Why You Should Sign Up for Medicare When You Hit 65

Published In Government Programs

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.


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

For some, enrollment is automatic, but for others enrollment is an active process that requires attention to the time of enrollment to avoid a late enrollment penalty and possibly a period without insurance coverage.

People who have enrolled to receive Social Security benefits automatically receive a Medicare card for Parts A and B when they turn 65. Those who have been receiving SSDI payments for at least 24 months or have ALS are also enrolled automatically.

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; however, your coverage will not begin until July 1. 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.

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.


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