Turning 65 & Medicare

Turning 65 marks an important milestone for making Medicare decisions. Pro Insurance Resources is here to be your trusted partner.

Enrolling in Medicare the Year You Turn 65

Turning 65 is a significant milestone. One of the most important aspects of this age is starting Medicare, the federal health insurance program. Some people may be eligible before this due to certain health conditions or disabilities, but for many Americans, the year you turn 65 is when you first become eligible for Medicare. It’s essential to understand your options, deadlines, and available resources.

Initial Enrollment Period (IEP)


Your Medicare enrollment timeline depends on your age, work status, and current coverage. For most people, the first chance to sign up for Medicare:


  • Starts 3 months before your 65th birthday
  • Includes your birthday month
  • Ends 3 months after

This 7-month window is generally the best time to enroll in:


  • Part A (hospital insurance)
  • Part B (medical insurance)
  • Part C (Medicare Advantage)
  • Part D (drug plan) if not included in Part C

Important Notes

  • Enroll on time to avoid late penalties — especially for Part B and Part D.

  • Guaranteed issue rights during this initial enrollment window allow you to sign up for a Medigap plan without medical checks; once this right expires, you can face delays or higher costs based on health conditions if you want to join a Medicare Supplement plan.

  • You can sign up for Original Medicare (Parts A and B) through the Social Security Administration. Learn more about the process from Medicare.gov.

Still Working at 65?


If you have creditable employer coverage, you may wish to delay enrollment in Parts B and D without penalty. Once you retire or lose employer coverage, you’ll qualify for a Special Enrollment Period (SEP) and can enroll at that time. We can help confirm whether your employer coverage counts as “creditable.”


Automatic Enrollment for Social Security Recipients


If you’re already receiving Social Security benefits before age 65, in most cases you’ll be automatically enrolled in Medicare Parts A and B. Your Medicare card should arrive in the mail about three months before your 65th birthday.

Avoiding Late Enrollment Penalties

Some parts of Medicare carry lifetime penalties if you don’t sign up when first eligible.


  • Part B penalty: You’ll pay a 10% increase in your premium for every 12-month period you delay — unless you have creditable coverage.

  • Part D penalty: You’ll pay a 1% increase on the national base premium for every month you go without coverage, unless you have creditable drug coverage.

To avoid penalties, enroll as soon as you're eligible or confirm you’re covered by a qualified plan.

Turning 65 Frequently Asked Questions

  • When should I start the enrollment process?

    Ideally, three months before your 65th birthday. That way your coverage starts on time and you avoid gaps or penalties.

  • Do I need to enroll in Medicare if I’m still working?

    Maybe. If your employer is a larger one (20 or more employees) and the health insurance they offer is considered “creditable,” you may delay enrollment in Part B and/or Part D. But if your company has fewer than 20 employees, then you will likely need to enroll in Medicare at 65. In this situation, Medicare is considered the primary payor, and your employer coverage is considered secondary.

  • How do I know if my drug plan is creditable?

    Your employer, VA, retiree plan, or union are required by CMS to provide written notice of creditable drug coverage each year. These letters should be sent out by October 15, before the start of the Medicare Annual Enrollment Period.

  • I’m already on Medicare. Do I need to do anything each year?

    It’s smart to review your Medicare Advantage or Part D plan each year with a licensed agent before the Annual Enrollment Period. Costs, coverage, and provider and pharmacy networks can change from year to year; we can help you decide whether to stick with your current plan or make changes. If you do nothing, your plan will automatically renew.

  • What if I miss my enrollment window?

    You may face penalties or delays in coverage. Contact us right away if you think you’ve missed it — we can help you look at your options and find out if you may qualify for a Special Enrollment Period.

  • What if my Medicare Advantage or Part D plan leaves Medicare?

    If your Medicare Advantage (Part C) or Medicare drug plan (Part D) is ending its contract with Medicare or exiting your service area, you should receive a notice from your plan by October 2, explaining your options. You will also receive a notice from CMS, which will tell you how to find other plans in your area. You’ll be granted a Special Enrollment Period (SEP) to choose a new Medicare Advantage or Part D plan or return to Original Medicare (and join a separate drug plan if needed). This SEP typically occurs just after the Annual Enrollment Period and lasts from December 8 to the last day of February.


    Note:


    • If your Medicare Advantage plan ends and you don’t make a change by December 31, you will be put in Original Medicare on January 1. In that case, you won’t have coverage for prescription drugs unless you enroll in a Part D plan.

    • The SEP gives you “guaranteed issue” rights to enroll in a Medigap plan without medical review, meaning existing conditions can’t be cause for higher premiums or denial of coverage. You have this guaranteed issue right for 63 days following the last day of enrollment in your Medicare Advantage plan.

