Medicare for People Turning 65: What to Know Before You Enroll

There is a 7-month window to sign up for Medicare around your 65th birthday, and if you delay without health coverage from a current employer, Medicare may add a penalty to your premium for as long as you have it.

Do You Have to Sign Up for Medicare at 65?

Not always. People who already receive Social Security or Railroad Retirement benefits are enrolled in Medicare without having to apply. Everyone else has to sign up through Social Security, though if you’re still working and covered by your employer’s plan, you can often delay Part B.

The penalty only applies when you skip Part B without qualifying coverage from a current employer.

Will You Be Enrolled Automatically?

Only if you're already receiving Social Security or Railroad Retirement Board benefits at least 4 months before you turn 65. In that case, Medicare enrolls you in Parts A and B and mails your card about 3 months before coverage starts. Everyone else signs up through Social Security.

If you're enrolled automatically, you can keep Medicare Part B or decline it. Premium-free Part A works differently. Once you're receiving Social Security, the only way to turn down Part A is to withdraw your Social Security application and repay the benefits you've received. For nearly everyone, the real decision is whether to keep Part B. If you're not receiving benefits yet, you won’t receive a reminder when your window opens.

Your 7-Month Initial Enrollment Period

Your Initial Enrollment Period is a 7-month window: the 3 months before the month you turn 65, your birthday month, and the 3 months after. It's your first chance to sign up for Parts A and B, and the month you sign up indicates when coverage begins.

Coverage always starts on the first of a month.

• Sign up in the 3 months before your birthday month: coverage begins the first day of the month you turn 65.
• Sign up in your birthday month or the 3 months after: coverage begins the first day of the month after you sign up.
• If your birthday is on the 1st of the month: your coverage can start the month before your 65th birthday, and your window shifts a month earlier to match.

Signing up in the first 3 months means coverage is in place the month you turn 65. If you wait until later in the window, you'll have a gap between your birthday and your start date.

Your drug coverage (Part D) and any Medicare Advantage (Part C) decision happen in this same window. For plan basics, see what Medicare Parts A, B, C, and D cover.

A note on Medigap. If you plan to add a Medigap (supplemental) policy, you get a 6-month Medigap Open Enrollment Period under federal law, starting the first month you have Part B and are 65 or older. During those months, an insurer can't refuse to sell you any policy it offers or charge you more because of a health condition. That window opens when Part B begins, even if that’s while you still have employer coverage, so taking Part B early can use up the window before you need it.

Still Working at 65? What to Know Before You Delay Part B

If you or your spouse are still working and you’re covered by that employer’s group health plan, you can usually delay Part B without a penalty. You can sign up any time while that coverage lasts, or within 8 months after the job or the coverage ends, whichever comes first. This is called a Special Enrollment Period.

The coverage has to come from a job you or your spouse currently hold. COBRA and retiree coverage don’t count, and neither do Marketplace plans. Your 8-month window starts when you stop working, even if you take COBRA afterward.

Employer size: If the employer has 20 or more employees, the group plan pays first and Medicare pays second. That’s why some people skip Part B and its premium while they’re covered. If the employer has fewer than 20 employees, Medicare pays first once you turn 65, and the group plan may pay little or nothing for care it expects Medicare to cover. Most people in that situation sign up for Parts A and B during their Initial Enrollment Period. The same threshold applies when the coverage comes through your spouse’s employer.

Health Savings Accounts. You can’t contribute to an HSA once any part of Medicare begins. If you sign up after 65, the timing gets confusing, because Part A coverage reaches back 6 months from when you apply (though never earlier than the month you turned 65). To avoid an IRS penalty, CMS advises stopping HSA contributions 6 months before you apply for Medicare.

Before you decide, ask HR whether the plan stays primary once you turn 65, and whether its drug coverage is creditable, meaning at least as good as standard Part D. If the answer to either is no, you’ll likely want to enroll on time.

Feeling confused? Most people are.

Once your Medicare coverage starts, a Solace advocate can answer coverage questions and sort out how it works with the plan you already have.

See If You Qualify →

What Happens If You Wait?

If you miss your Initial Enrollment Period and don’t qualify for a Special Enrollment Period, you’ll wait for the next sign-up window and pay more once you’re enrolled. The Part B and Part D penalties both last for as long as you have that coverage.

