When Can You Sign Up for Medicare?

🔑 10 Key Takeaways

1. Your Initial Enrollment Period (IEP) is 7 months long. It starts 3 months before you turn 65, includes your birthday month, and ends 3 months after. Sign up during the first 3 months for the fastest coverage start.

2. If you’re already collecting Social Security, you’re auto-enrolled. If you’re receiving Social Security benefits at least four months before your 65th birthday, you’re automatically enrolled in Parts A and B.

3. The 2026 Part B premium is $202.90/month. The Part A inpatient hospital deductible rises to $1,736 in 2026, a $60 increase from 2025.

4. Late enrollment penalties can haunt you for life. The Part B penalty adds 10% to your monthly premium for each full 12-month period you delayed enrollment, and you pay it for as long as you have Medicare.

5. Still working at 65? You may be able to delay without penalty. If your employer has group health insurance with 20+ employees, you can postpone Part B and get an 8-month Special Enrollment Period once you stop working or lose coverage.

6. The disability waiting period is 24 months. If you’re under 65 and receive SSDI, you’re automatically enrolled in Medicare after receiving disability benefits for 24 months.

7. ALS and ESRD skip the waiting period entirely. If you have ALS, you get Medicare automatically as soon as disability benefits begin. ESRD coverage can start as early as the first month of dialysis in certain cases.

8. Open Enrollment runs October 15 – December 7 every year. Changes made during this window take effect January 1 of the following year.

9. Medigap rules vary dramatically by state. Only four states — Connecticut, Massachusetts, Maine, and New York — require continuous or annual guaranteed issue protections for Medigap for all beneficiaries ages 65 and older.

10. IRMAA surcharges kick in above $109,000 (single) or $218,000 (joint). For higher-income beneficiaries, total monthly Part B premiums range from $284.10 to $689.90 in 2026.

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📋 Your 7-Month Initial Enrollment Window Opens Earlier Than You Think

Most people fixate on their 65th birthday as the Medicare starting gun, but the enrollment period actually begins three full months before that date. This 7-month Initial Enrollment Period is your golden window, and where you sign up within it directly affects when coverage kicks in.

Here’s the critical timeline most articles gloss over: signing up in the first three months before your birthday month means coverage can start as early as the first day of your birthday month. Wait until your birthday month or later, and you’re looking at a one-to-three-month delay before coverage actually begins.

⏰ When You Enroll During IEP	📅 When Coverage Starts
3 months before birthday month	1st day of birthday month
During birthday month	1 month after enrollment
1 month after birthday month	2 months after enrollment
2 months after birthday month	3 months after enrollment
3 months after birthday month	3 months after enrollment

💡 Insider tip: If your birthday falls on the 1st of the month, your Medicare eligibility actually starts the month before. Someone born on March 1 becomes eligible on February 1 — a quirk that catches many people off guard and can shift your entire enrollment timeline.

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💰 What Happens When You Miss the Sign-Up Window at 65

Missing your IEP without qualifying coverage elsewhere is one of the most expensive mistakes in retirement planning. The penalties aren’t one-time fees — they’re permanent monthly surcharges baked into your premiums for as long as you have Medicare.

For each 12-month period you delay enrollment in Part B, you pay a 10% premium penalty that applies for as long as you have Medicare. To put that in real dollars: if you delayed enrollment in Part B for seven years, your monthly premium with the penalty would be $344.93 in 2026 compared to the standard $202.90.

Part D penalties work differently but are equally painful. The late enrollment penalty is calculated by multiplying 1% of the national base beneficiary premium ($38.99 in 2026) by the number of full uncovered months you were eligible but didn’t enroll.

⚠️ Penalty Type	📊 How It’s Calculated	⏳ Duration
Part A (if premium applies)	10% higher premium for twice the years you delayed	Limited duration
Part B	10% increase per full 12-month delay period	Lifetime
Part D	1% of $38.99 per uncovered month	Lifetime (as long as you have drug coverage)
Part C (Medicare Advantage)	No direct penalty	N/A — but requires A & B enrollment first

💡 Critical exception: If you or your spouse is still working and has healthcare coverage through an employer with 20 or more plan members, you can delay enrolling without penalties. However, COBRA coverage, marketplace insurance, and retiree coverage from a former employer do not count for this exception.

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🏢 Still Working Past 65? Here’s When to Actually Enroll

This is where more people make costly errors than anywhere else in the Medicare system. The rules depend entirely on the size of your employer and the type of coverage you carry.

