Your Medicare Turning-65 Checklist: Navigating Your Options

Turning 65 is a significant milestone, often bringing new healthcare decisions with it. For many, this means becoming eligible for Medicare, the federal health insurance program for people 65 or older, certain younger people with disabilities, and people with End-Stage Renal Disease (ESRD) or Amyotrophic Lateral Sclerosis (ALS). Understanding your choices and deadlines is key to ensuring you have the right coverage when you need it.

This guide will walk you through the essential steps and considerations as you approach your 65th birthday, helping you understand Medicare's different parts, enrollment periods, costs, and available options.

Key takeaways

• Enroll on time to avoid penalties: Your Initial Enrollment Period (IEP) is a 7-month window around your 65th birthday. Missing it can lead to permanent late enrollment penalties for some parts of Medicare.
• Understand Medicare's four parts: Part A (hospital insurance), Part B (medical insurance), Part C (Medicare Advantage, an all-in-one alternative), and Part D (prescription drug coverage) each cover different services.
• Compare Original Medicare vs. Medicare Advantage: You generally choose between getting your benefits directly through Original Medicare (Parts A & B) and adding supplemental plans, or opting for a Medicare Advantage Plan (Part C) which bundles benefits, often including Part D.
• Factor in potential costs: Even with Medicare, you'll have premiums, deductibles, and other out-of-pocket expenses. These vary depending on the parts you choose and any additional plans you enroll in.
• Consider your current coverage: If you're still working or have other health insurance, understand how it coordinates with Medicare before making enrollment decisions.

What is Medicare and how does it work?

Medicare is a health insurance program funded by the federal government. It's designed to help cover healthcare costs for millions of Americans. It's not a single plan, but rather a program divided into different parts, each covering specific services. Each part plays a specific role in your overall health coverage.

• Part A (Hospital Insurance): Helps cover inpatient hospital stays, care in a skilled nursing facility, hospice care, and some home health care. Most people don't pay a monthly premium for Part A if they've worked and paid Medicare taxes for at least 10 years (40 quarters).
• Part B (Medical Insurance): Helps cover doctor's services, outpatient care, durable medical equipment, and some preventive services. Most people pay a monthly premium for Part B.

• Part C (Medicare Advantage): These are health plans offered by private companies approved by Medicare. They provide all your Part A and Part B benefits, and often include Part D prescription drug coverage and additional benefits like dental, vision, and hearing. When you enroll in a Medicare Advantage Plan, you're still in Medicare.
• Part D (Prescription Drug Coverage): Helps cover the cost of prescription drugs. It's offered by private companies approved by Medicare. You can get Part D as a standalone plan if you have Original Medicare, or it may be included in a Medicare Advantage Plan (MAPD).

These parts work together to provide comprehensive coverage, but your specific choices will determine how your healthcare is delivered and what your costs will be. It's important to understand the distinctions as you plan your enrollment.

When should I enroll in Medicare?

The timing of your Medicare enrollment is critical. The most common enrollment period for those turning 65 is your Initial Enrollment Period (IEP). This is a 7-month window that includes:

• The three months before the month you turn 65.
• The month you turn 65.
• The three months after the month you turn 65.

Missing your IEP, especially for Part B, can result in permanent late enrollment penalties. For Part B, your monthly premium could increase by 10% for each full 12-month period you were eligible for Part B but didn't sign up, unless you qualify for a Special Enrollment Period. For Part D, if you go 63 days or more without creditable prescription drug coverage after your IEP ends, you may face a late enrollment penalty added to your premium for as long as you have Part D. This penalty is 1% of the national base beneficiary premium for each month you delayed enrollment.

Special Enrollment Periods (SEPs)

If you're still working at 65 and have group health coverage through your employer or your spouse's employer, you might be able to delay enrolling in Part B and/or Part D without penalty. This is often allowed if the employer plan is considered "creditable coverage" by Medicare. Once your employment or group health coverage ends (whichever comes first), you'll generally have an 8-month Special Enrollment Period to sign up for Part B and a 63-day Special Enrollment Period for Part D. This is a key consideration if you plan to keep working past 65.

What are the different parts of Medicare?

