If you are turning 65, you are about to become eligible for Medicare — and the decisions you make in the next few months will affect your healthcare costs for years to come. The rules are not complicated once you understand the basics, but there are enrollment deadlines you need to know about, choices between coverage options, and costs to plan for.
This guide covers what Medicare is, when you need to enroll, what you need to decide, and what it will cost you in 2026. If you are approaching 65 and have not started thinking through Medicare yet, this is the right place to start.
What Medicare is
Medicare is the federal health insurance program for people 65 and older, as well as certain younger people with qualifying disabilities. It is organized into parts, each covering a different category of care.
- Part A (Hospital Insurance) — Covers inpatient hospital stays, skilled nursing facility care following a qualifying hospital stay, hospice, and some home health services. Most people pay no monthly premium for Part A if they or a spouse worked and paid Medicare taxes for at least 10 years.
- Part B (Medical Insurance) — Covers doctor visits, outpatient care, preventive services, lab work, and medically necessary equipment. Part B has a monthly premium. The standard premium in 2026 is $202.90 per month.
- Part C (Medicare Advantage) — An alternative to Original Medicare offered through private insurance companies approved by Medicare. These plans bundle Part A and Part B coverage, often including Part D and extra benefits like dental and vision, under a single plan with its own cost structure and provider network.
- Part D (Prescription Drug Coverage) — Covers prescription medications. If you choose Original Medicare, you generally need to enroll in a standalone Part D plan. Most Medicare Advantage plans include drug coverage.
Parts A and B together are called Original Medicare. When people say they are “on Medicare,” they typically mean either Original Medicare or a Medicare Advantage plan.
Your enrollment window — and why it matters
You do not automatically get enrolled in Medicare when you turn 65 unless you are already receiving Social Security benefits. If you are not receiving Social Security yet, you need to sign up yourself — and there is a specific window to do it.
Your Initial Enrollment Period (IEP) is a 7-month window:
- The 3 months before the month you turn 65
- The month you turn 65
- The 3 months after the month you turn 65
For example, if your birthday is in September, your window runs from June through December. Signing up in the first three months of your window means your Part B coverage starts on the first of your birthday month. Waiting until after your birthday month may delay your coverage start date by one to three months.
Missing this window without a qualifying reason means waiting for the General Enrollment Period (January 1 through March 31 each year), with coverage starting July 1 — and potentially facing a permanent late enrollment penalty that adds to your premium for life.
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Original Medicare or Medicare Advantage — your first big choice
Once you enroll in Parts A and B, you face the most consequential decision in your Medicare setup: do you stay with Original Medicare, or join a Medicare Advantage plan?
Original Medicare gives you nationwide flexibility — you can use any doctor, hospital, or specialist that accepts Medicare, with no referral requirements. The tradeoff is that there is no annual cap on out-of-pocket costs. Most people on Original Medicare also add a standalone Part D drug plan and a Medigap supplement policy to fill the coverage gaps.
Medicare Advantage plans are offered by private insurers and often include dental, vision, and hearing benefits not available under Original Medicare. They also have annual out-of-pocket maximums, which limit your exposure in a bad health year. The tradeoff is provider networks — your coverage may be limited to in-network doctors and facilities, and you may need referrals to see specialists.
Neither is right for everyone. The best choice depends on your current doctors, health conditions, prescriptions, travel habits, and what you can budget for premiums versus out-of-pocket costs. Switching from Medicare Advantage back to Original Medicare later in life also has complications, particularly around Medigap eligibility. Getting this decision right at 65 matters.
If you choose Original Medicare — consider a Medigap policy
Original Medicare leaves two significant cost gaps: Part B pays 80% of approved costs, leaving you responsible for the remaining 20% with no annual limit. And the Part A hospital deductible in 2026 is $1,736 per benefit period — not per year, but per benefit period, which can apply more than once.
A Medigap policy (also called Medicare Supplement insurance) is private coverage sold to fill some or all of those gaps. The critical window: in most states, insurance companies must sell you any Medigap plan at standard rates, with no medical underwriting, during the 6 months immediately after your Part B coverage begins. After that window closes, they can charge more or deny coverage based on your health history.
