Turning 64 in 2026? Your Pre-Medicare Year Checklist

Marketplace Coverage at 64: The 2026 Subsidy Cliff and the Handoff to Medicare

Marketplace coverage at age 64 sits in the most expensive age band under the ACA's 3-to-1 age-rating rule, so the 2026 return of the 400% Federal Poverty Level subsidy cliff hits this group hardest. Enhanced premium tax credits expired on January 1, 2026, which means a household of two earning above $86,560 in 2026 receives no premium tax credit through healthcare.gov, and full-price premiums for a 64-year-old can exceed $1,000 per month before credits in high-cost counties in 2026. Below the cliff, the credit still caps the benchmark premium at a share of income. Lowering countable income with pre-tax retirement or HSA contributions can move a household back under the line. Marketplace enrollees reconcile advance credits on Form 8962 using the 1095-A that healthcare.gov mails each January, so keep that form for the 2026 tax year and report projected 2027 income accurately during Open Enrollment. Reporting income too low means repaying credits in 2027 at tax time, while reporting it too high means overpaying premiums all year, so update healthcare.gov whenever a pension, Social Security, or part-time paycheck changes.

Premium tax credits end once Medicare Part A coverage starts, and healthcare.gov instructs enrollees to cancel the Marketplace plan effective the day before Medicare begins to avoid paying for overlapping coverage. Marketplace coverage does not count as active employer coverage, so keeping only a Marketplace plan past 65 and skipping Part B still triggers the 2026 Part B penalty of 10% for each full 12 months of delay. Medicare, not the Marketplace, becomes your primary coverage at 65, and a Marketplace Special Enrollment Period is not needed to drop your plan. Losing job coverage before 65 is a qualifying life event that opens a 60-day Marketplace SEP, so a 64-year-old who retires can enroll in a healthcare.gov plan within 60 days of the loss instead of waiting for November. Coverage under that Marketplace SEP starts the first day of the month after plan selection, which makes the timing of a retirement date at 64 worth planning with the Medicare window in mind.

Medicaid and Medicare Savings Programs Before 65: Medi-Cal, MassHealth, and Other State Brands

Medicaid enrollment is year-round, and in the 40 expansion states plus DC it covers adults under 65 with income up to 138% of the Federal Poverty Level, which in 2026 is $22,025 for one person and $29,863 for two. State programs go by different names: Medi-Cal in California, AHCCCS in Arizona, MassHealth in Massachusetts, HUSKY Health in Connecticut, and Apple Health in Washington. The 10 non-expansion states (Alabama, Florida, Georgia, Kansas, Mississippi, South Carolina, Tennessee, Texas, Wisconsin, Wyoming) leave many adults under 100% of the Federal Poverty Level in a coverage gap in 2026, with neither Medicaid nor a Marketplace credit. Applying at 64 through healthcare.gov or your state Medicaid agency costs nothing and can lock in $0 coverage in 2026 until Medicare starts. Medicaid uses current monthly income rather than last year's tax return, so a 64-year-old who retires mid-year can qualify quickly in 2026 even if earlier income was high. Report the drop in pay on the application and keep pay stubs or an employer termination letter as proof.

Expansion Medicaid ends when you become entitled to Medicare, so the 65th birthday triggers a handoff rather than a cliff. Medicare Savings Programs, run by state Medicaid agencies, pay the Part B premium of $202.90 per month in 2026 for enrollees with income near 135% of the Federal Poverty Level and limited assets, and the Extra Help program from Social Security caps Part D copays. Applying for both in the first month of your IEP keeps Part B, Part D, and cost-sharing affordable from day one. Medicare Savings Program tiers (QMB, SLMB, and QI) start on dates set by each state, so file early and confirm your state's start date with the agency. Enrollees who also carry Medicaid coverage may qualify for full dual-eligible benefits, including help with Medicare cost-sharing in 2026. Ask the eligibility worker at your state agency to screen you for every tier in one application. Keep your Medicaid approval letter, because it serves as proof of coverage when you reach Medicare.

HSA Contributions Stop 6 Months Before Medicare Part A Starts

Health Savings Account holders face a Medicare rule that catches many 64-year-olds. When you apply for Medicare or Social Security after age 65, Part A coverage is retroactive up to 6 months, but never earlier than your first month of eligibility. IRS Publication 969 prohibits HSA contributions for any month you are enrolled in Medicare, so a deposit made during those retroactive months becomes an excess contribution that carries a 6% excise tax each year in 2026 until removed. The 2026 HSA limits are $4,400 for self-only coverage and $8,750 for family coverage, plus a $1,000 catch-up for people age 55 and older. Working backward from your planned application date, schedule your last HSA deposit at least 6 months earlier, and prorate the annual limit by the number of months you are eligible. Employer contributions count toward the same limit, so tell payroll to stop them too. Distributions for qualified medical expenses stay tax-free after Medicare starts, including Part B, Part D, and Medicare Advantage premiums. Ask your HSA custodian for a written contribution history so you can show the IRS which months were eligible.

