Medicare at 65: Are You Eligible?

Turning 65 is a big day in the lives of most Americans. If you worked and paid Medicare and
Social Security taxes, you’re able to retire with full Social Security benefits, and you’re eligible to
enroll in Medicare.

If you’re about to hit that retirement milestone, here’s what you need to know about your
Medicare eligibility and benefits.

Who is considered eligible for Medicare?

The rules for Medicare eligibility are pretty simple. You are entitled for full Medicare benefits,
including premium-free Part A, if you are an American citizen or permanent legal resident of at
least five years, and one of the following applies to you:

• You (or your spouse) has worked enough years to qualify for either Social Security benefits or railroad retiree benefits (usually around 10 years), or
• You (or your spouse) worked for the government under the pension system, but paid Medicare taxes.

You can still get Medicare if you or your spouse don’t have a qualifying work history, you’ll just
have to pay Part A premiums, which may be as high as $437 in 2019, along with your Part B
premium payments.

Is my spouse eligible for Medicare when I turn 65?

Medicare is individual insurance; you can’t cover your spouse or dependent children under your
policy. Your spouse will have to get health insurance through an employer or other plan until he
or she reaches 65 and enrolls in Medicare.

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

If you don’t enroll in Medicare when you first become eligible, and you go without health
insurance coverage, you’ll pay a late enrollment penalty with your Medicare premium when you
eventually enroll. This penalty never goes away, you’ll pay it as long as you have Medicare
coverage.

If I’m still working at 65, do I have to enroll in Medicare?

That depends on the size of your employer. If you work for a company with 20 or more
employees, you can delay Medicare enrollment as long as you are working and/or you have
health insurance through that employer.

When your employment or health insurance coverage ends, you have a special Medicare open
enrollment period of eight months. If you enroll during this period, you won’t pay any late
enrollment penalty.

Note, however, that for Medicare’s purposes, only coverage through active employment counts.
If you are using COBRA to get health insurance from your employer, you can’t delay Medicare
enrollment without penalty.

If you work for a small employer, your employer may opt to end your group insurance coverage
when you become eligible for Medicare. In this instance, you must enroll at age 65 and
Medicare becomes your primary insurer. Your employer may allow offer some supplemental
retirement insurance benefits that work with your Medicare benefits, but these become
secondary to Medicare. In other words, if you don’t enroll in Medicare, your employer’s plan
doesn’t have to cover any of your health care costs.