Medicare is a federal health insurance program you become may be able to access for at 65, and Social Security handles your enrollment

Medicare and Social Security are separate programs run by the same federal agency, but they work together in a practical way: when you turn 65, Social Security automatically notifies Medicare about you, and you become covered unless you actively decline it. You do not have to apply to Medicare separately if you are already receiving Social Security retirement or disability benefits — the enrollment happens behind the scenes.

If you are not yet receiving Social Security when you turn 65, you will need to sign up for Medicare yourself, either online at Medicare.gov, by phone at 1-800-MEDICARE, or in person at your local Social Security office. The enrollment window is three months before the month you turn 65, the month itself, and three months after — missing this window can result in a permanent penalty on your premiums.

Medicare has four parts: Part A covers hospital stays and skilled nursing care, Part B covers doctor visits and outpatient services, Part D covers prescription drugs, and Part C (Medicare Advantage) is an alternative to A and B offered by private insurers. Most people pay a monthly premium for Part B and Part D, while Part A is usually free if you or your spouse paid Medicare taxes for at least 10 years.

Key Takeaways

  • Social Security automatically tells Medicare about you when you turn 65 if you are already receiving benefits, so you do not need to apply twice.
  • If you are not receiving Social Security yet, you must sign up for Medicare yourself during the three-month window around your 65th birthday or face a permanent premium increase.
  • Medicare Part A (hospital) is usually free, but Part B (doctor) and Part D (drugs) charge monthly premiums that vary based on your income.
  • You can delay Medicare Part B and Part D without penalty if you are still working and covered by an employer health plan, but you must tell Social Security this when you turn 65.

How your Social Security benefit and Medicare premiums connect

Your Social Security check and your Medicare premiums are linked: Medicare Part B and Part D premiums are deducted directly from your Social Security payment each month. If your Social Security benefit is not large enough to cover the full premium, you will receive a bill for the difference.

Your Part B and Part D premiums are based on your income from two years prior. If your income was higher two years ago, you may pay a higher premium now — this is called an Income-Related Monthly Adjustment Amount (IRMAA). If your income has dropped since then (for example, because you retired), you can request that Medicare recalculate your premium, but you will need to provide proof of the income change.

If you delay taking your Social Security benefit past 65, you do not have to delay Medicare. You can enroll in Medicare at 65 and let your Social Security benefit grow at the same time — these are independent decisions.

When you can delay Medicare without a penalty

You can delay Medicare Part B and Part D past 65 without penalty if you are covered by an active employer health plan — either your own or your spouse's. This is called having "creditable coverage." You must tell Social Security that you are declining Medicare due to employer coverage when you turn 65, even if you do not enroll.

Once you leave your employer plan, you have eight months to sign up for Medicare Part B and Part D without penalty. If you wait longer than eight months, you will pay a permanent 10 percent increase in your Part B premium for each year you delayed, and a similar penalty on Part D that lasts as long as you have the coverage.

Part A (hospital insurance) does not have a late-enrollment penalty, so you can delay it without consequence. However, if you are not working and not covered by an employer plan, you should enroll in Part A at 65 to avoid gaps in coverage.

How to coordinate your Social Security and Medicare enrollment

If you are receiving Social Security retirement benefits, you will be automatically enrolled in Medicare Part A and Part B about three months before you turn 65. You will receive a Medicare card in the mail and can start using it on the first day of the month you turn 65. You do not need to do anything unless you want to decline Part B because you have employer coverage.

If you are not yet receiving Social Security, visit Medicare.gov or call 1-800-MEDICARE to enroll in Medicare. You can also visit your local Social Security office in person. Have your Social Security number, proof of citizenship or legal residency, and proof of age (birth certificate, passport, or driver's license) ready.

For Part D (prescription drug coverage), you will need to choose a plan during the same enrollment window. Different plans cover different drugs at different costs, so compare plans on Medicare.gov to find one that covers your current medications. If you do not enroll in Part D when you first become may be able to access and you go without drug coverage, you will pay a penalty when you do enroll.

What happens to your benefits if you move or travel abroad

If you move to another state, your Social Security and Medicare benefits continue without interruption. Your Medicare card works in all 50 states. If you move to a different state, you may want to review your Medicare Advantage or Part D plan, because coverage and costs vary by state.

If you travel outside the United States, Medicare Part A and Part B do not cover care received outside U.S. borders, except in limited cases near the border (Canada and Mexico). Some Medicare Advantage plans offer limited emergency coverage abroad. If you plan to live outside the U.S. permanently, contact Social Security to understand how your benefits will be affected — some benefits can continue, but the rules depend on your citizenship and the country you move to.

How to update your information with Social Security and Medicare

If your address, phone number, or banking information changes, update it with Social Security at ssa.gov, by phone at 1-800-772-1213, or in person at your local office. Social Security will automatically pass this information to Medicare, so you only need to update it in one place.

If your income changes significantly (for example, you retire or return to work), you can request that Medicare recalculate your Part B and Part D premiums. Contact Medicare at 1-800-MEDICARE or visit Medicare.gov to report the change and provide documentation of your new income.

If you move, change your mailing address with Social Security as soon as possible so you receive important notices about changes to your benefits or premiums. Medicare will use the same address to send you your annual notices about plan changes and coverage options.

Frequently Asked Questions

Do I have to take Social Security at 65 to get Medicare?

No. You can delay your Social Security benefit and still enroll in Medicare at 65. They are separate decisions. However, if you are not receiving Social Security, you must actively sign up for Medicare yourself during the enrollment window, or you will face a permanent penalty.

What if I am still working at 65 and have health insurance through my job?

You can delay Medicare Part B and Part D without penalty as long as your employer plan is active. You must tell Social Security you are declining Medicare due to employer coverage. Once you leave your job, you have eight months to enroll without penalty. Part A has no late-enrollment penalty and can be delayed indefinitely if you have other coverage.

Can I change my Medicare plan after I enroll?

Yes. You can change your Part D plan or switch to or from a Medicare Advantage plan during the Annual Enrollment Period, which runs from October 15 to December 7 each year. Changes take effect January 1. If you have a may have access to life event (such as moving or losing employer coverage), you may be able to change plans outside this window.

What if my Social Security benefit is not enough to cover my Medicare premiums?

If your benefit is smaller than your premium, you will receive a bill for the difference each month. You can also look into programs like the Medicare Savings Program or Low-Income Subsidy, which may help pay your premiums and out-of-pocket costs if your income is below a certain level. Contact your state Medicaid office or call 1-800-MEDICARE to learn whether you may be may be able to access.

Do I need to do anything when I turn 65 if I am already receiving Social Security disability benefits?

No. Your disability benefits automatically convert to retirement benefits at 65, and you will already be enrolled in Medicare because you have been receiving Social Security. Your benefit amount stays the same, and your Medicare coverage continues without interruption.