Does Medicare Automatically Start at Age 65?

So, you’re ready to get Medicare. Will Medicare just start at 65 without your input? There’s a simple way to find out.

Whether or not you have to register for Medicare on your own depends on whether you get federal retirement benefits — Social Security or Railroad Retirement Benefits. Americans who are already receiving benefit checks from either federal program will be auto-enrolled in Medicare when they turn 65. All others need to manually sign up for Medicare.

What Are Cases When Medicare Automatically Starts?

Medicare will automatically start when you turn 65 if you’ve received Social Security Benefits or Railroad Retirement Benefits for at least 4 months prior to your 65th birthday.

You’ll automatically be enrolled in both Medicare Part A and Part B at 65 if you get benefit checks. According to the Social Security Administration, more than 30% of seniors claim Social Security benefits early.¹ For those seniors, Medicare Part A and Part B will automatically start when they reach the age of 65.

When do You Get Your Medicare Card?

You can expect to receive your Medicare card in the mail three months before your birthday. Your Medicare card will come with a complete enrollment package that includes basic information about your coverage. Your card won’t be usable until you turn 65, even though you’ll receive the card before that time.

What Are Your Costs?

Keep in mind that you’ll still have to pay the usual costs of Medicare, even though you’re automatically enrolled. Once your Medicare is active, the cost of your Part B premium will be deducted from your Social Security or RRB benefits.

What If You Already Enrolled in Medicare?

If you already have Original Medicare (Part A and B) when you’re 65 — people with disabilities, end stage renal disease or ALS — everything will continue as normal. There will be no change in your Medicare coverage if you turn 65 while you’re already on Medicare. Fortunately, you won’t have to worry about qualifying for coverage in the future. As long as you want to be enrolled, you’ll stay eligible.

What about Medicare Supplement (or Medigap)?

You’ll also be able to purchase Medigap if it wasn’t offered to beneficiaries under the age of 65 in your area. Even if you already had one of these supplementary plans, you’ll be eligible to switch to a different Medigap policy without medical underwriting when you turn 65. You’ll receive a one-time open enrollment period for Medigap that starts on the first day of the month that you turn 65.

What If I Switch to Medicare Advantage?

And if you want to switch to Medicare Advantage (or already have an Advantage plan and want to pick a different one), you’ll have a one-time Initial Enrollment Period for Medicare Advantage (Part C) that begins 3 months before the month you turn 65 and lasts for 7 months.

What I Have Part A?

If you already have Medicare Part A when you’re 65, then you’ll be enrolled in Part B automatically. You’ll receive a replacement Medicare card in the mail three months before your birthday. The replacement card with Part B coverage cannot be used until you turn 65.

You’ll also be able to purchase Medicare Supplement (Medigap) coverage, since Medicare Supplement requires Part B.

As is the case for people who become newly-eligible for Medicare when they turn 65, you still have the option to reject Medicare Part B (and avoid the monthly premium), but you’ll potentially face a delayed enrollment later on, as well as a late enrollment penalty (if you’re rejecting Part B because you have supplemental coverage from a current employer’s plan, you can safely delay your Part B enrollment).

When Does Medicare NOT Automatically Start?

Medicare will NOT automatically start when you turn 65 if you’re not receiving Social Security Benefits or Railroad Retirement Benefits for at least 4 months prior to your 65th birthday. You’ll need to apply for Medicare coverage.

There’s no such thing as a Medicare office – enrollment in the program is handled by the Social Security Administration (or the Railroad Retirement Board, if the RRB manages your retirement benefits). If you have to enroll in Medicare Part A and/or B on your own, you can visit your local Social Security office.

You can also sign up for Medicare online by following the instructions at the Social Security Administration Medicare Benefits’ web page. In most cases, signing up online will take ten minutes.

What If Your Medicare Card Didn’t Arrive?

If you’re expecting to receive a Medicare card but haven’t yet received one three months before your 65th birthday, the first thing to do is to not worry. Medicare sends out hundreds of thousands of cards per year without issue. It’s possible for the card to be delayed or for there to be an error. To confirm whether a Medicare card is heading your way,  check with your local Social Security office to make sure that you’re enrolled.

Should You Wait Until 65 to Sign Up for Medicare?

If you wait to sign up right before your 65th birthday (or wait until after you turn 65), you may go for months without coverage.

Initial Enrollment Period (signing up ASAP)

Your Initial Enrollment Period will last for 7 months. This Initial Enrollment Period begins 3 months before the month of your 65th birthday and ends 3 months after your birthday month. If you fail to enroll before your birthday month, your coverage will be delayed by a month or more.

