Your Medicare Questions, Answered

Medicare Advantage (Part C) replaces Original Medicare — you use network doctors and the plan manages your benefits. Medicare Supplements (Medigap) work alongside Original Medicare — you keep any doctor who accepts Medicare while the Medigap plan covers most of what Medicare doesn't. Advantage plans often have $0 premiums but have copays and networks; Supplements have monthly premiums but far more predictable out-of-pocket costs. The right choice depends on your health, travel habits, and doctors.

Your Initial Enrollment Period (IEP) is the 7-month window surrounding your 65th birthday — 3 months before, the month of, and 3 months after. Missing this window without qualifying for a Special Enrollment Period (SEP) can trigger lifetime late-enrollment penalties. If you're still working and covered by employer insurance, different rules apply. We recommend scheduling a Medicare strategy session at least 6 months before your 65th birthday.

First, decide which path applies to you — then follow the steps below.

📋 Step-by-Step Enrollment Process

Step 1 — Confirm your eligibility
You are eligible for Medicare at age 65 if you (or your spouse) have worked and paid Medicare taxes for at least 10 years (40 quarters). Go to ssa.gov/myaccount and create or log in to your My Social Security account to verify your earnings record and confirm eligibility.

Step 2 — Check if you're automatically enrolled
If you are already receiving Social Security benefits before turning 65, you will be automatically enrolled in Medicare Part A and Part B. Your Red, White & Blue Medicare card will arrive in the mail about 3 months before your 65th birthday. Skip to Step 6 if this applies to you. If you want to decline Part B (still working, 20+ employee employer), return the card with the Part B box checked "decline" or call Social Security at 1-800-772-1213.

Step 3 — Choose your enrollment method
You have three options to apply:
• Online (fastest): ssa.gov/medicare/sign-up — takes about 10 minutes
• By phone: Call Social Security at 1-800-772-1213 (TTY: 1-800-325-0778), Monday–Friday 8am–7pm
• In person: Visit your local Social Security office — find it at ssa.gov/locator

Step 4 — Complete the application
Have the following ready:
• Your Social Security number
• Your birth certificate or proof of age
• Proof of U.S. citizenship or lawful alien status (if applicable)
• Your current health insurance information (policy number, group number, insurance company name)
• If applying for Part A only: a statement from your employer confirming active group health coverage

PATH A (still working) — Part A only: On the online application, you will be given the option to apply for Part A without Part B. Select Part A only and indicate that you have active employer coverage.

PATH B (retiring or no employer coverage) — Part A & B: Apply for both. Your coverage will begin based on when in your Initial Enrollment Period you apply (see timing note below).

Step 5 — Know your coverage start date
Your Initial Enrollment Period (IEP) is 7 months: 3 months before your birthday month, your birthday month, and 3 months after.
• Apply in the 3 months before your birthday month → coverage starts the 1st of your birthday month
• Apply during your birthday month → coverage starts the following month
• Apply in the 3 months after your birthday month → coverage is delayed 2–3 months

Tip: Apply 3 months before your 65th birthday for the earliest possible coverage start with no gap.

Step 6 — Receive your Red, White & Blue Medicare Card
After your application is processed (typically 2–4 weeks online, longer by mail), Social Security will mail your official Medicare card to the address on file. The card shows:
• Your name
• Your Medicare number (a unique 11-character alphanumeric ID — not your Social Security number)
• Which parts you're enrolled in (Part A, Part B, or both) and the effective date

Keep this card safe — you'll need it when visiting doctors, hospitals, and pharmacies. Consider making a photocopy. If your card is lost or stolen, you can request a replacement at Medicare.gov or by calling 1-800-MEDICARE.

Step 7 — Choose your coverage plan (within 6 months of Part B start)
Your Medicare card alone provides Original Medicare (Parts A & B). You still need to decide:
• Medicare Supplement (Medigap) + Part D drug plan — predictable costs, any doctor nationwide
• Medicare Advantage (Part C) — often $0 premium, bundles drug coverage, network-based

Your Medigap Open Enrollment Period runs for exactly 6 months from your Part B effective date. During this window, no insurance company can deny you or charge you more based on health history. This window does not repeat — missing it can permanently limit your Supplement options.