Understanding what each part of Medicare covers is fundamental to making informed decisions. Medicare is not a one-size-fits-all program, and you have choices in how you receive your benefits. Here's a closer look at what each part entails:

Medicare Part A (Hospital Insurance)

Part A helps cover inpatient care in a hospital, including semi-private rooms, meals, nursing services, and drugs and supplies administered as part of your inpatient treatment. It also covers short-term skilled nursing facility care after a hospital stay, hospice care, and some home health services. Most people do not pay a monthly premium for Part A because they or their spouse paid Medicare taxes through employment for at least 10 years. If you paid Medicare taxes for less than 10 years, you may have to pay a monthly premium for Part A. For 2026, the inpatient hospital deductible is $1,736 per benefit period; this figure is set annually.

Medicare Part B (Medical Insurance)

Part B covers medically necessary services, such as doctor's visits, outpatient care, preventive services, and durable medical equipment (like wheelchairs or walkers). It also covers mental health services, ambulance services, and some home health care. Everyone typically pays a monthly premium for Part B. For 2026, the standard Part B premium is $202.90. There is also an annual deductible, which is $283 for 2026. After you meet the deductible, you generally pay 20% of the Medicare-approved amount for most doctor's services, outpatient therapy, and durable medical equipment. Individuals with higher incomes pay a higher Part B premium, known as the Income-Related Monthly Adjustment Amount (IRMAA).

Medicare Part C (Medicare Advantage Plans)

Medicare Advantage Plans are an alternative way to receive your Medicare benefits. These plans are offered by private insurance companies that contract with Medicare. When you join a Medicare Advantage Plan, you still have Medicare, but the plan delivers your Part A and Part B benefits. Many Medicare Advantage Plans also include Part D prescription drug coverage (MAPD plans) and may offer extra benefits that Original Medicare doesn't cover, such as routine dental, vision, or hearing care, and fitness programs.

Medicare Advantage Plans often have their own network of doctors, hospitals, and other healthcare providers, similar to an HMO or PPO. You will continue to pay your Part B premium, and you may also pay an additional premium to the Medicare Advantage Plan. Co-payments and deductibles will vary by plan, but there is an annual out-of-pocket maximum beyond which the plan pays 100% of your covered medical costs. Plan availability, benefits, and costs vary significantly by location and carrier.

Medicare Part D (Prescription Drug Coverage)

Part D helps cover the costs of prescription drugs. It's offered through private insurance companies either as a standalone Prescription Drug Plan (PDP) to complement Original Medicare, or as part of a Medicare Advantage Plan (MAPD). Each Part D plan has a formulary (list of covered drugs), and costs can vary based on the drug and the plan's tier system. When choosing a Part D plan, you should look at its formulary (the list of covered drugs), whether your specific medications are covered, what tier they fall into (which affects your co-pay), the plan's deductible, and its monthly premium. The costs for medications under Part D can vary, but the structure is generally a deductible, followed by an initial coverage phase where you pay a portion, until your annual out-of-pocket spending reaches $2,100 for 2026. After you reach this cap, the plan pays 100% of your covered prescription drug costs for the rest of the year. An important benefit available to those with Part D is the Medicare Prescription Payment Plan; if you enroll in this program, you can spread your out-of-pocket prescription drug costs throughout the year over monthly bills, potentially paying $0 at the pharmacy counter for covered drugs.

How do Medicare costs work?

Understanding the various costs associated with Medicare is crucial for budgeting and planning your healthcare. These costs can include premiums, deductibles, coinsurance, and co-payments.

• Premiums: This is a monthly fee you pay for your coverage. Most people don't pay a premium for Part A. Everyone typically pays a premium for Part B (the 2026 standard is $202.90). You will also pay a premium for any Part D plan or Medicare Advantage Plan you choose.
• Deductibles: This is the amount you must pay out-of-pocket before your insurance begins to pay. For 2026, the Part A deductible per benefit period is $1,736, and the Part B annual deductible is $283. Part D plans also have a deductible, which can be up to $615 for 2026.

• Coinsurance: Once you meet your deductible, coinsurance is a percentage of the cost you pay for covered services. For example, under Original Medicare Part B, you typically pay 20% of the Medicare-approved amount after your deductible.
• Co-payments: This is a fixed amount you pay for a covered service, such as a doctor's visit or a prescription drug, at the time you receive the service. These are more common with Medicare Advantage and Part D plans.
• Out-of-Pocket Maximums: Medicare Advantage Plans have an annual out-of-pocket maximum for Part A and Part B services. Once you reach this limit, the plan pays 100% of your covered services for the rest of the year. For Part D, once your annual out-of-pocket spending for covered prescription drugs reaches $2,100 in 2026, the plan pays 100% of your covered drug costs for the rest of the year. Original Medicare does not have an out-of-pocket maximum, which is why many beneficiaries choose to enroll in a Medicare Supplement (Medigap) policy to help cover these costs.