General Enrollment Period (waiting to enroll, with a penalty)

You’ll have the option to sign up during the General Enrollment Period – which falls between January 1 and March 31 every year – if you didn’t sign up during the Initial Enrollment Period. But you’ll potentially be charged a late enrollment penalty. Your premiums for Part B will be permanently increased by 10% for each year that you neglected to sign up for Part B and your monthly premiums for Part A will temporarily increase by 10%. As a rule, most people don’t pay premiums for Part A, but then again, most people don’t delay signing up for Part A. Your coverage will start on July 1, three months after the General Enrollment Period ends.

You may be able to avoid the late enrollment penalty and having to wait for the General Enrollment Period if you qualify for a Special Enrollment Period.

Special Enrollment Period (waiting to enroll, without a penalty)

If you delay Part B because you have health insurance through your current employer (or your spouse’s current employer), you can sign up for Part B later on, during a Special Enrollment Period. This Special Enrollment Period will last for 8 months after you (or your spouse) leave the employer or the group coverage ends. It’s a good idea to sign up 2 months before leaving work, so that your Medicare coverage will be ready once your employer-sponsored healthcare ends.

As long as the group coverage was offered by an employer that has at least 20 employees, you won’t be subject to a late enrollment penalty for delaying Part B, as long as you enroll in Part B within 8 months of the employer-sponsored coverage ending. 

It’s important to check with your insurer or HR department to make sure that your coverage is sufficient to postpone Medicare enrollment.

What If You’re Still Working at 65?

If you’re still working at 65 and receiving health insurance through your employer, you may still need to sign up for Medicare. If your company offers health insurance and has fewer than 20 employees, your health insurer will refuse to pay for costs that Medicare would have covered. Signing up for Medicare will ensure that those costs are covered. 

If your company has more than 20 employees, it’s still a good idea to enroll in free Part A coverage right away. Your coverage will be free since you already paid Medicare taxes. However, if you have a Health Savings Account, you won’t be able to contribute to it once you enroll in Medicare, even if you only enroll in Part A.

Can You Be Rejected for Medicare?

As long as you meet the eligibility requirements for Medicare, then no, you can’t be rejected for Medicare. Medicare is available to everyone turning 65, even if you have pre-existing health conditions.

What If You Worked 10 Years or Less?

Most people will qualify for coverage by paying Medicare and Social Security taxes for 10 years through any combination of employers. You’ll need to have spent 10 years doing taxable work to enroll in Medicare Part A for free. If you’ve worked for less than 10 years in the US, you’ll need to pay monthly premiums for Medicare Part A.

However, if your spouse who is 62 or older has enough quarterly credits or receives Social Security benefits, then you’ll still qualify. You may also be able to qualify based on your spouse’s work record if you’re widowed or divorced.

What Should You Do Once You Get Medicare?

Although you can rely on Original Medicare alone, 86% of Medicare enrollees also have some type of additional coverage.² It can be from an employer, a privately-purchased plan or from a government-run program like Medicaid. Original Medicare pays for a great deal of healthcare, but still leaves you with potentially costly gaps in healthcare coverage. Supplementary plans can cover these gaps – including deductibles and copayments – at a fraction of the out-of-pocket rate.

MedicareGuide.com’s plan selector is designed to bring you the best Medicare Supplement plans intelligently. These plans, also known as Medigap policies, fill the “gaps” in coverage that Original Medicare would otherwise charge you.

Are You Legally Required to Sign Up for Medicare?

The law doesn’t require you to get Medicare, although in some states people who have no health insurance coverage are given a tax penalty.

Can You Get Private Insurance Instead of Medicare?

If you have Medicare Part A or Part B, insurers generally aren’t allowed to sell you a traditional individual health insurance plan (these are sometimes called Obamacare or marketplace plans).

You can purchase individual health insurance if you’ve never enrolled in Medicare because you think the overall costs are too high. If you’re in the unusual situation of paying for Part A premiums, you can also switch to individual health insurance.

If you develop a medical condition before turning 65 that would qualify you for Medicare, such as ESRD, you can decline to purchase Medicare.

If you decide to purchase private insurance once you’re eligible for Medicare – unless you’re continuing the employer-sponsored insurance that qualifies you for a Special Enrollment Period – then you’ll have to pay the costly late enrollment penalty once you do apply.

If you’re nearing the age of 65, then it’s important you start considering your Medicare coverage.