Turning 65 — Medicare Workflow

The 9-step workflow

1. 1

   Identify your Initial Enrollment Period (IEP)

   Your IEP is 7 months long: the 3 months before your 65th-birthday month, the birthday month itself, and the 3 months after. Sign-up timing within the IEP affects when coverage starts. Missing the IEP without other creditable coverage triggers lifetime late-enrollment penalties on Part B and Part D.

2. 2

   Decide whether to take Part A only or Part A + Part B at 65

   Part A (hospital) is premium-free for most people who paid into Medicare via payroll taxes. Part B (outpatient) has a standard monthly premium of $202.90/month in 2026 (per CMS) plus IRMAA additions for higher incomes. If you have other creditable coverage (employer group plan with 20+ employees), you may be able to delay Part B without penalty.

3. 3

   Check whether employer coverage is creditable for Part B delay

   Active employment coverage at an employer with 20+ employees usually qualifies as creditable - you can delay Part B without penalty. COBRA, retiree-only plans, and small-employer (< 20 employees) coverage typically don't qualify. Confirm with your employer's benefits administrator in writing.

4. 4

   Decide between Original Medicare + Medigap vs Medicare Advantage

   Original Medicare + Medigap (Plans G, N, etc.): broad provider access nationally, predictable supplemental premiums, but no built-in drug coverage (Part D needed separately) and no dental/vision/hearing. Medicare Advantage: bundled, often $0 premium, includes drug coverage and often dental/vision/hearing, but with network restrictions and prior authorization. The right choice depends on your providers, prescriptions, travel, and risk tolerance.

5. 5

   If choosing Medigap, use your guaranteed-issue window

   During the 6 months after your Part B effective date, you have guaranteed-issue rights to any Medigap plan sold in your state regardless of health. After this window, switching Medigap plans typically requires medical underwriting and you can be declined or charged more. This is a one-time window in most states.

6. 6

   Choose a Part D drug plan that covers your current medications

   Compare each candidate Part D plan's formulary against every prescription you currently take. Tier placement affects out-of-pocket cost significantly. If you have no current prescriptions, choose a low-premium plan to avoid the lifetime late-enrollment penalty - you can change plans during Annual Enrollment Period (Oct 15 - Dec 7) each year.

7. 7

   Project IRMAA exposure based on income from 2 years prior

   IRMAA (Income-Related Monthly Adjustment Amount) increases Part B and Part D premiums when modified adjusted gross income exceeds thresholds. Medicare uses your tax return from 2 years prior. A Roth conversion, large capital gain, or RMD in the look-back year can trigger IRMAA. Form SSA-44 lets you appeal IRMAA based on a life-changing event (retirement, divorce, work stoppage).

8. 8

   If contributing to an HSA, stop contributions before Medicare effective date

   Once enrolled in any part of Medicare (including Part A), you can't contribute to an HSA. Many people enroll in Part A automatically when claiming Social Security and trigger this restriction without realizing it. Stop HSA contributions in the month Part A starts.

9. 9

   Coordinate Medicare with retiree health coverage if applicable

   Retiree health plans typically become secondary to Medicare at 65. Confirm with your former employer's plan administrator what happens to your retiree coverage when Medicare starts - some plans pay only what Medicare doesn't, others fully replace Medicare. Get the rule in writing.

Related guides

FAQ

When exactly does Medicare coverage start if I sign up during my Initial Enrollment Period?

If you enroll during the 3 months before your 65th-birthday month, coverage starts on the first day of your birthday month. If you enroll during your birthday month or later, coverage start dates may be delayed. Verify the current rules on Medicare.gov - timing rules changed under recent legislation.

What's the late enrollment penalty for Part B?

The Part B late enrollment penalty is 10% of the standard premium for each full 12-month period you could have had Part B but didn't sign up. The penalty is permanent - it stays with you for as long as you have Part B. Late enrollment penalties for Part D follow a different formula based on months without creditable drug coverage.

Can I switch from Medicare Advantage to Medigap later?

Yes, but it can be difficult. Outside of specific guaranteed-issue situations (which vary by state), switching to Medigap requires medical underwriting - and you can be declined or charged more based on health. Some states (Connecticut, Maine, Massachusetts, New York) have continuous guaranteed-issue Medigap; others don't. This is one of the most important reasons to choose carefully at age 65.

Do I need to enroll in Medicare if I'm still working at 65?

If your employer has 20+ employees and you have creditable coverage through your job, you can usually delay Part B without penalty. You may still want to enroll in premium-free Part A (which won't disrupt your employer coverage but does block HSA contributions). If your employer has fewer than 20 employees, Medicare is generally primary - you usually need to enroll in Part B at 65 to avoid coverage gaps.

How do I appeal IRMAA if my income dropped after the look-back year?

File Form SSA-44 with the Social Security Administration. Qualifying life-changing events include marriage, divorce, death of spouse, work stoppage, work reduction, loss of income-producing property, loss of pension, and employer settlement payment. Documentation is required - tax returns, employer letters, or court orders depending on the event.