When to enroll in Medicare
You can delay Medicare Part B past age 65 without penalty if you're covered by an employer or union group health plan through active employment (yours or your spouse's). This is called a Special Enrollment Period (SEP).
Note: small employers (20 or fewer employees) may require Medicare enrollment at 65.
If you're delaying enrollment, have HSA contributions, or have individual/family insurance, please read the CMS publication "Medicare and You" Section 1 at medicare.gov.
How to apply for Medicare Part A and Part B
- The application takes 3 to 6 weeks to process
- You can apply up to 3 months before you want coverage to start
- Coverage starts the first day of the month you turn 65
For example, if your 65th birthday is June 15:
- Apply March 1 to May 31: coverage starts June 1
- Apply June 1 to September 30: coverage starts the first of the month after you apply
Apply at ssa.gov/medicare.
Note: If you're already receiving Social Security benefits, you'll automatically receive your Medicare card.
Your Medicare coverage options
After enrolling in Medicare Part A and Part B, you'll choose additional coverage from the private insurance marketplace. Whichever option you choose, you'll still pay the federal Part B premium (starting at $203/month in 2026).
Option 1: Medicare Supplement (Medigap) and a Part D prescription plan
This option is for people who want comprehensive coverage and their choice of providers. About 25% of my clients choose it.
- No network restrictions: use any provider that accepts Medicare
- Guaranteed acceptance if you apply within 6 months of your Part B start date
- Standardized plans: Plan G benefits are identical across all insurers
- No basic vision, dental, or hearing aid benefits. Separate dental and hearing coverage is available.
The most popular plan is Plan G, which pays 100% after you pay the annual Part B deductible ($283 in 2026).
Typical monthly costs:
- Part A: $0
- Part B: $203
- Medicare Supplement Plan G: ~$290
- Premiums increase an average of 4% to 6% per year, often outpacing inflation. In 2026, many plans saw increases near 20%.
- Part D prescription plan: $0 to $50
- Total: ~$490/month
After 6 months on Part B, insurers can medically underwrite and refuse coverage. There is no annual open enrollment period for Medicare Supplement.
Option 2: Medicare Advantage with prescription coverage
This option is for people who want lower premiums with managed care. About 75% of my clients choose it.
- HMO or PPO networks: you must use in-network providers (except in emergencies)
- HMO: you need a primary care referral to see a specialist
- PPO: no referrals needed, plus out-of-network benefits
- No medical underwriting: acceptance is guaranteed
- Includes vision, dental, and hearing aid benefits
PPO Medicare Advantage plans are getting hard to find. Many insurers have pulled them from the market, and fewer are available each year.
How the costs work:
- Low premiums, but you pay copays or coinsurance for services
- Plans can change benefits annually
- Many high-cost services require pre-authorization
Sample costs (example only):
- Primary care visit: $0
- Specialist visit: $55
- Emergency room: $130
- Hospital stay: $555/day (first 5 days)
- X-rays: $30
- Generic prescriptions: $0/month
- Brand name prescriptions: 15% coinsurance
- Chemotherapy/dialysis: 20% coinsurance
- Annual out-of-pocket limits: $6,700 medical, $2,100 prescription
Typical monthly costs:
- Part A: $0
- Part B: $203
- Medicare Advantage premium: $0 to $100
- Total: ~$203/month
Enrollment rules
Medicare Advantage
- Best time: within 3 months of your Part B start date
- Also: during the Annual Enrollment Period (Oct 15 to Dec 7) for a Jan 1 start
Medicare Supplement
- Guaranteed issue: within 6 months of your Part B start
- After 6 months: may require medical underwriting
"Trial Right" protection
If you join Medicare Advantage when first eligible at 65, or switch from Medicare Supplement to Medicare Advantage for the first time, you have a one-year trial period to return to Medicare Supplement with guaranteed acceptance.
After one year on Medicare Advantage, switching to Medicare Supplement may require medical underwriting.
For more information, search "Trial Right" at medicare.gov.
Annual changes
You can change Medicare Advantage or Part D prescription plans once a year during the Annual Enrollment Period (October 15 to December 7) with no medical underwriting.
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