How Medicare and Social Security work together.  They are closely connected—but they’re not the same program. You can enroll in Medicare without starting Social Security, or start Social Security and have your Medicare premiums deducted from your benefit automatically. This page explains how Medicare and Social Security work together so you can choose smart timing, avoid late-enrollment penalties, and coordinate income to manage IRMAA surcharges.

Medicare & Social Security: What Connects Them?

• Enrollment pathway: The Social Security Administration (SSA) handles Medicare enrollment for Parts A & B. You can enroll through SSA even if you delay your Social Security checks.
• Premium deductions: If you’re already receiving Social Security, your Part B (and usually Part D) premiums are deducted from your monthly benefit. If you delay Social Security, you’ll be billed directly until benefits start.
• IRMAA: Higher-income retirees may pay a surcharge on Parts B & D called IRMAA. It’s based on your IRS-reported MAGI from two years prior and administered by SSA.
• COLAs: Social Security cost-of-living adjustments help offset Part B premium changes (your net deposit can still change year to year).

Do I Need Social Security to Enroll in Medicare?

No. You can (and often should) enroll in Medicare at 65 even if you’re delaying Social Security to earn Delayed Retirement Credits. If you’re covered by active employer group coverage (20+ employees) you may qualify to delay Part B without penalty—get personalized guidance before you decide.

Key Timelines That Tie Medicare and Social Security Together

• Initial Enrollment Period (IEP): Seven months around your 65th birthday for Medicare Parts A & B.
• Special Enrollment Period (SEP): If you had qualifying employer coverage, you can enroll later without penalty after that coverage ends.
• Medigap Open Enrollment: A six-month window that starts when your Part B becomes effective—guaranteed issue, no medical underwriting.
• Part D Late Penalty: Applies if you go 63+ days without creditable drug coverage after eligibility.

Medicare, Social Security & IRMAA (Income Surcharges)

SSA reviews your modified adjusted gross income (MAGI) from two years prior to determine if IRMAA applies. Planning withdrawals and Roth conversions, timing annuity income, and managing capital gains can help reduce future surcharges. If your income has dropped due to a life-changing event (retirement, marriage status change, etc.), you can appeal IRMAA with SSA.

Working Past 65: Coordination Tips

• Large employer coverage (20+): You can usually delay Part B; confirm your plan is creditable for both medical and drug coverage.
• Small employer (under 20): Medicare is typically primary—you’ll want to enroll in Parts A & B to avoid gaps and penalties.
• HSA caution: If you plan to keep contributing to an HSA, do not start any part of Social Security or Part A. Part A is retroactive up to six months and would disqualify HSA contributions for that period.

Do Premiums Come Out of My Social Security Check?

Yes—once you start Social Security, SSA typically deducts Medicare Part B and any Part D or Medicare Advantage premiums from your monthly benefit automatically. If you’re delaying Social Security, you’ll receive a bill or set up EFT until your benefits begin.

When Delaying Social Security but Starting Medicare Makes Sense

• Maximizing lifetime benefits: Waiting on Social Security can earn roughly 8% per year (DRCs) until age 70.
• Healthcare coverage: You still enroll in Medicare at 65 to avoid penalties and gaps.
• Cash-flow bridge: Cover Part B/D premiums from savings, work income, or guaranteed annuity income.

Common Medicare & Social Security Questions