you missed your IEP, you may have to pay a higher Part B monthly premium for late enrollment unless you qualify for a SEP. The same holds for Part A if you don’t receive it premium-free.

Medicare Advantage Open Enrollment Period

Suppose you’re already enrolled in Medicare Advantage. In that case, during the Medicare Advantage Open Enrollment Period, from January 1 through March 31 each year, you can:

  • Switch to another Medicare Advantage plan with or without drug coverage one time
  • Join a Medicare Part D prescription drug plan
  • Drop your Medicare Advantage Plan and return to Original Medicare

Your new coverage is effective the first of the month after the plan receives your request.

What Happens After I Apply?

After you apply for Medicare, the Centers for Medicare & Medicaid Services (CMS) will mail you a “Welcome to Medicare” complete enrollment package about 30 days after your application is approved. It will include a letter, your Medicare card, and a booklet explaining the decisions you’ll need to make before your coverage begins.

If you’re automatically enrolled in Medicare, you should receive your package three months before your Medicare coverage starts, then a reminder letter one month before coverage. Because your enrollment was automatic, you can refuse Part A, Part B, or both — either because you have other creditable job-related coverage or private insurance, or simply don’t want it.

The Medicare card you receive with your welcome package three months before your 65th birthday can’t be used until the 1st of the month of your 65th birthday. Your card will include your Medicare number and coverage start date, indicating whether you have Medicare Part A (Hospital Insurance), Part B (Medical Insurance), or both.

If you don’t receive it, you can check its status on the Social Security website or contact your local Social Security office to ensure you’re enrolled.

When Does Medicare Not Automatically Start?

Medicare doesn’t start automatically if you haven’t received your Social Security or Railroad Retirement benefits at least four months before your 65th birthday. You’ll have to apply through one of the means listed above. If you need further assistance, Medicare enrollment is administered by the Social Security Administration — or the Railroad Retirement Board if that is who is providing your benefits.

How to Find the Right Medicare Plan for You

The options, coverages, deadlines, names, and rules around each type of Medicare plan can appear confusing. Fortunately, several resources are available to help you. However, to avoid the risk of going for months without coverage, you may not want to wait until right before your 65th birthday to start the process. Instead of just wondering, “what age can you get Medicare,” you’ll want to take action three months before your 65th birthday.

For additional government assistance, visit or call (800) 633-4227. You can also contact your local State Health Insurance Assistance Program (SHIP) for help with plans, coverages, and costs.

Still Have Questions?

For more detailed assistance, you can browse plans in your area on the OpenMedicare website. If you prefer, you can call OpenMedicare at (844) 910-2061 directly to be connected with a licensed agent who will help you find the ideal plan for you and get you enrolled comfortably within the various deadlines.

OpenMedicare is a non-government website operated by a licensed Medicare insurance agency. OpenMedicare is not affiliated with or connected with or any other government program or agency.

Any information we provide is limited to the plans we offer in your area, as we do not always offer every available plan. Please contact or 1–800–MEDICARE to get information on all of your options.

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