Social Security and Medicare: What Happens at 65?

Turning 65 brings up two big questions:

•  “Do I start Social Security?”

•  “And what do I do about Medicare?”

These are two separate government programs — but they often work together. Understanding how they connect can save you time, money, and confusion.

Social Security: When Should You Start?

You can begin collecting Social Security as early as age 62. However, if you start before your Full Retirement Age, your monthly benefit will be permanently reduced.  For individuals turning 65 in 2026 (born in 1961), your Full Retirement Age is 67. If you wait until age 67, you receive your full monthly benefit.  If you delay beyond 67 (up to age 70), your benefit increases each year you wait. Some people choose to start earlier than others.  It depends on your financial situation, health, and retirement plans. Consulting an accountant is best.

Medicare: Separate from Social Security

Medicare eligibility generally, with a few exceptions, begins at age 65, regardless of whether you start Social Security. That’s where many people get confused.  You do not have to start Social Security in order to enroll in Medicare.  Original Medicare includes:

• Part A – Hospital Insurance

• Part B – Medical Insurance

• Part D – Prescription Drug Coverage

There are deductibles and coinsurance costs with Original Medicare. People can choose to complete their coverage with:

• A Medicare Supplement (Medigap) plan  OR

• A Medicare Advantage plan

The right choice depends on your health needs and financial preferences.

How Social Security and Medicare Work Together

If you are already collecting Social Security when you turn 65:

• You are automatically enrolled in Medicare Part A and Part B.

• Your Part B premium is typically deducted from your Social Security check.

If you are not collecting Social Security yet:

• You must actively enroll in Medicare.

• You can enroll online at SSA.gov, by phone, or in person.

• You will be billed directly for your Medicare premiums.

What If You’re Still Working at 65?

Many people today continue working past age 65.  If you have employer health coverage through active employment (yours or your spouse’s), you may be able to delay enrolling in Medicare Part B without penalty.  If your employer has less than 20 employees, you may be required to enroll in Medicare. However, if your employer has 20 or more employees, you may be able to simply continue with that coverage and delay enrollment in Medicare. Later, when you retire and lose employer coverage, as long as your coverage has been continuous, you qualify for a Special Enrollment Period (SEP) to enroll in Medicare.  You will need proof of prior employer coverage when you enroll to avoid late enrollment penalties. Use form CMS-L564, one for you and one for your spouse if needed, found on SSA.gov. Scroll down to the bottom of the first page and click on "Forms".

Key reminders:

• Medicare is individual coverage. Employer insurance often covers spouses or dependents, Medicare does not. That can affect the timing of retirement decisions.

• Enrolling in Part A of Medicare is voluntary and optional once you turn 65, and has no premium, as long as you qualify. You may enroll to get your Medicare number for Part A only. However, keep in mind that if you enroll in any Part of Medicare, including Part A, you will no longer be able to contribute to an HSA.

The Bottom Line

Social Security and Medicare are connected — but they are not the same. You can:

• Take Social Security and Medicare at the same time

• Take Medicare at 65 and delay Social Security

• Continue working and delay both

The right timing depends on your personal situation.  Turning 65 is not just a birthday — it’s a planning milestone.  Making informed decisions now can make retirement feel much smoother.

Medicare and Social Security