If you don’t have to pay a premium for Part A, you can choose to sign up when you turn 65 or anytime later. Part A is usually free and doesn’t interfere with employer coverage, so most working adults should sign up for it at 65 regardless of their employment status.

Part B is the decision point. You can wait until you or your spouse stop working or lose health insurance to sign up for Part B without a late enrollment penalty, as long as the employer plan qualifies. Once that employer coverage ends, you have an 8-month Special Enrollment Period to enroll.

🏥 Coverage Situation at 65	✅ Recommended Action
Employer plan (20+ employees), still working	Enroll in Part A; delay Part B until you stop working
Employer plan (fewer than 20 employees)	Enroll in both A and B immediately — your plan pays secondary
COBRA coverage	Enroll in A and B immediately — COBRA doesn’t extend your SEP
Retiree coverage from former employer	Enroll in A and B — retiree plans often require Medicare enrollment
Marketplace / ACA plan	Enroll in A and B — marketplace plans are not creditable employer coverage
VA benefits	Enroll in Part A (free); Part B optional depending on needs

💡 The COBRA trap: COBRA coverage doesn’t extend your limited time to sign up for Medicare. Many people assume their 18 months of COBRA buys them time to think about Medicare. It doesn’t. Your enrollment clock is ticking from the moment your active employment ends, and waiting for COBRA to expire could trigger permanent penalties.

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♿ Why the 24-Month Medicare Disability Waiting Period Exists (and How to Survive It)

When Congress voted in 1972 to expand Medicare to cover people with disabilities, it included the two-year delay to help mitigate the cost of adding those beneficiaries to the rolls and to avoid replacing coverage some workers would be able to get from their former employers through COBRA.

That means if you’re approved for SSDI at age 50, you won’t see Medicare coverage until 24 months of receiving disability payments have passed. When you factor in the separate 5-month SSDI waiting period, people who can no longer work have to wait a total of 29 months from the onset of disability for Medicare coverage.

According to a Commonwealth Fund report, nearly 39% of individuals do not have health insurance at some point during the waiting period, and 24% have no coverage during the entire period.

🔍 Disability Scenario	⏱️ Medicare Start Date
Standard SSDI approval	25th month of receiving disability benefits
ALS (Lou Gehrig’s disease)	Immediately upon SSDI approval — no waiting period
End-Stage Renal Disease (ESRD)	As early as 1st month of dialysis (conditions apply)
SSDI approved at age 64	Coverage begins at 65 (standard age eligibility kicks in first)
Returning to work on SSDI	93 months of premium-free Part A after trial work period

💡 Survival strategies during the gap: If you’re stuck in the waiting period, explore Medicaid eligibility in your state, marketplace plans through Healthcare.gov (SSDI recipients may qualify for subsidies), or your state’s COBRA extensions beyond the federal 18-month minimum.

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📆 Every Medicare Enrollment Period You Need to Know in 2026

Medicare has multiple enrollment windows throughout the year, and each one serves a different purpose. Missing the right one means waiting months — sometimes an entire year — before you get another chance.

📌 Enrollment Period	📅 Dates	🎯 Who It’s For	⚡ What You Can Do
Initial Enrollment Period (IEP)	7 months around your 65th birthday	New Medicare enrollees	Enroll in Parts A, B, C, D, and Medigap
Annual Open Enrollment (AEP)	Oct. 15 – Dec. 7	All Medicare beneficiaries	Switch between Original Medicare and MA; change Part D plans
Medicare Advantage Open Enrollment (MAOEP)	Jan. 1 – Mar. 31	Current MA enrollees only	Switch MA plans or return to Original Medicare + Part D
General Enrollment Period (GEP)	Jan. 1 – Mar. 31	People who missed their IEP	Enroll in Part A and/or Part B (penalties may apply; coverage starts July 1)
Special Enrollment Period (SEP)	Varies	Those with qualifying life events	Enroll/change coverage due to job loss, moving, losing employer coverage, etc.
Medigap Open Enrollment	6 months starting when you’re 65+ and enrolled in Part B	New Part B enrollees age 65+	Buy any Medigap plan sold in your state — guaranteed issue, no health questions

💡 The Part D deadline nobody talks about: If you let more than 63 days lapse without creditable drug coverage, the Part D penalty begins accumulating immediately. Even if you take zero prescriptions today, enrolling in a low-premium Part D plan protects you from this penalty.

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🗺️ State-by-State: Where Medigap Rules Give You Extra Protection (or Leave You Stranded)

While Medicare Parts A, B, C, and D follow the same federal rules in all 50 states, Medigap (Medicare Supplement) is where your state of residence dramatically changes your options. Medigap is the only form of private coverage for Medicare beneficiaries that has no federally mandated annual open enrollment period.

