Updated February 2026
Most people, including your parents, sign up for Medicare when they “retire” and hit 65, unless one or both of them still works and they may be covered by an employer’s health plan.
But retirement at age 65 is not as fixed as it once was. Maybe because people are living longer, maybe because they think they need to stay busy and connected to be healthy and happy in their declining years, or maybe because they still need the money. For whatever reasons retirement is being redefined–even though as far as Medicare is concerned, 65 is still the magic enrollment number.
Here’s what’s happening, and while it may not affect your parents, you need to be aware of this trend as you inch toward 65. A 2023 survey from the Transamerica Center for Retirement Studies found that almost 49% of Baby Boomer workers queried expected to or already are working pass 70 or didn’t intend to retire, ever. A 2023 survey from the Employee Benefits Research Institute (EBRI) found that 32% of workers queried expected to retire before 65,and 41% when they were 70 and older, or never retire.
Of course, such intentions can be offset by any number of factors, including job loss, down-sizing, poor health, even the demands of caregiving for an aging or ailing family member, but the vagaries of future employment and retirement should force seniors who are still working and the upcoming retirement generation to think seriously about when to enroll in Medicare, and why they should do it.
Eligibility
People qualify for Medicare when they turn 65 if they collect or qualify to collect Social Security or Railroad Retirement benefits. Even if they do not meet these criteria, they still qualify if they are a current resident of the United States and are either a citizen or a permanent resident, a Green card holder, who has lived in the US for five continuous years before applying for Medicare.
In addition, several categories of those under 65 qualify for Medicare: Those who have End-Stage Renal Disease, or kidney failure, and have enough work history to qualify for Medicare, and those who have been getting Social Security Disability Insurance or Railroad Disability Annuity checks for total disability for at least 24 months. Those suffering from Amyotrophic Lateral Sclerosis (ALS), more commonly known as Lou Gehrig’s disease, qualify for Medicare coverage without a waiting period.
Initial Enrollment
Subject to the limited exceptions discussed above, most people must wait until they are 65 to enroll in Medicare. Seniors who began receiving Social Security benefits before age 65 are automatically enrolled in Medicare Part A (hospitalization coverage) when they turn 65. Seniors who apply for Social Security benefits after reaching the age of 65 are also enrolled in Part A automatically when their benefits are approved. Those who have been receiving SSDI payments for at least 24 months or have ALS are also enrolled automatically.
Medicare recipients do not pay for Part A coverage. The premium for Medicare Part B is deducted from their monthly Social Security benefit. When seniors apply for Social Security, they are asked whether they want to enroll in Part B. Since seniors face a late enrollment penalty if they do not apply for Part B when they turn 65, most seniors will answer “yes” to that question. As we discuss below, the primary exception applies to seniors who are still working and covered by group health insurance.
Seniors can apply for reduced Social Security benefits at age 62 and full benefits between the age of 66 and 67 (depending on their year of birth). Some seniors defer their application for Social Security benefits after they become eligible for full benefits because, up to the age of 70, their monthly benefit increases if they wait. However, if seniors wait to apply for Social Security, they must still apply for Medicare at age 65 to avoid paying a lifelong penalty. Since the senior has no Social Security benefit from which the premium is deducted, the premium for Part B must be paid directly to the Centers for Medicare & Medicaid Services.
Tip: For more information about the various Parts of Medicare and what they cover, see Understanding Your Elderly Parents’ Medicare Coverage.
Those who have not signed up for Social Security at 65, who do not have enough work history to qualify for free Part A, or who have Medicare Part A but declined Part B because they had insurance coverage from a current employer need to follow procedures for what is termed “active enrollment.”
That means they can enroll in Parts A, B and D during a seven-month period that starts three months before their 65th birthday month, includes the birthday month, and ends three months after that birthday month. To be sure coverage starts by the time they turn 65, most experts suggest they enroll within the three-month period before their birthday month.
Still Working and Covered by an Employer?
If you or your spouse still work and are covered under a group health plan provided by an employer who has 20 or more employees, you can delay Medicare enrollment until the job ends. Throughout that period, you can enroll in Medicare Part B and for up to eight months after the job ends without risking incurring penalties. This eight-month period is known as the “special enrollment period.”
If you miss the deadline and your coverage expires, you may find yourself uninsured because you will not be able to enroll until the next “general enrollment period,” which is January 1 through March 31 of each year. In most cases, coverage begins the month after the senior enrolls. In addition to being uninsured for that time gap, you may also be subject to a late enrollment penalty.
Those who fail to sign up for Part B because they are covered by an employer’s plan, opt for employer’s retiree benefits or go with COBRA–under federal COBRA law, companies with at least 20 workers must allow former workers to buy into their group health plan for up to 18 months–may encounter problems even if they failed to sign up because they didn’t want to pay for coverage they thought they already had.
When you turn 65, employer plans may consider government insurance to be your primary payer and will only pay for medical expenses that Part B won’t cover, something those who failed to sign up for Part B discover the hard way when the employer’s plan rejects their claims for services Part B should have covered.
For More Specifics
As you approach the magic enrollment age 65 and want more detailed information abut Medicare, you will find too many sources and far too much material to assimilate. Each year, Medicare sends beneficiaries an official Medicare handbook. For more information and a downloadable copy of the latest handbook, consult the official Medicare.gov website.
Part D coverage of prescription drugs is offered by private insurers, not by Medicare. Part D coverage is often included in Medicare Advantage plans. The eight-month special enrollment period that applies to Part B coverage does not apply to Part D. Seniors have only 63 days to enroll in Part D or a Medicare Advantage plan after they turn 65 or lose employer drug coverage. Failing to enroll during that two-month period may result in a lifelong penalty in the form of a higher Part D premium.
In addition, seniors who want to purchase a Medigap policy (supplemental coverage for Medicare deductibles and co-payments) will have more affordable premiums if they enroll in Medigap within six months of turning 65 and enrolling in Part B. Seniors who miss that enrollment period may be required to obtain a medical examination and may be charged a higher premium or denied coverage if they have a preexisting condition. Seniors who enroll when they are first eligible, on the other hand, cannot be denied Medigap coverage or charged more based on preexisting conditions.
A number of other websites–among them Medicare Rights Center, Center for Medicare Advocacy, and AARP–may offer a slightly different approach to the same materials with their own sets of questions and answers. If you want guidance on how to sign up, especially when trying to decide on your best choice for Part D coverage, consult a licensed insurance agent. The services should be free.
(The article was updated February 2026.)