What is the Medicare enrollment window if I turn 64 in 2026?

Your Initial Enrollment Period is 7 months long and centers on your 65th birthday month. It starts on the first day of the month 3 months before that birthday month and ends on the last day of the 3rd month after it. If you turn 64 on March 15, 2026, you turn 65 on March 15, 2027, and the window runs December 1, 2026 through June 30, 2027. Enroll in the first 3 months so coverage starts on the first day of your birthday month. Anyone born on the 1st of a month becomes eligible one month earlier, so their window also starts one month earlier.

How do I document my Medicare application at 64 or 65?

Gather proof of age, your Social Security number, and proof of US citizenship or lawful presence before you apply at ssa.gov. If you are delaying Part B because of active employer coverage, ask HR to complete Form CMS-L564 (Request for Employment Information) and file it with Form CMS-40B. Bring your most recent 2025 tax return for income checks and your Marketplace Form 1095-A if you are ending a healthcare.gov plan. Save a copy of every form and note the date you submitted it, since the 2026 Part B late penalty of 10% per 12 months depends on proving timely enrollment.

What if I miss my Medicare enrollment window?

If you miss your 7-month Initial Enrollment Period and have no Special Enrollment Period, you wait for the General Enrollment Period, January 1 through March 31 each year, with coverage starting the month after you enroll. Part B then carries a 10% penalty for each full 12-month period you could have had it, and in 2026 that adds about $20.29 per month on the $202.90 premium for every year of delay, for life. Part D adds 1% of the national base premium per month in 2026 after a gap of 63 days or more without creditable drug coverage. Medigap insurers in most states can also deny you or charge more after the 6-month window.

Can I get retroactive Medicare coverage?

Part A can be retroactive up to 6 months, but never before the month you became eligible, if you apply after age 65 and qualify for premium-free Part A. Part B is not retroactive: coverage starts the month after you enroll when you sign up in or after your birthday month. Enrolling in the 3 months before your birthday month starts Part B on the first day of your birthday month. The Part A retroactive rule is why you must stop HSA contributions 6 months before you apply, since IRS Publication 969 treats deposits in retroactive Medicare months as excess contributions in 2026.

What is the difference between COBRA, the Marketplace, and Medicare at 64?

COBRA continues your employer plan at 102% of the full premium in 2026 for up to 18 months, but it does not count as active employer coverage, so it never lets you delay Part B. A healthcare.gov Marketplace plan can offer premium tax credits below 400% of the Federal Poverty Level in 2026 and ends when you choose. Medicare becomes primary at 65 and requires Part B enrollment on time. Losing job coverage at 64 opens a 60-day Marketplace SEP and a 60-day COBRA election window, so compare both before choosing, and plan the switch to Medicare at your birthday month.

What state-specific rules apply before Medicare?

Medicaid expansion drives most state differences. In the 40 expansion states plus DC, adults under 65 qualify at 138% of the Federal Poverty Level, about $22,025 for a single person in 2026, under names such as Medi-Cal, MassHealth, AHCCCS, and HUSKY Health. The 10 non-expansion states (AL, FL, GA, KS, MS, SC, TN, TX, WI, WY) leave a coverage gap under 100% FPL in 2026. Medigap rules also vary: Massachusetts requires guaranteed issue, and Connecticut regulates supplement plans through its Insurance Department. Call your State Health Insurance Assistance Program at shiphelp.org for free local counseling.

Do I qualify for Medicaid or a Medicare Savings Program at 64?

You qualify for expansion Medicaid before 65 if your household income is at or below 138% of the Federal Poverty Level in 2026, which is $22,025 for one person and $29,863 for two in the household table above. Enrollment is year-round through healthcare.gov or your state Medicaid agency. At 65 the state moves you to a Medicare Savings Program if your income is near 135% of the Federal Poverty Level and your assets are limited, and that program pays the Part B premium of $202.90 per month in 2026. Extra Help through ssa.gov caps Part D copays.

What happens to my Marketplace subsidy when I enroll in Medicare?

Your premium tax credit ends the month your Medicare Part A coverage starts, and you should cancel the Marketplace plan effective the day before Medicare begins by calling 1-800-318-2596 or updating your healthcare.gov account. Staying on a Marketplace plan without a subsidy is allowed but costs full price, and it does not delay the 2026 Part B penalty of 10% per 12 months. At tax time, reconcile any advance credits on Form 8962 using your 1095-A. Enrolling in Part B first without ending the Marketplace plan can leave you paying for overlapping coverage.