When Does Medicare Coverage Begin?

In this article...
  • Many people start getting Medicare benefits at age 65, either automatically or by enrolling. Some may get Medicare before they reach age 65, and some people may get Part A for free when they’re spouse reaches age 62. Learn more about the complex rules of Medicare.
Smiling grandfather plays with young grandson on couch at home

Age 65 is often synonymous with getting Social Security and Medicare benefits. But the age at which a person’s Medicare benefits begin can differ based on a number of circumstances. 

For most people, Medicare coverage begins on the first day of the month that you turn 65 years old. For example, if you turn 65 on July 14, your Medicare benefits start on July 1. If your birthday happens to be on the first of the month, your coverage begins on the first day of the month before your birthday. 

Some people choose to delay their Medicare benefits after age 65, however, while other people may qualify for Medicare before 65 because of a disability, meaning their Medicare benefits start before age 65. 

Below we’ll outline Medicare at age 65, Medicare before age 65 and Medicare after age 65 so that you can better understand how and when your Medicare benefits may start. 

Do I Automatically Get Medicare When I Turn 65?

Medicare automatically starts for many people on the first day of the month they turn 65 years old. In order to qualify for Medicare when you turn 65, you must meet each of the following Medicare eligibility requirements:

  1. You are a U.S. citizen or permanent legal resident alien who has lived in the U.S. for at least five years.

  2. You are receiving Social Security retirement benefits or Railroad Retirement Board retirement benefits, or you’re eligible to receive either of these benefits but have not yet begun collecting them.

  3. You are 65 years old. 

Can I Get Medicare Before Age 65?

You may qualify for Medicare benefits as young as age 20 if any of the following events occur:

  1. You have collected Social Security disability benefits for at least 24 months. If you qualify for Medicare through disability benefits paid by Social Security or the Railroad Retirement Board, your coverage will begin on the first day of your 25th month of disability benefits. This means that once you receive disability benefits for 24 months, you qualify for Medicare to start on the first day of the following month.

  2. You receive a disability pension from the Railroad Retirement Board.

  3. You have ALS (Lou Gehrig’s disease). If you qualify for Medicare because you’re diagnosed with ALS, your coverage will begin the same month your disability benefits begin. 

  4. You have permanent kidney failure that requires regular dialysis or a kidney transplant and you have paid Social Security taxes for a specified period based on your age. If you qualify for Medicare because of kidney failure, your benefits will usually begin on the first day of the fourth month of your dialysis treatments. 

Medicare After Age 65: Do You Have to Sign Up for Medicare When You Are 65?

Some people choose not to start Medicare until after age 65. This can typically happen for one of two reasons.

1. You Don’t Qualify for Premium-Free Part A

In order to qualify for premium-free Part A of Medicare (which covers hospital insurance), you must work and pay Medicare taxes for at least 40 quarters (10 years). If you have not paid at least 40 quarters-worth of Medicare taxes by age 65, you will have to pay a monthly premium for your Part A benefits. 

Some beneficiaries who do not qualify for premium-free Part A may choose to continue working past 65 in order to reach their required 40 quarters of Medicare taxes and therefore avoid paying the Part A premium once they do enroll in Medicare. 

2. You Aren’t Collecting Social Security Retirement Benefits Yet

Many people choose to delay collecting Social Security retirement benefits until they can retire at the full retirement age and collect the maximum Social Security benefit amount. If you aren’t yet collecting Social Security retirement benefits, you won’t be automatically enrolled in Medicare. You may still receive your Medicare benefits, but you will not be automatically enrolled and must take the steps to manually sign up for Medicare. 

For some people, Medicare coverage does not start at age 65 because they are not yet collecting Social Security and are either unaware they had to manually sign up or because they have continued to work and remain enrolled in their employer’s health insurance

What Month Does Medicare Part B Start?

The dates and scenarios above apply to Medicare Part A. The other half of Original Medicare is Part B, which covers outpatient health care services, durable medical equipment and doctor’s office services. Part B can start at the same time as Medicare Part A if you sign up for it prior to the month you turn 65. 

If you’re automatically enrolled in Medicare at 65, you will typically be automatically enrolled in Part A and Part B. Since Part B is optional, you can choose to disenroll from Medicare Part B after age 65 if you desire, though it isn’t typically recommended.

If you do not enroll in Part B before the month you turn 65 and you aren’t automatically enrolled, you typically must sign up during the Medicare General Enrollment Period at the start of the new year, and your Part B coverage will not begin until July 1.

You may potentially qualify for a Medicare Special Enrollment Period to sign up for Part B if you aren’t automatically enrolled at age 65.

If you plan on keeping your employer-provided health insurance coverage when you turn 65, you should make sure you carefully review your Medicare enrollment options so that you don’t potentially face a Part B late enrollment penalty or any lapse in coverage.

When Do Private Medicare Plans Start?

For private Medicare plans, the starting date of your coverage may vary depending on the type of plan you have and when you enrolled.

If you apply for a new Medicare Advantage plan (also called Medicare Part C) or Medicare Part D prescription drug plan – or if you switch from one MA plan or Part D plan to another – during the Fall Medicare Open Enrollment Period (also called the Annual Election Period) that takes place each October 15 to December 7, your plan benefits start on January 1 of the following year.

You could potentially qualify for a Special Enrollment Period for either a Medicare Advantage plan or Medicare Part D plan at any point in the year, depending on your situation. When your Special Enrollment Period takes place may determine when your Medicare Advantage plan or Part D plan may start.

Benefits for Medicare Supplement Insurance plans, also called Medigap, begin on the same day as your Original Medicare coverage, if you sign up prior to the month you turn 65. If you wait until your birthday month or later to enroll, your coverage would typically begin on the first day of the following month. You should be mindful, however, of your Medigap Open Enrollment period, which is in effect during the first 6 months that you are at least 65 years old and enrolled in Medicare Part B.

Medicare enrollment periods and coverage effective dates can be complex and my be unique to your specific circumstances. Call 1-800-MEDICARE (1-800-633-4227) for any questions related to your Medicare eligibility, enrollment process or coverage start date. You may also be able to speak with a representative from your State Health Insurance Plans (SHIP) organization who can help you get started with Medicare.