You don’t have to wait until you’re retired or no longer employed to enroll in Medicare. Your options ultimately depend on your current health insurance coverage and budget.

Most people become eligible for Original Medicare (parts A and B) at age 65 years. If you’re still working, you may be able to delay Medicare enrollment without having to pay a late fee.

People who qualify for premium-free Part A (hospital insurance) typically sign up when their eligibility begins. Some people keep their preexisting health coverage and enroll in premium-free Part A for dual benefits.

You can wait to enroll in Part B (medical insurance) until you stop working or lose employer-sponsored coverage, whichever comes first. You won’t pay a late enrollment penalty in this scenario.

If you’re self-employed or have a health insurance policy limited to certain groups, like retiree coverage, you may need to sign up for Medicare when you turn 65 years old to avoid a monthly Part B late enrollment penalty.

If you have insurance from Medicaid, the Health Insurance Marketplace, or another private company, contact your insurer to learn more. Some companies will decrease or stop coverage for services that would be covered if you enrolled in Medicare.

Unless you currently have creditable drug coverage, waiting to sign up for a prescription drug plan (Part D) could result in a monthly late enrollment penalty.

There’s often little downside to enrolling in premium-free Medicare Part A. You may be eligible if you or a spouse paid into Medicare through payroll taxes for at least 10 years of employment or enrolled in Medicare before age 65 years.

Depending on whether you currently have and plan to keep an employer-sponsored health insurance plan, Medicare may act as a primary or secondary payer.

The primary plan pays up to the limits of its coverage. The secondary plan pays only when the primary payer does not cover certain costs.

Medicare generally acts as a primary payer if you work for a company with fewer than 20 employees. In some cases, Medicare may provide better coverage than what you currently receive.

Medicare typically acts as a secondary payer if you work for a company with at least 20 employees or a company participating in a qualifying multiemployer group plan. In this case, Medicare can help fill in gaps in your existing coverage.

Confirm your eligibility

Most people qualify for premium-free Part A. If you have a Login.gov or ID.me account, use it to log in to the Social Security website, where you can find out if you’ve paid into Medicare long enough to qualify.

You can create an account using the information in this guide. Your employer may also be able to tell you more about your eligibility.

Paying a premium for more than one policy can be expensive. If you aren’t eligible for premium-free Part A, enrolling in Medicare when you already have other health insurance may cost you more with little benefit.

Check your current plan against the most recent Part A premiums to decide whether it’s worth switching insurers or having both. In 2024, you’ll pay $278 or $505 per month, depending on how long you or a spouse worked and paid Medicare taxes.

If you cancel your current health insurance coverage and switch to Medicare, you must enroll in parts A and B to avoid paying penalties.

Part B has a monthly premium, even if you qualify for premium-free Part A. The higher your income, the higher your premium will be. In 2024, you’ll pay at least $174.70 per month.

If you keep your current health insurance coverage and enroll in Part B, you’ll be paying for coverage you may not need or use.

It’s also important to understand that you can’t contribute to (pay into) a health savings account (HSA) while you’re covered by any Medicare policies. However, you can continue withdrawing money until you have a zero-balance account.

Medicare coverage is retroactive, so if you enroll when you’re age 65 years or older, coverage usually begins 6 months before your application date. That means HSA contributions should stop at least 6 months before you plan to enroll.

If your Medicare coverage overlaps with contributions to your HSA, you’ll have to pay a tax penalty.

You are usually not required to enroll in Medicare as soon as you become eligible if you are already covered by a group health plan or private insurance policy.

In some cases, it may make sense to switch to Medicare completely. You can enroll in Original Medicare (parts A and B) with separate drug coverage (Part D) or Medicare Advantage (Part C), which usually bundles coverage from parts A, B, and D.

If you have questions about enrollment or are unsure what to choose, consider contacting your local State Health Insurance Assistance Program (SHIP). SHIP provides free, unbiased, one-on-one insurance counseling.