The federal government guarantees you one six-month Medigap open enrollment window when you turn 65 and enroll in Part B. After that, in most states, insurers can reject you or charge sky-high premiums based on your medical history.

States with the strongest Medigap consumer protections (continuous or annual guaranteed issue):

🏆 State	🛡️ Protection Level
Connecticut	Continuous guaranteed issue — buy Medigap anytime
Massachusetts	Continuous guaranteed issue — unique plan structure
Maine	Annual guaranteed issue window
New York	Continuous guaranteed issue — buy anytime at community-rated pricing

States with “birthday rule” Medigap switching windows (growing trend as of 2026):

🎂 State	📅 Window Details
California	60-day window starting on birth month; switch to equal or lesser plan from any carrier
Idaho	63 days from birthday
Oregon	30-day window starting on birth month
Louisiana	63 days from birthday; must stay with same carrier or affiliate
Nevada	60-day window from 1st day of birth month
Maryland	30-day window after birthday
Oklahoma	60-day window from birthday
Kentucky	60-day window following birthday; same plan, different insurer
Delaware	Effective Jan. 1, 2026 — same or lesser benefits
Indiana	Effective Jan. 1, 2026 — same plan type, different insurer
Virginia	Effective July 2025 — same plan, different insurer
Wyoming	63-day window from birthday; same or lesser benefits

States where under-65 disabled beneficiaries have the least Medigap access:

Four states have no provisions and no plans geared to the under-65 population — Arizona, North Dakota (recently ended its high-risk pool), Nevada (limited), and Utah. Meanwhile, 16 states make all Medigap plans guaranteed-issue for under-65 beneficiaries and include restrictions on premiums.

💡 If you’re under 65 with a disability: Research your specific state’s rules before assuming you can buy Medigap. In states without protections, you may face medical underwriting or flat-out denials. Contact your State Health Insurance Assistance Program (SHIP) for free, personalized guidance.

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💵 The IRMAA Surprise: When Higher Income Means Higher Medicare Premiums

Most new enrollees don’t realize that Medicare premiums aren’t flat — they’re income-tested. The IRMAA income brackets apply to beneficiaries with income exceeding $109,000 for single filers or $218,000 for joint filers.

What makes IRMAA particularly tricky is the two-year lookback. Your 2026 IRMAA is based on your 2024 Modified Adjusted Gross Income, and IRMAA follows a “cliff” structure, meaning even $1 over an income threshold can trigger a significantly higher monthly premium.

💼 Filing Status & 2024 MAGI	💲 2026 Monthly Part B Premium	💊 Part D Monthly Surcharge
Single: ≤$109,000 / Joint: ≤$218,000	$202.90 (standard)	$0.00
Single: $109,001–$137,000 / Joint: $218,001–$274,000	$284.10	$14.50
Single: $137,001–$171,000 / Joint: $274,001–$342,000	$405.80	$37.40
Single: $171,001–$205,000 / Joint: $342,001–$410,000	$527.50	$60.30
Single: $205,001–$500,000 / Joint: $410,001–$750,000	$649.20	$83.20
Single: ≥$500,000 / Joint: ≥$750,000	$689.90	$91.00

💡 Strategic move: If you retired in 2024 and your income dropped significantly from your working years, you can request an IRMAA reconsideration from the SSA using a “life-changing event” appeal. Work stoppages, pension plan terminations, and divorces all qualify as valid reasons to use current-year income instead.

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🩺 When to Sign Up for Part B vs. Part D: They’re Not the Same Decision

A common mistake is treating Part B and Part D enrollment as identical decisions. They have different penalty structures, different creditable coverage rules, and different enrollment windows.

Part B (medical insurance): You should enroll during your IEP unless you have qualifying employer group coverage. The penalty is 10% per full year of delay, applied permanently.

Part D (prescription drug coverage): You should enroll when first eligible unless you have creditable drug coverage — meaning coverage at least as good as standard Part D. If you don’t go more than 63 days without creditable drug coverage, you won’t pay the Part D late enrollment penalty.

