You Just Turned 65—Now Here’s What You Should Actually Do About Medicare

Key Takeaways

• Turning 65 triggers your Initial Enrollment Period (IEP), a limited window of time to make crucial Medicare decisions. Missing it can lead to costly penalties and coverage gaps.

• Even if you’re still working or have other coverage, evaluating Medicare options now can protect your finances and ensure you’re not missing out on benefits you’re entitled to.

Your Medicare Clock Just Started: What That Means

The day you turn 65 is more than just a birthday—it’s the beginning of your eligibility for Medicare. But eligibility doesn’t mean automatic coverage in all cases. Instead, it starts a very specific timeline known as your Initial Enrollment Period (IEP).

Your IEP is a seven-month window:

• Three months before the month you turn 65

• The month you turn 65

• Three months after your birth month

This period is when you can enroll in Medicare Parts A and B—and consider your options for Part C (Medicare Advantage) or Part D (prescription drug coverage).

Failing to enroll during this window can lead to late enrollment penalties, which may last a lifetime depending on the coverage you delayed.

Start with Medicare Part A and B: The Basics

You’ll want to understand what Original Medicare covers. It’s made up of two parts:

Medicare Part A (Hospital Insurance)

• Inpatient hospital care

• Skilled nursing facility care (not long-term care)

• Some home health and hospice care

If you’ve worked at least 10 years (40 quarters) and paid Medicare taxes, you usually don’t pay a premium for Part A.

Medicare Part B (Medical Insurance)

• Doctor visits

• Outpatient care

• Preventive services

• Durable medical equipment (like walkers, oxygen equipment)

Part B does come with a monthly premium. For 2025, the standard premium is $185, and the annual deductible is $257. Higher-income beneficiaries may pay more under the Income-Related Monthly Adjustment Amount (IRMAA).

Deciding Whether to Delay Part B

If you’re still working and have employer-sponsored health coverage—or your spouse does—you may be able to delay Part B without penalty.

To delay without consequences, your employer must have 20 or more employees. In that case, you qualify for a Special Enrollment Period (SEP) later, allowing you to sign up for Part B after your employment or group coverage ends.

If your employer has fewer than 20 employees, Medicare typically becomes primary, and you may need to enroll in Part B when you’re first eligible to avoid gaps in coverage.

Do You Need Prescription Drug Coverage Now?

Even if you don’t take any medications, enrolling in Medicare Part D during your IEP protects you from late enrollment penalties.

The Part D late enrollment penalty is calculated based on how long you went without coverage after your IEP, and it’s added to your premium for as long as you have drug coverage.

If you already have creditable drug coverage through another source, such as a retiree plan or employer plan, you may not need to enroll in Part D right away—but keep your plan’s documentation in case Medicare asks for proof later.

What About Medicare Advantage?

Medicare Advantage (Part C) is an alternative to Original Medicare. These plans combine Parts A and B, and often include drug coverage and extra benefits like dental or vision.

You can enroll in a Medicare Advantage plan during your IEP, as long as you’ve already enrolled in both Parts A and B.

However, you should carefully compare:

• Out-of-pocket maximums

• Access to doctors and hospitals

• Drug formularies

• Coverage rules such as prior authorization or referrals

Also remember: If you switch from Original Medicare to a Medicare Advantage plan and later decide to return, you may not be guaranteed the right to buy a Medigap policy, which helps pay for Original Medicare’s out-of-pocket costs.

If You Want Medigap, Timing Is Critical

Medigap (also called Medicare Supplement Insurance) can only be purchased if you’re enrolled in Original Medicare (Parts A and B).

Your best time to enroll is during your Medigap Open Enrollment Period, which is a six-month period starting the month you’re both:

• 65 or older, and

• Enrolled in Medicare Part B

During this window, you have guaranteed issue rights, meaning:

• No medical underwriting

• You can’t be denied or charged more due to pre-existing conditions

If you miss this window, you could be subject to higher premiums or even denial based on your health history.

What Happens If You Miss the Initial Enrollment Period?

If you don’t sign up for Part B (or Part A, if you need to pay for it) during your IEP and you don’t qualify for a Special Enrollment Period, you’ll need to wait for the General Enrollment Period (GEP) from January 1 to March 31 each year.

Coverage will start the first of the month after you enroll, and you may have to pay late enrollment penalties:

• Part B penalty: 10% for each full 12-month period you were eligible but didn’t enroll, added to your monthly premium permanently

• Part A penalty: Applies only if you have to pay for Part A; the premium increases by 10% for twice the number of years you delayed

If You’re Already on Social Security

If you’re receiving Social Security benefits before age 65, you’ll be automatically enrolled in Parts A and B at age 65. Your Medicare card will be mailed out about three months before your 65th birthday.

You can decline Part B if you don’t want it—just follow the instructions on the card. But think carefully before doing this, as you may trigger penalties later.

Coordinating Medicare with Other Coverage

You may have other insurance coverage—through an employer, COBRA, a union, or even VA benefits. Medicare works differently with each.

Here’s how Medicare generally coordinates:

• Employer coverage (20+ employees): Employer plan pays first, Medicare pays second

• Employer coverage (<20 employees): Medicare pays first

• COBRA: Medicare is primary; COBRA is secondary

• Retiree coverage: Medicare is usually primary

• VA benefits: You can use both, but they don’t work together. Medicare won’t pay at VA facilities, and VA won’t pay at non-VA providers.

Understanding how Medicare interacts with your other coverage helps you avoid unnecessary costs or denied claims.

Annual Enrollment Period Still Matters

Even after your IEP ends, you can make changes to your Medicare coverage each year during the Annual Enrollment Period (AEP) from October 15 to December 7. During this time, you can:

• Switch between Medicare Advantage and Original Medicare

• Change Part D drug plans

• Join a new Medicare Advantage plan

Changes made during AEP take effect January 1 of the following year.

Your First Steps After Turning 65

Here’s a checklist to help guide your immediate actions:

• Review your current health coverage (if any)

• Understand your Initial Enrollment Period timeline

• Compare Original Medicare vs. Medicare Advantage

• Consider whether you need drug coverage

• Decide if Medigap is the right fit—and when to enroll

• Coordinate benefits if you have other insurance

• Avoid penalties by enrolling on time

Setting Yourself Up for a Smooth Medicare Experience

You’ve reached a critical milestone, and what you do next determines the kind of coverage—and the costs—you’ll face for years to come. Missing deadlines or misjudging your needs now can lead to higher out-of-pocket expenses or limited options later. That’s why understanding enrollment periods, coverage types, and coordination rules is essential right now.

If you still have questions about what to do next, speak with a licensed agent listed on this website who can help you compare options, avoid penalties, and feel confident in your next steps.