If you plan to go with Original Medicare, start shopping for Medigap as soon as your Part B effective date is confirmed. Do not wait until after the open enrollment window.
Medicare rules can vary based on your situation, so it’s important to review your options carefully.
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What Medicare costs in 2026
- Part A premium: $0 for most people who worked and paid Medicare taxes for 10 or more years (40 quarters)
- Part B premium: $202.90/month standard in 2026. Higher-income individuals pay more through IRMAA surcharges — these apply above $109,000 for individuals or $218,000 for married couples filing jointly, based on 2024 tax returns
- Part B annual deductible: $283 in 2026
- Part A hospital deductible: $1,736 per benefit period in 2026
- Part D premiums: Vary by plan. Enrollment is during your Initial Enrollment Period or the Annual Enrollment Period each fall (October 15 – December 7)
If you are in a Medicare Advantage plan, your total costs depend on that plan’s structure — premiums, copays, and out-of-pocket maximums vary significantly across plans and regions.
Still working at 65? When you can delay
If you or your spouse is actively employed and covered by an employer health plan from that current employment, you may be able to delay enrolling in Part B without penalty. The key qualifier: it must be coverage from active employment — COBRA coverage and retiree health plans do not count.
When that employer coverage ends, you will have an 8-month Special Enrollment Period to sign up for Part B without a late penalty. However, you should confirm the details with your HR department before assuming you qualify — the rules have nuances, and a wrong assumption can result in a permanent penalty. For a full breakdown of the employer coverage rules, what counts as qualifying, and what to do when coverage ends, see our guide to Medicare and employer coverage at 65. For the full range of SEP triggers beyond employer coverage, see our Medicare Special Enrollment Periods guide.
Part A is usually free and has no premium, so most people enroll in Part A at 65 regardless of whether they delay Part B.
What happens if you miss your enrollment window
Missing your Initial Enrollment Period without qualifying coverage triggers permanent penalties — they are added to your premium for as long as you have Medicare, not just for a limited time.
- Part B late enrollment penalty: 10% is added to your monthly premium for every 12-month period you were eligible but did not enroll. If you went 2 years without enrolling, your premium increases by 20% — permanently.
- Part D late enrollment penalty: 1% of the national base beneficiary premium for every month you went without creditable prescription drug coverage. Also permanent.
If you have already missed a window or are unsure whether your current coverage qualifies as “creditable,” a licensed Medicare advisor can help you understand whether a Special Enrollment Period applies to your situation. For a full breakdown of every enrollment window, how penalties are calculated, and when exceptions apply, see our guide to Medicare enrollment deadlines and penalties.
Your Medicare checklist — what to do now
- Find your 65th birthday month and count back 3 months — that is when your enrollment window opens. Mark it on your calendar now.
- Contact Social Security to enroll in Part A and Part B. Call 1-800-772-1213 or apply online at ssa.gov. You can usually complete enrollment online in about 10 minutes.
- Decide between Original Medicare and Medicare Advantage. Review plans available in your area at medicare.gov/plan-compare.
- If you choose Original Medicare, start shopping for Medigap plans immediately — your open enrollment window begins when your Part B coverage starts and lasts only 6 months.
- Enroll in a Part D prescription drug plan if your coverage does not already include it — see our Part D guide for how plans work and how to compare them.
- If you are still working with employer coverage, confirm with HR that it counts as primary coverage and whether you can defer Medicare enrollment without penalty.
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Disclosure: We may receive a referral fee from Chapter if you choose to use their service. Chapter is a licensed health insurance agency and is not affiliated with or endorsed by Medicare or any government agency.
Related Medicare guides
Medicare Overview — How Medicare is structured, what each part covers, and how to navigate the system
Medicare Advantage vs. Original Medicare — A detailed comparison to help you decide which coverage track is right for you
Medicare Part A vs. Part B — What each part covers, the costs, and how they work together
What Medicare Does NOT Cover — Coverage gaps in Original Medicare and what you can do about them