🔬 Comparison	Part B	Part D
2026 standard premium	$202.90/month	Varies by plan (avg. ~$46.50)
Penalty trigger	No qualifying employer coverage	No creditable drug coverage for 63+ days
Penalty calculation	10% per full 12-month delay	1% of $38.99 per uncovered month
Penalty duration	Lifetime	Lifetime (while you have drug coverage)
Enrollment if you miss IEP	General Enrollment Period: Jan. 1–Mar. 31 (coverage starts July 1)	Annual Open Enrollment: Oct. 15–Dec. 7
2026 annual deductible	$283	Up to $615 (varies by plan)

💡 The Part D zero-prescription trap: Even if you currently take no medications, skipping Part D enrollment is a gamble. The penalty compounds every month you’re uncovered, and the longer you wait, the more you’ll pay when you eventually do need prescriptions. Low-cost Part D plans with premiums under $10/month exist specifically for this purpose.

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❓ Frequently Asked Questions

What is the earliest you can apply for Medicare?

The earliest most people can enroll is three months before their 65th birthday, which is the start of the 7-month Initial Enrollment Period. For those under 65 with disabilities, enrollment happens automatically after 24 months of receiving SSDI benefits. People with ALS get enrolled immediately upon receiving disability benefits, and those with ESRD can start coverage as early as the first month of dialysis under certain conditions.

Why do I have to wait 2 years for Medicare if I’m disabled?

The 24-month waiting period was written into the 1972 law that extended Medicare to people with disabilities. Congress included the delay primarily to control the cost of expanding the program and to avoid immediately replacing employer-sponsored coverage that many disabled workers could access through COBRA. Advocacy groups have pushed to eliminate or reduce this waiting period for decades, but no legislation has successfully passed as of 2026.

What is the best age to go on Medicare?

For most people, 65 is the optimal enrollment age because it triggers the IEP and Medigap open enrollment windows simultaneously. However, if you have solid employer coverage through a company with 20 or more employees, delaying Part B until you stop working can make financial sense. The key consideration is whether your employer plan is truly “creditable” — if it isn’t, every month you delay adds to your penalty.

Can I sign up for Medicare before turning 65?

Yes, but only through specific qualifying pathways: receiving SSDI for 24 months, having ALS, or having ESRD. You cannot simply buy into Medicare early because you want to — there is no option to enroll based on age alone before 65, regardless of health status or willingness to pay.

When should I sign up for Medicare Part B if I am still working?

If your employer has 20 or more employees and provides group health coverage, you can safely delay Part B until you retire or lose that coverage. Once that happens, you have an 8-month SEP to enroll penalty-free. However, if your employer has fewer than 20 employees, Medicare becomes your primary payer at 65, and you should enroll in Part B during your IEP to avoid coverage gaps and penalties.

What happens if I don’t sign up for Medicare at 65?

If you don’t enroll during your IEP and don’t qualify for a Special Enrollment Period, you’ll have to wait until the General Enrollment Period (January 1 – March 31), and your coverage won’t start until July 1 of that year. During the gap, you could be uninsured. On top of that, you’ll pay a 20% late enrollment penalty on Part B premiums if you waited two full years, and this penalty is permanent.

When can I sign up for Medicare Part D?

Your first chance is during your IEP — the same 7-month window around your 65th birthday. After that, the Annual Open Enrollment Period (October 15 – December 7) is your main opportunity to enroll in or switch Part D plans. If you lose creditable drug coverage at any point, you get a 63-day window to enroll in Part D without penalty.

Do Medicare enrollment rules differ by state?

Parts A, B, C, and D enrollment timelines are identical nationwide. The major state-by-state differences involve Medigap. Some states have enrollment opportunities that go beyond the minimum requirements set by the federal government. Three states — Massachusetts, Minnesota, and Wisconsin — even use non-standard Medigap plan structures instead of the traditional lettered plans available elsewhere.

Is there a way to appeal Medicare penalties?

Yes. If you believe your penalty was assessed in error — for example, you had creditable coverage that wasn’t properly reported — you can request a reconsideration. For Part B penalties, contact the SSA. For Part D penalties, your drug plan will provide instructions on how to file an appeal. The key is having documentation of your prior creditable coverage, such as a letter from your employer confirming your plan met Medicare’s standards.

What is the $2,000 out-of-pocket cap I keep hearing about for 2025?

Starting in 2025, the Inflation Reduction Act capped annual out-of-pocket spending on Part D prescription drugs at $2,000, with the 2026 threshold at $2,100, after which you automatically get catastrophic coverage and pay nothing for covered Part D drugs for the rest of the year. This is a major financial protection that makes Part D enrollment even more valuable than before.

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The bottom line: Medicare enrollment isn’t a single event — it’s a series of time-sensitive decisions where getting the timing right can save you thousands of dollars over your lifetime. Mark your calendar three months before your 65th birthday, verify whether your current coverage qualifies as creditable, and contact your local SHIP office (free in every state) for personalized guidance before making any enrollment decisions.