Part B. Medicare adds 10% to your premium for each full 12-month period you could have had Part B and didn’t. Two years late means 20% added. On the 2026 standard premium of $202.90, that’s an extra $40.58 a month, for a total of $243.50 after rounding. Because the penalty is a percentage, it grows whenever the premium does.

Part D. The penalty applies if you go 63 days or more without creditable drug coverage. Medicare charges 1% of the national base beneficiary premium ($38.99 in 2026) for each full month you went without it. Fourteen months without coverage means 14% added to your plan premium, or $5.50 a month at 2026 rates.

Part A. This only matters if you have to pay for Part A. The premium goes up 10%, and you pay the higher amount for twice the number of years you delayed.

The next window. The General Enrollment Period runs January 1 through March 31 each year, and coverage starts the month after you sign up. If your Initial Enrollment Period closed in April, that can mean going without Part B until the following February.

What Medicare Costs When You Turn 65 (2026)

For 2026, the standard Part B premium is $202.90 a month with a $283 annual deductible. Part A is premium-free if you or your spouse paid Medicare taxes for at least 40 quarters, about 10 years of work. Part A still has a deductible for hospital stays: $1,736 per benefit period in 2026.

Part D and Medicare Advantage premiums are set by private plans and vary by plan and location.

A Turning-65 Timeline

• 6 months before your 65th birthday: Check whether you'll be receiving Social Security by 65. If you're working, ask HR about employer size and whether the drug coverage is creditable. If you contribute to an HSA, plan to stop before the month your Medicare coverage starts.
• 3 months before: Your Initial Enrollment Period opens. Sign up now if you want coverage to begin in your birthday month. Compare Part D plans, and decide between Original Medicare and Medicare Advantage.
• Your birthday month: Coverage begins if you signed up early or were enrolled automatically. If you have Part B, your Medigap window opens too.
• 3 months after: Your Initial Enrollment Period closes at the end of this month.

When to Get Help

If you’re already on Medicare, or your coverage is about to start: A Solace advocate works with your existing Medicare coverage. Your advocate handles prior authorizations, works through denials, and coordinates between your doctors and your plan.

If you haven’t enrolled yet: Start with Social Security (ssa.gov or 1-800-772-1213) or Medicare.gov. Our guide on how to sign up for Medicare covers the steps in detail.

Frequently Asked Questions

Do I have to enroll in Medicare when I turn 65?

Medicare doesn't require you to take Part B at 65. If you have no health coverage from a current employer, though, signing up during your 7-month Initial Enrollment Period is how you avoid a permanent late penalty. If you already receive Social Security or Railroad Retirement benefits, you're enrolled automatically. If you don't, you sign up yourself.

Does everyone automatically get Medicare at 65?

No. You're enrolled automatically only if you receive Social Security or Railroad Retirement Board benefits at least 4 months before you turn 65. Otherwise, you sign up during your Initial Enrollment Period, which runs from 3 months before your birthday month to 3 months after.

What happens if I don't take Medicare when I turn 65?

Without qualifying coverage from a current employer, your Part B premium rises 10% for each full 12-month period you could have enrolled, and you pay that for as long as you have Part B. You may also owe a Part D penalty. You'll also wait for the General Enrollment Period (January 1 to March 31) to sign up, with coverage starting the month after.

Is it a good idea to get Medicare if you're still working at 65?

It depends on your employer coverage. If you or your spouse are actively working and covered by that employer’s group health plan, you can generally delay Part B without a penalty and sign up within 8 months after the job or plan ends. If the employer has fewer than 20 employees, Medicare pays first, so enrolling on time usually makes sense anyway. COBRA, retiree coverage, and Marketplace plans don’t count as coverage from current work.

How much does Medicare cost when you turn 65?

In 2026, the standard Part B premium is $202.90 a month, with a $283 annual deductible. Part A is premium-free if you or your spouse paid Medicare taxes for at least 40 quarters (about 10 years). Part D and any supplemental coverage cost extra.

Is Medicare free when you turn 65?

Not entirely. Part A has no premium for people who paid Medicare taxes for at least 40 quarters, but Part B has a monthly premium ($202.90 in 2026). Drug coverage and supplemental plans are separate costs.