Quick Answer: Turning 65 makes you eligible for Medicare. Your Initial Enrollment Period (IEP) is 7 months total: the 3 months before your 65th birthday, your birthday month, and the 3 months after. You are only auto-enrolled if you are already collecting Social Security; everyone else must actively sign up at SSA.gov. In 2026, Part B costs $202.90/month with a $283 deductible, and Part A is premium-free for most people but carries a $1,736 hospital deductible. If you have employer coverage from a job with 20+ employees, you can delay Part B without penalty using a Special Enrollment Period when you retire.
Turning 65 is the single biggest milestone in US health coverage. Almost everyone who has worked at least 10 years in covered employment qualifies for premium-free Part A, and everyone qualifies to pay into Part B. But Medicare is not a simple checkbox at 65. It involves four parts, two enrollment paths, several deadlines, and lifetime penalties for getting it wrong.
This guide covers the 6 decisive steps to enroll in 2026, what to do if you are still working at a job with employer coverage, and the late-enrollment penalties that follow you for the rest of your life. Almost every mistake here is permanent. Start by understanding whether Medicare is free or has a cost, then compare Medigap vs Medicare Advantage before your Initial Enrollment Period opens. If you take prescription drugs, check does Medicare cover prescription drugs to understand Part D before Day 1.
6 Steps to Get Coverage
Common Mistakes That Cost People Thousands
The most expensive mistakes people make around their 65th birthday. Most of these penalties are permanent:
- Assuming auto-enrollment. Unless you are already collecting Social Security, no one signs you up for Medicare. You must go to SSA.gov or call Social Security yourself during your 7-month IEP.
- Skipping Part B because you have COBRA or retiree coverage. Neither counts as active employer coverage for the Part B delay rule. Take Part B at 65 or face the 10% per year lifetime penalty.
- Going without Part D drug coverage. Even if you take no prescriptions today, going 63+ days without creditable drug coverage triggers a 1% per month Part D penalty that lasts the rest of your life.
- Missing the 6-month Medigap Open Enrollment window. After it ends, Medigap insurers in most states can deny you or charge more based on health, often pricing you out permanently.
- Picking Medicare Advantage without checking the provider network. Your current doctors and specialists may be out of network, leading to either much higher costs or starting over with new providers.
- Not asking about Medicare Savings Programs and Extra Help. If your income is under roughly 135% FPL, you can get your Part B premium paid and your Part D copays capped at a few dollars, but you have to apply.
Frequently Asked Questions
When exactly does my Medicare Initial Enrollment Period start?
Your Initial Enrollment Period (IEP) is 7 months long. It starts on the first day of the month 3 months before the month you turn 65, includes your birthday month, and ends on the last day of the 3rd month after your birthday month. For example, if you turn 65 in August 2026, your IEP runs from May 1, 2026 through November 30, 2026. Sign up in the first 3 months for coverage to start on your birthday month.
Am I automatically enrolled in Medicare when I turn 65?
Only if you are already collecting Social Security or Railroad Retirement benefits when you turn 65. In that case, Medicare mails you a card and enrolls you in Parts A and B automatically about 3 months before your birthday. Everyone else must actively enroll at SSA.gov or by calling 1-800-772-1213. In 2026, most people delay claiming Social Security past 65, so most must sign up themselves.
What is the late enrollment penalty for Part B in 2026?
If you miss your IEP and do not qualify for a Special Enrollment Period, your Part B premium increases by 10 percent for every full 12-month period you could have had Part B but did not. The penalty is permanent and follows you for the rest of your life. At the 2026 standard premium of $202.90, two years late means about $40 extra per month, forever.
Can I delay Medicare if I still have employer health insurance?
Yes, but only if it is active group coverage from a current employer with 20 or more employees (yours or your spouse's). In that case you can delay Part B without penalty and get an 8-month Special Enrollment Period when that coverage ends. COBRA, retiree health plans, and individual marketplace plans do NOT count. Employers under 20 employees usually require Medicare to pay first at 65, so most people in that situation should enroll on time.
What is the Part D late enrollment penalty?
If you go 63 consecutive days or more without creditable prescription drug coverage after first becoming eligible for Medicare, you pay a 1 percent per month penalty for the rest of your life, added to whatever Part D plan you eventually pick. Creditable coverage means coverage at least as good as standard Part D, like most employer drug plans. Always confirm in writing whether your current drug coverage is creditable.
Do I have to take Part A at 65 even if I have other coverage?
Most people should take premium-free Part A at 65 because it costs nothing if you qualify based on work history. The one exception: if you contribute to a Health Savings Account (HSA), enrolling in any part of Medicare (including Part A) stops HSA contributions. Some people delay both A and B to keep contributing to an HSA, but this requires careful planning and only works for active workers with a real HSA-eligible plan.
What is Medigap and when do I have to enroll?
Medigap (Medicare Supplement Insurance) is a private policy that fills the cost-sharing gaps in Original Medicare, such as the 20 percent coinsurance Part B leaves open. Your one and only guaranteed-issue window is the 6 months that begin the first month you are both age 65 and enrolled in Part B. During this window, no insurer can deny you or charge more based on your health. After it ends, in most states they can.
How much will Medicare cost me in 2026?
Most people pay $0 for Part A (premium-free if you or a spouse worked 10+ years in Medicare-covered jobs). Part B's standard premium is $202.90 per month with a $283 annual deductible. Part A has a $1,736 hospital deductible per benefit period. Part D plan premiums average roughly $40-$60. Higher incomes pay extra Part B and Part D premiums through IRMAA. If your income is under about 135 percent of FPL, the Medicare Savings Program can pay your Part B premium and the Extra Help program caps your drug copays at a few dollars.
