Medicare and Social Security, side by side.
They are separate programs but they interact. Here is when Medicare auto-enrolls, how premiums are paid, and what changes if you delay Social Security.
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Auto-enrollment at 65
If you are already receiving Social Security retirement benefits when you turn 65, you are automatically enrolled in Medicare Part A and Part B. Your Medicare card arrives in the mail about 3 months before your 65th birthday.
If you are NOT receiving Social Security at 65, you have to actively enroll in Medicare yourself. See our turning-65 timeline.
How Part B premiums get paid
If you receive Social Security retirement, your Part B premium is automatically deducted from your monthly benefit. If you are not on Social Security yet, you pay Medicare directly each quarter (or set up an EFT bill pay through Medicare).
Delaying Social Security past 65
You can delay Social Security retirement up to age 70 (and get a higher monthly benefit later). This does NOT delay your Medicare enrollment requirement. You still need to enroll in Medicare at 65 — or face the late enrollment penalty.
IRMAA — the income-related surcharge
If your modified adjusted gross income is above set thresholds, you pay an Income-Related Monthly Adjustment Amount (IRMAA) on top of standard Part B and Part D premiums. The threshold and surcharge change yearly. IRMAA is based on your tax return from 2 years prior.
If you have a big income event (selling a business, large capital gains) and your income drops later, you can request reconsideration of IRMAA based on a "life-changing event."