Turning 65:
A Medicare Enrollment Roadmap

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Your Medicare Turning-65 Timeline

✅ Step 1: Sign up for Medicare

  • If you’re already taking Social Security → you’re automatically enrolled.

  • If not → apply online at SSA.gov.

✅ Step 2: Choose Your Path (3 Options)

1. Original Medicare (Parts A & B Only)
2. Medicare Advantage (MAPD)

  • Usually lower premiums

  • Bundled coverage

  • Provider networks

  • Extras like dental, vision, hearing, OTC, and fitness
    3. Original Medicare + Medigap + Part D

  • Higher monthly premium

  • Very low costs when care is used

  • Nationwide access

✅ Step 3: Add Prescription Drug Coverage

Even if you don’t take medications now, you need Part D (standalone or inside MAPD) to avoid a lifetime late-enrollment penalty.

✅ Step 4: Medigap (if you choose Original Medicare)

You have a 6-month window from when Part B starts to choose a Medigap plan without health questions.

✅ Step 5: Enrollment Deadlines

You have until 3 months after your birthday month to choose a Medicare Advantage or Part D plan.
Missing this deadline may lead to penalties and delays until the next enrollment period.

✅ Step 6: Stay in Touch

I’ll review your coverage every year during Medicare’s Annual Enrollment Period (Oct 15 – Dec 7).

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What “Original Medicare Only” Means

Part A = Hospital Coverage

  • Inpatient care

  • Skilled nursing facility

  • Hospice

Part B = Medical Coverage

  • Doctors and outpatient care

  • Preventive care

  • Durable medical equipment

What Original Medicare Does NOT Cover

  • Prescriptions

  • Dental

  • Vision

  • Hearing

  • Routine care

  • Out-of-pocket caps

  • Foreign travel (limited exceptions)

You MUST Enroll in Part B

Part B is essential. Without it, you only have hospital coverage (Part A).
Part B covers:

  • Doctors

  • Surgeries

  • Outpatient care

  • Preventive services

You need Part B if you ever want:

  • A Medicare Advantage plan

  • A Medigap plan

Skipping Part B (without employer coverage):

  • Lifetime penalty

  • Possible coverage gaps

You SHOULD Enroll in Part D (Prescription Drugs)

Even if you take no medications now, you need creditable drug coverage.
Skipping Part D leads to:

  • Permanent penalty: 1% of the national base premium for every month you delay

Part D can be added separately if you are NOT in a MAPD plan.

What’s Missing with Original Medicare Alone

❌ No out-of-pocket maximum

Medicare pays 80% of approved services.
You pay the other 20% with no cap → unlimited financial risk.

❌ No coverage for common needs

Dental, vision, hearing, OTC items — all require separate coverage.

❌ Medigap is optional but recommended

Medigap covers:

  • Deductibles

  • Coinsurance

  • The 20% gap

If you skip Medigap during your 6-month Open Enrollment, you may need underwriting later.

❌ Limited travel coverage

Medicare covers care only inside the U.S. (rare foreign emergency exceptions).

If You Choose Original Medicare Alone:

  • ✅ Must enroll in Part B

  • ✅ Should add Part D

  • ⚠️ No cap on medical costs

  • ⚠️ No dental/vision/hearing coverage

Medicare Deductibles (2025)

Part A (Hospital Insurance)

  • Inpatient deductible: $1,676 per benefit period

  • Days 1–60: $0

  • Days 61–90: $419/day

  • Days 91+: $838/day (lifetime reserve days)

  • After lifetime reserve days → patient pays all costs

A “benefit period” resets after 60 days without inpatient care.

Part B (Medical Insurance)

  • Annual deductible: $257
    After that, Medicare pays 80% and the client pays 20% with no maximum limit.

Source: CMS 2025 Fact Sheet
https://www.cms.gov/newsroom/fact-sheets/2025-medicare-parts-b-premiums-and-deductibles

How Medigap Affects Deductibles

  • Plan G: Covers everything except the Part B deductible ($257)

  • Plan N: Leaves the deductible + small copays

This is why people add Medigap or Medicare Advantage—Original Medicare alone exposes them to unlimited costs.

If You Only Have Part A and Are Still Working

Most people take premium-free Part A at 65.
They delay Part B (and sometimes Part D) if they have creditable employer coverage.

Part B premium for 2025 is ~$185/month.

How Employer Coverage Works with Part A

If employer has 20+ employees:

  • Employer plan = primary

  • Medicare = secondary

If employer has fewer than 20 employees:

  • Medicare = primary

  • Employer plan = secondary
    → They must enroll in Part B to avoid unpaid claims.

When You Retire or Lose Employer Coverage

You get a Special Enrollment Period (SEP):

  • 8 months to enroll in Part B (no penalty)

  • 63 days to enroll in Part D (no penalty)

You may also qualify for guaranteed-issue rights to buy Medigap.

Key Risks to Know

  • HSA Warning: If contributing to an HSA, do NOT enroll in Part A.

  • Small Employer Exception: With <20 employees → Must enroll in A & B at 65.

  • COBRA & Retiree Coverage: NOT creditable for delaying Part B.

Medigap Open Enrollment Period (OEP)

1. Timing

Starts the first month you are 65+ and enrolled in Part B.
Lasts 6 months.

Example:

  • Birthday: September 15

  • Part B starts: September 1

  • OEP: September 1 – February 28/29

2. Guaranteed Issue Rights

During this period:

  • No medical underwriting

  • Cannot be denied

  • Cannot be charged more due to health

  • Pre-existing conditions covered

3. Available Plans

Plans: A, B, C*, D, F*, G, K, L, M, N
(C and F are not sold to new Medicare enrollees after 2020)

4. Why It Matters

After OEP:

  • Underwriting applies

  • Possible denials or high premiums

5. Medicare Advantage Interaction

You only get Medigap GI rights when leaving MA under special conditions.

6. Summary

The Medigap 6-month window is the best and safest time to enroll.

Now that you’re familiar with the basics, you’re better prepared to compare Medicare plans and make informed decisions that support your health goals.

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