Should You Start Medicare and Social Security at the Same Time?

When you turn 65, a big question looms—should you start Medicare and Social Security at the same time? The answer depends entirely on your circumstances, and as we like to say here at Medicare School, the right choice isn’t always the obvious one.

Let’s walk through the most important factors to help you decide what’s best for your retirement health and income strategy.

When It Makes Sense to Start Both at 65

If you’re fully retired at 65—meaning you’re not earning any wages, 1099 income, commissions, or W-2 income—it might make sense to start both Medicare and Social Security at the same time. In this case, you’re no longer subject to the Social Security earnings test, which limits how much you can earn without seeing your benefits reduced.

For example, if you start Social Security before your full retirement age (which is 67 if you were born in 1960 or later), you can only earn up to $23,400 per year before penalties kick in. For every $2 you earn above that, $1 gets deducted from your Social Security check. So if you’re still working, it might be smarter to wait.

Then there’s the break-even point. If you take Social Security early at 65, it’ll take until about age 82 before your total lifetime benefits catch up to what you would have received by waiting. If you expect to live well into your 80s, waiting could give you higher monthly income over time.

Don’t forget spousal benefits. A spouse can receive up to 50% of the other spouse’s full retirement age benefit—but only if the primary spouse has already filed. Coordinating your filing strategy is key to maximizing what you both receive.

How Early Filing Affects Your Budget

Social Security benefits are reduced if you take them early. Starting at 65 instead of 67 results in a 12% reduction. If you start at 62, the reduction jumps to about 30%.

Let’s look at some quick numbers:

• A $2,000 monthly benefit becomes $1,760 if taken at 65
• A $2,500 benefit becomes $2,200

If you need the money to make your budget work, early filing might be necessary. But if you can hold off, delaying could lead to a more secure retirement.

When You Might Delay Medicare but Not Social Security

Some people have excellent employer-provided group health plans (usually from companies with 20 or more employees). If that’s you, you may want to take Social Security at 65 but delay Medicare Part B.

Medicare Part A is automatic once you sign up for Social Security, but you can opt out of Part B by returning your Medicare card or submitting CMS Form 1763. As long as your employer coverage is credible and continuous, you won’t face penalties for enrolling in Part B later through a Special Enrollment Period.

When You Need to Take Medicare at 65

Certain groups are required to sign up for Medicare at age 65, regardless of whether they’re taking Social Security. These include:

• Those without employer coverage
• Anyone on COBRA
• Retired military personnel with Tricare for Life
• Employees of small companies with 19 or fewer workers
• Individuals using Affordable Care Act (ACA) marketplace plans

COBRA and Tricare shift to secondary payer status once Medicare becomes available, meaning Medicare Part B is necessary to maintain full coverage. ACA plans lose their financial incentives at age 65, making Medicare the better option.

When It Makes Sense to Delay Medicare

If you have a strong group health plan through an employer with 20+ employees and you’re still contributing to a Health Savings Account (HSA), you’ll want to avoid enrolling in any part of Medicare.

Enrolling in Medicare Part A disqualifies you from making HSA contributions, so even if Part A is premium-free, it’s better to delay enrollment entirely if the HSA is part of your financial strategy.

Just be aware: Medicare Part A only carries penalties for those who don’t have enough work history—specifically fewer than 40 quarters of employment. If you’ve met that mark, there’s no penalty for enrolling later.

Comparing Medicare with Employer Coverage

Let’s say you have employer coverage but it’s not great—maybe the premiums are high or the coverage is weak. In that case, it’s worth comparing the total out-of-pocket costs and benefits of staying with your employer’s plan versus switching to Medicare.

Medicare often provides stronger coverage and may be less expensive, especially when paired with a good Medicare Supplement or Advantage plan.

Spousal Benefits and Filing Strategies

Spouses can qualify for Social Security benefits based on their partner’s work record, but a few rules apply. You must be married for at least one year, and the primary spouse must already be receiving benefits.

The old strategy of filing and suspending to trigger spousal benefits no longer works under current rules. So, timing your filings together is essential to make sure both partners get the most out of their benefits.

The Bottom Line

There’s no one-size-fits-all answer. Whether you start Medicare and Social Security at the same time or stagger your enrollment depends on your income, employment status, health coverage, and retirement goals.

Our recommendation? Take a close look at your total financial picture. What’s your budget? Are you still working? Do you have a spouse to coordinate with? These answers can make or break your retirement strategy.