You’re Turning 65—But Are You Actually Eligible for Medicare Yet?

Key Takeaways

• Turning 65 does not automatically make you eligible for every part of Medicare; eligibility depends on your work history, citizenship status, and whether you receive certain benefits.

• Missing your Medicare enrollment window could result in late penalties and gaps in coverage, so knowing your timeline is essential.

Understanding the Basics of Medicare Eligibility at 65

If you’re approaching your 65th birthday, you might assume you’re automatically eligible for Medicare. But eligibility isn’t as clear-cut as you might think. While many people do qualify when they turn 65, several factors can impact your access to benefits and the cost of your coverage.

Who Is Automatically Enrolled in Medicare at 65?

Some individuals are enrolled in Medicare automatically when they turn 65. In 2025, this still applies to people who meet the following conditions:

• You are receiving Social Security or Railroad Retirement Board (RRB) benefits at least four months before your 65th birthday.

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

If you meet these criteria, you’ll be automatically enrolled in both Medicare Part A (hospital insurance) and Part B (medical insurance). Your Medicare card should arrive in the mail three months before your 65th birthday.

When You Must Sign Up Yourself

If you’re not already receiving Social Security or RRB benefits when you turn 65, you will need to actively enroll in Medicare. This applies to a growing number of Americans who delay claiming Social Security in order to receive higher monthly payments later on.

In these cases, you must manually sign up during your Initial Enrollment Period (IEP), which lasts for seven months:

• Begins: Three months before the month you turn 65

• Includes: Your birthday month

• Ends: Three months after the month you turn 65

Signing up within this window ensures you avoid late penalties and don’t face a gap in your coverage.

Eligibility Requirements for Medicare Parts A and B

Even if you’ve turned 65, you’ll need to meet specific eligibility criteria:

Medicare Part A

Most people qualify for premium-free Part A if:

• You or your spouse worked and paid Medicare taxes for at least 10 years (40 quarters)

If you don’t qualify for premium-free Part A, you can still purchase it, but the monthly premium in 2025 can be over $500 depending on your work history.

Medicare Part B

You are eligible for Part B if:

• You are 65 or older and a U.S. citizen or permanent resident for at least five years

Part B is not free for anyone. In 2025, the standard monthly premium is $185, and high-income earners may pay more based on income-related monthly adjustment amounts (IRMAA).

What If You’re Still Working at 65?

Many people continue to work past age 65 and have employer-sponsored health insurance. If this is your situation, whether you need to sign up for Medicare depends on your employer’s size:

• 20 or more employees: You can delay Part B without penalty because your employer insurance is primary.

• Fewer than 20 employees: You must enroll in Medicare when eligible because Medicare becomes your primary insurance.

If you delay Part B due to current employment, you’ll be eligible for a Special Enrollment Period (SEP) after your employment ends or your employer coverage ends—whichever comes first. This SEP lasts for eight months and allows you to sign up for Part B without a late enrollment penalty.

What Happens If You Miss Your Enrollment Window?

Failing to enroll during your IEP or SEP can result in lifelong penalties and delayed coverage:

• Late Enrollment Penalty for Part B: Your premium may go up 10% for each 12-month period you could have had Part B but didn’t.

• General Enrollment Period (GEP): If you miss all other enrollment periods, you must wait until January 1 to March 31 to enroll, with coverage starting on July 1.

This gap in coverage could mean significant out-of-pocket costs.

Eligibility for Medicare Part D (Prescription Drug Coverage)

Medicare Part D is available to anyone eligible for Parts A or B. However, you must actively enroll in a Part D plan or a Medicare Advantage plan that includes drug coverage.

Even if you don’t take many prescriptions now, delaying enrollment in Part D could trigger a late penalty that adds permanently to your premium.

To avoid this penalty, you must have creditable drug coverage through another source, such as an employer plan or a retiree health plan.

Eligibility for Medicare Advantage (Part C)

To enroll in a Medicare Advantage plan in 2025, you must:

• Be enrolled in both Part A and Part B

• Live in the plan’s service area

You cannot enroll in a Medicare Advantage plan without having both Parts A and B. Medicare Advantage is an alternative to Original Medicare that includes all services under A and B and may include drug coverage and additional benefits.

Eligibility for Medicare Supplement (Medigap) Plans

Medigap plans help cover costs not paid by Original Medicare, such as deductibles, coinsurance, and copayments. To be eligible, you must:

• Be enrolled in both Medicare Part A and Part B

• Apply during your Medigap Open Enrollment Period, which starts the first day of the month you are both 65 or older and enrolled in Part B

This six-month window is crucial. After it ends, you may be subject to medical underwriting and could be denied coverage or charged more based on your health.

Are Non-Citizens Eligible for Medicare?

Yes, if you are a lawfully present non-citizen who has lived in the U.S. for at least five continuous years, you may be eligible for Medicare at age 65.

However, you will likely need to pay premiums for Part A unless you qualify through a spouse’s work history.

When Eligibility Differs: Special Cases

There are situations where people may qualify for Medicare before age 65 or under different rules:

• Disability: If you’ve received Social Security Disability Insurance (SSDI) for 24 months, you’re automatically enrolled in Medicare.

• End-Stage Renal Disease (ESRD): You may qualify for Medicare without the 24-month waiting period.

• Amyotrophic Lateral Sclerosis (ALS): You are eligible for Medicare the same month your SSDI benefits begin.

These individuals are subject to different enrollment periods and should seek personalized advice.

Why Timing Matters More Than You Think

It’s not enough to know that you’re turning 65—you need to know when your eligibility starts, how your coverage is affected by current or past employment, and what penalties could follow a delay. Every timeline matters:

• IEP: 7 months around your 65th birthday

• SEP: 8 months after employment or coverage ends

• GEP: January 1 to March 31 (with July 1 coverage start)

Missing any of these could mean paying more for the rest of your life.

Planning Ahead Ensures Peace of Mind

Turning 65 is a milestone, but it’s also the beginning of a new set of responsibilities related to your healthcare. Medicare is not automatic for everyone, and even when it is, the decisions you make at this stage can have long-term consequences.

Make sure you understand whether you qualify now or need to take action. Look into:

• Your work history and Social Security status

• Whether your current insurance qualifies as creditable coverage

• The penalties and timing rules for each part of Medicare

If you’re unsure, it’s better to ask now than to assume you’re covered.

Don’t Let Eligibility Confusion Cost You Later

Whether you’re automatically enrolled or required to take action, missing key deadlines could cost you thousands over time. Understanding when and how you’re eligible isn’t just about meeting age criteria—it’s about making the most informed decisions.

For one-on-one support in evaluating your eligibility and plan options, reach out to a licensed agent listed on this website for personalized advice.