Turning 65: Your Complete Medicare Guide

Turning 65 is a major milestone, and for most Americans, it means becoming eligible for Medicare. But Medicare enrollment isn't automatic for everyone, and the rules can be confusing.

This guide walks you through everything you need to know: when to enroll, what coverage to choose, and how to avoid the costly mistakes that trip up thousands of people every year.

Your 7-Month Initial Enrollment Period

When you turn 65, you have a specific window to enroll in Medicare called your Initial Enrollment Period (IEP). This 7-month period is centered around your 65th birthday:

Medicare Parts: What You Need to Know

Medicare is divided into different "parts," each covering different services. Understanding these parts is essential before you enroll.

Still Working at 65?

If you're still employed and have health insurance through your job, your Medicare decisions depend on the size of your employer:

Employer with 20+ Employees

Your employer insurance is primary. You have options:

• Option 1: Delay Medicare entirely and stay on employer coverage
• Option 2: Enroll in Part A only (it's free) and keep employer coverage
• Option 3: Enroll in both Parts A and B, drop employer coverage

Employer with Fewer Than 20 Employees

Medicare becomes your primary insurance at 65. You should:

• Enroll in Parts A and B during your Initial Enrollment Period
• Your employer coverage becomes secondary
• Delaying Part B will result in penalties

Your Coverage Options at 65

Once you're enrolled in Medicare Parts A and B (Original Medicare), you have two main paths for additional coverage:

Path 1: Original Medicare + Medigap + Part D

• Keep Original Medicare as your base coverage
• Add a Medigap policy to cover deductibles and coinsurance
• Add a standalone Part D plan for prescription drugs

Best for: Those who want to see any doctor, travel frequently, or prefer predictable costs.

Path 2: Medicare Advantage (Part C)

• Replace Original Medicare with an all-in-one private plan
• Usually includes drug coverage (Part D)
• Often includes extras like dental and vision

Best for: Those who want lower premiums, extra benefits, and don't mind network restrictions.

For a detailed comparison, see our Medigap vs Medicare Advantage Guide.

What Medicare Costs at 65

Standard Medicare Costs (2024)

• Part A Premium: $0 for most people (if you or spouse paid Medicare taxes for 10+ years)
• Part A Deductible: $1,632 per benefit period
• Part B Premium: $174.70/month (higher if income exceeds $103,000)
• Part B Deductible: $240/year
• Part B Coinsurance: 20% of Medicare-approved amounts
• Part D Premium: Varies by plan ($15-$100+/month)

Additional Coverage Costs

• Medigap Premium: $100-$300+/month depending on plan and location
• Medicare Advantage Premium: $0-$150/month (many plans are $0)

How to Enroll in Medicare

Automatic Enrollment

You're automatically enrolled in Parts A and B if:

• You're already receiving Social Security benefits
• You're receiving Railroad Retirement Board benefits

Your Medicare card will arrive about 3 months before your 65th birthday.

Manual Enrollment

You need to actively enroll if:

• You haven't started Social Security yet
• You're still working with employer coverage
• You only want Part A (not Part B)

Ways to Enroll

1. Online: Visit ssa.gov and click "Apply for Medicare"
2. Phone: Call Social Security at 1-800-772-1213 (TTY: 1-800-325-0778)
3. In Person: Visit your local Social Security office

Turning 65 Medicare Checklist

Common Mistakes to Avoid

1. Missing Your Enrollment Window

If you miss your Initial Enrollment Period and don't qualify for a Special Enrollment Period, you'll have to wait for the General Enrollment Period (January-March) and face permanent penalties.

2. Not Understanding the Part B Penalty

The Part B late enrollment penalty is 10% of the premium for every 12-month period you were eligible but didn't enroll. This penalty lasts for life.

3. Confusing COBRA with Employer Coverage

COBRA doesn't give you a Special Enrollment Period. If you're on COBRA at 65, enroll in Medicare immediately.

4. Missing the Medigap Open Enrollment Window

Your Medigap open enrollment period is the 6 months starting when you turn 65 AND are enrolled in Part B. During this window, you can buy any Medigap policy regardless of health. After it closes, you may be denied or charged more.

5. Not Enrolling in Part D

Even if you don't take medications now, you should enroll in a Part D plan. The late enrollment penalty is 1% of the national average premium for every month you were eligible but didn't enroll, and it's permanent.

Frequently Asked Questions

When should I apply for Medicare?

Apply during the 3 months before your 65th birthday for coverage to start on the first of your birthday month. This is the ideal timing.

Is Medicare Part A really free?

Part A is premium-free if you or your spouse paid Medicare taxes for at least 40 quarters (10 years). If not, you may pay up to $505/month in 2024.

Can I delay Medicare if I'm still working?

Yes, if you have coverage through an employer with 20+ employees. You can delay Parts A and B and enroll during a Special Enrollment Period when that coverage ends.

What if I'm on my spouse's insurance?

The same rules apply. If your spouse works for an employer with 20+ employees, you can delay Medicare. When your spouse retires or you lose coverage, you have 8 months to enroll.

Do I have to take Part B?

No, Part B is optional. However, if you delay Part B without qualifying coverage and later decide to enroll, you'll pay permanent penalties.

Can I have Medicare and employer insurance at the same time?

Yes, but which one pays first depends on your employer size. With employers of 20+, employer insurance is primary. With smaller employers, Medicare is primary.