    It’s important to review your options so you don’t have a gap in coverage. For help comparing plans, give us a call, visit Medicare.gov/plan-compare or call 1‑800‑MEDICARE.

What Seniors Need to Know About Turning 65

Turning 65 is a significant milestone. One of the most important aspects of this age is becoming eligible for Medicare, the federal health insurance program. It’s essential to understand your options, deadlines, and available resources. Below, we'll walk through what to expect and how to navigate this stage.

Medicare Basics: What is it?

Medicare is a federal health insurance program primarily for individuals aged 65 and older. It also covers some younger individuals with disabilities and those with End-Stage Renal Disease (ESRD). 


Medicare is divided into several parts:


Medicare Part A (Hospital)

Medicare Part B (Medical)

Medicare Advantage (Also called Medicare Part C)

Medicare Part D (Drug Coverage

Late Enrollment Penalties for Medicare

There are a couple of late enrollment penalties to know. These occur when you do not sign up for Medicare during your IEP:


Part B Penalty: A 10% increase in premiums for each 12-month period you were eligible but didn’t enroll.


Part D Penalty: 1% of the national base premium for every month you were without prescription drug coverage when eligible.

Partner With Experts to Make Turning 65 Even Better

Reaching 65 is an opportunity to take charge of your health care and plan for the future. By understanding your Medicare options, adhering to key dates, and utilizing available resources, you can make informed decisions that fit your unique needs.


If you have any questions, reach out to us. We look forward to helping you explore your Medicare options!

A person is sitting at a table with a laptop and a clipboard.

Key Dates & Deadlines for Medicare

Initial Enrollment Period (IEP)
Your Initial Enrollment Period (IEP) is a seven-month window around your 65th birthday:


Starts three months before the month you turn 65

Includes the month you turn 65

Ends three months after your birthday month


Note: If your birthday falls on the 1st of the month, this window shifts (four months before to two months after your birth month)


During this time, you can:


Enroll in Medicare Parts A and B

Choose a Medicare Advantage Plan

Sign up for a Part D Prescription Drug Plan


Automatic Enrollment
If you already receive Social Security or Railroad Retirement Board (RRB) benefits, you’ll likely be automatically enrolled in Medicare Parts A and B. You’ll receive your Medicare card in the mail about three months before your 65th birthday. 


If you’re not receiving these benefits, you must sign up for Medicare through the Social Security Administration.


Special Enrollment Period (SEP)
If you’re still working and have health coverage through your employer or union, you may qualify for a Special Enrollment Period (SEP) to sign up for Medicare without a late enrollment penalty after your Initial Enrollment Period ends. The SEP typically lasts for eight months after your employment or group coverage ends.

Annual Enrollment Period (AEP)

Every year from October 15th to December 7th, you can add or make changes to your Medicare coverage, including:


Enroll in, switch, or drop Medicare Advantage plans 

Enroll in, switch, or drop Medicare Part D prescription drug plans


Open Enrollment Period for Medicare Advantage Plans (OEP)

If you're enrolled in a Medicare Advantage plan, you can switch to a different plan or return to Original Medicare from January 1st to March 31st each year.


How to Choose the Right Medicare Plan

Finding the right coverage is critical, and that’s where we can help. Working with a knowledgeable Medicare insurance agent provides you with the best opportunity to find the right plan for you and your family. For more information, read below to get a high-level overview of the differences and what each plan type offers.


Medicare Part A (Hospital)

Covers inpatient hospital stays, skilled nursing facility care, hospice care, and some home healthcare services.


Medicare Part B (Medical)

Covers certain doctors’ services, outpatient care, medical supplies, and preventive services.


Medicare Advantage

Also called Medicare Part C, these plans combine the benefits of Original Medicare (Part A and Part B) into a single plan with additional coverage, like dental, vision, hearing, wellness, and more. 


Medicare Part D (Drug Coverage)

Medicare Part D Prescription Drug Plans (PDP) work in tandem with Original Medicare (Part A and Part B) and Medicare Advantage plans to provide prescription drug coverage. 

Original Medicare vs. Medicare Advantage

Original Medicare (Parts A and B): Offers nationwide coverage but does not include additional benefits like dental or vision. Beneficiaries often purchase supplemental Medigap policies to cover out-of-pocket costs.


Medicare Advantage (Part C): Offers an all-in-one plan through private insurers, often including additional benefits and lower out-of-pocket costs, but with more restricted provider networks.


Medigap vs. Medicare Advantage

Medigap supplements Original Medicare, while Medicare Advantage plans are an alternative to it. 


Medicare Advantage plans often include additional benefits such as vision, dental, and wellness programs, but they usually require using in-network providers.


Medigap plans work alongside Original Medicare, allowing you to see any Medicare-approved provider and offering more predictable costs. 


Long-Term Care

Medicare does not cover most long-term care services, such as nursing homes or personal care. If this is a concern, consider exploring other insurance options.