What are my coverage options: Original Medicare vs. Medicare Advantage?

This is one of the most important decisions you'll make when enrolling in Medicare. You generally have two main paths to consider:

Option 1: Original Medicare (Parts A & B) with potential additions

With Original Medicare, the government directly pays for your healthcare services. You can see any doctor, hospital, or supplier in the U.S. that accepts Medicare. To get more comprehensive coverage and help with out-of-pocket costs, you can add:

• A Medicare Supplement Insurance (Medigap) Policy: These plans are offered by private companies and help pay some of the costs that Original Medicare doesn't cover, such as deductibles, co-payments, and coinsurance. You pay a separate monthly premium for a Medigap policy. It's important to note that Medigap plans generally do not cover prescription drugs, so you'd also need a Part D plan.
• A Medicare Part D Prescription Drug Plan (PDP): A standalone plan to cover your prescription medications.

Option 2: Medicare Advantage Plan (Part C)

Medicare Advantage Plans are offered by private insurance companies approved by Medicare. These plans bundle your Part A, Part B, and usually Part D benefits into one plan. Many plans also offer extra benefits, like vision, dental, hearing, and wellness programs. Instead of paying directly for each service under Original Medicare, you often pay co-payments for services within the plan's network. It's important to compare plans available in your area carefully, as benefits, costs, and provider networks can vary significantly by plan and carrier.

What if I'm still working and have employer coverage?

If you're nearing 65 but still working and have health insurance through your employer (or your spouse's employer), you have important decisions to make. Your employer coverage might affect when and how you enroll in Medicare.

• Employer size matters: If your employer has 20 or more employees, your group health plan is usually the primary payer, and Medicare is secondary. In this case, you might be able to delay Part B and Part D enrollment without penalty until your employment or coverage ends. It's often recommended to enroll in Part A at 65, even if you keep working, as it's typically premium-free for most people.
• Smaller employers: If your employer has fewer than 20 employees, Medicare usually becomes the primary payer once you turn 65. In this scenario, you would generally need to enroll in Part B during your Initial Enrollment Period to avoid gaps in coverage and potential late enrollment penalties.

• HSAs: If you have a Health Savings Account (HSA) and want to continue contributing to it, you should generally not enroll in any part of Medicare, including premium-free Part A. Once you enroll in Medicare, you can no longer contribute to an HSA without facing tax penalties. However, you can use existing HSA funds to pay for Medicare premiums and other qualified medical expenses.

Always check with your employer's benefits administrator to understand how your specific group health plan works with Medicare and whether it's considered "creditable coverage" for prescription drugs. This will help you avoid penalties and ensure continuous coverage.

How do I actually enroll?

Enrolling in Medicare can seem complex, but by breaking it down, it becomes more manageable. The process depends on whether you're already receiving Social Security benefits.

• If you're already receiving Social Security benefits: You will typically be automatically enrolled in Part A and Part B when you turn 65. Your Medicare card will be mailed to you about three months before your 65th birthday. If you want to decline Part B (e.g., because you have creditable employer coverage), follow the instructions on the card.
• If you are NOT receiving Social Security benefits: You will need to actively sign up for Medicare. You can do this in several ways:

• Online: Visit Social Security's website at SSA.gov to apply for Medicare only. This is generally the easiest and fastest way.
  • By phone: Call Social Security at 1-800-772-1213 (TTY 1-800-325-0778), Monday through Friday, 8 a.m. to 7 p.m. local time.
  • In person: Visit your local Social Security office.

Once you have Part A and Part B, you then choose your path: either staying with Original Medicare and deciding on a Medigap policy and/or a standalone Part D plan, or enrolling in a Medicare Advantage Plan (which typically includes Part D). You can enroll in a Medicare Advantage Plan or a standalone Part D plan during your Initial Enrollment Period, or later during the Annual Enrollment Period (October 15 – December 7) or a Special Enrollment Period.

Remember that plan details, including benefits, networks, and costs, vary by location and carrier. It's always a strong option to compare what's available in your specific zip code to find a plan that works well for your individual needs and budget.

Have questions? Call 1-877-443-3251 for free, no-obligation help from a licensed agent.

We do not offer every plan available in your area. Any information we provide is limited to those plans we do offer in your area. Please contact Medicare.gov or 1-800-MEDICARE to get information on all of your options. Medicare has neither reviewed nor endorsed this information.