Getting Started with Medicare
Turning 65? Here's Everything You Need to Know
Medicare can feel overwhelming, but it doesn't have to be. This guide breaks down the four parts of Medicare, when to enroll, and exactly what to do first — in plain language.
The Four Parts of Medicare
| Part | Coverage Type | Key Details |
|---|---|---|
| Part A | Hospital Insurance | Covers inpatient stays, skilled nursing, hospice, and some home health. Usually $0 premium if you worked 10+ years. |
| Part B | Medical Insurance | Covers doctor visits, outpatient care, lab tests, and durable medical equipment. Monthly premium ~$185/month in 2026. |
| Part C | Medicare Advantage | Private insurance alternative bundling Parts A, B, and often D. May include dental, vision, and hearing. |
| Part D | Prescription Drugs | Optional coverage for medications through private companies. New $2,000 out-of-pocket cap starting 2025. |
The Gaps in Original Medicare
Parts A and B together are called "Original Medicare." They cover a lot, but not everything. Understanding these gaps is critical:
- !Part A Deductible: ~$1,676 per benefit period (can happen multiple times per year)
- !Part B Deductible: ~$257 per year
- !20% Co-insurance: Under Part B, Medicare pays 80% — you pay the remaining 20% with no maximum limit on out-of-pocket spending
This is why most people add supplemental coverage — either a Medigap plan or a Medicare Advantage plan. Compare your options →
Enrollment Timeline
Initial Enrollment Period (IEP)
A 7-month window around your 65th birthday: 3 months before, your birth month, and 3 months after. This is when you should sign up for Parts A and B.
Special Enrollment Period (SEP)
An 8-month window for people who are retiring after 65 and were covered by a large employer group plan. Starts when your employer coverage ends.
Annual Election Period (AEP)
October 15 – December 7 each year. This is when you can change your Medicare Advantage or Part D plan for the following year.
Medigap Open Enrollment
A 6-month window starting when your Part B begins. During this time, no insurance company can deny you a Medigap policy due to health history.
Your Step-by-Step Action Plan
Verify Your Work History
Ensure you have 40 quarters (10 years) of work to qualify for $0 Part A premium.
Create an SSA Account
Set up a Login.gov or ID.me account at least 3 months before turning 65. Account setup guide →
Apply for Medicare
If you're not already receiving Social Security, apply for Parts A and B at SSA.gov during your IEP. SSA login guide →
Assess Financial Help
Check if you qualify for QMB, SLMB, or Extra Help programs that can reduce your costs significantly. Check eligibility →
Choose Your Coverage Path
Decide between Medigap (predictability and freedom) or Medicare Advantage (low premiums and extra perks). Compare plans →
Review Part D Yearly
Use the Medicare.gov plan finder between October 15 and December 7 to ensure your medications are covered for the coming year. Part D guide →
Setting Up Your Digital Accounts
Medicare now uses secure online portals for managing benefits. Here are the accounts you'll need:
Infographic: Securing Your Health Future
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