⚠️ Don't navigate this alone. The enrollment timing, plan selection, and open enrollment window decisions happen once — and mistakes can be permanent and costly. A free 30-minute call with Rodney ensures you make the right moves at the right time. Schedule your free Medicare enrollment consultation →

Original Medicare does not cover routine dental, vision, hearing, or most long-term care. It also has no annual out-of-pocket maximum, meaning your costs could be unlimited if you have a major illness. These gaps are why many people choose a Medicare Supplement or Medicare Advantage plan with added benefits.

Most people pay $0 for Medicare Part A (hospital) if they worked 40+ quarters. Part B (medical) has a standard monthly premium of $202.90 in 2026, though higher earners pay more through IRMAA surcharges. Part D (drug) costs vary by plan. Supplement premiums range from $80–$300+/month depending on your state and health.

IRMAA (Income-Related Monthly Adjustment Amount) is a surcharge added to your Part B and Part D premiums if your income exceeds certain thresholds. In 2026, singles earning over $106,000 and couples over $212,000 pay higher premiums. We can help you plan distributions from retirement accounts strategically to manage your IRMAA bracket.

Yes. The Annual Enrollment Period (AEP) runs October 15 – December 7 each year. During this window you can switch between Medicare Advantage plans, add/drop Part D drug coverage, or move from Medicare Advantage back to Original Medicare. Changes take effect January 1. A licensed advisor can compare all available plans in your zip code at no charge.

SNPs are specialized Medicare Advantage plans designed for people with specific chronic conditions (C-SNP), who are institutionalized (I-SNP), or who qualify for both Medicare and Medicaid (D-SNP). They offer coordinated care and benefits tailored to your condition. Not everyone qualifies — contact us to see if a SNP is right for you.

If you choose Original Medicare + a Medigap Supplement, you'll need a standalone Part D Prescription Drug Plan (PDP). Medicare Advantage plans typically include drug coverage. Skipping Part D when first eligible triggers a lifetime late enrollment penalty of 1% per month of delay.

Dental, vision, and hearing plans are popular additions since Original Medicare covers none of these. Hospital indemnity plans pay cash for each day you're hospitalized. Cancer, heart attack, and stroke policies provide lump-sum benefits if you receive a covered diagnosis. These products are typically very affordable and can dramatically reduce your out-of-pocket risk.

Yes — but only under specific conditions. If you (or your spouse) are covered under an active employer group health plan from a company with 20 or more employees, you can delay Medicare Part B without penalty. Your employer plan pays first; Medicare would be secondary. When you retire, you have an 8-month Special Enrollment Period (SEP) to sign up for Part B without penalty. If your employer has fewer than 20 employees, Medicare becomes your primary insurance at 65 even if you have employer coverage — you should enroll in both Part A and Part B to avoid uncovered claims and late penalties.

Yes — if your spouse is actively working and their employer has 20 or more employees, you can delay your own Medicare Part B without penalty. The coverage must come from your spouse's current active employment. If your spouse is retired and you're on their retiree health plan, that does not qualify — you must enroll in Medicare at 65.

No — this is one of the most common and costly Medicare mistakes. COBRA is not considered active employer coverage for Medicare delay purposes. Your 8-month Special Enrollment Period begins when your active employment ends, not when COBRA ends. If you retire, take COBRA, and don't enroll in Medicare within 8 months of leaving your job, you will face a permanent Part B late enrollment penalty regardless of your COBRA status.

When you retire or lose qualifying employer coverage, you have 8 months to enroll in Medicare Part B without a late penalty — this is your Special Enrollment Period. It begins the month after your employment ends or your employer coverage ends, whichever comes first. You don't need to wait for an Annual Enrollment Period. Enroll as early as possible — processing takes time and waiting the full 8 months can create a coverage gap. You'll need your employer to complete Form CMS-L564 documenting your qualifying coverage period.

Yes — this is critical. Once you enroll in Medicare (even just Part A), you can no longer contribute to a Health Savings Account (HSA). Additionally, Medicare Part A enrollment can be retroactive up to 6 months when you sign up after age 65. Any HSA contributions made during that retroactive period become excess contributions, triggering income taxes and a 6% penalty. If you have an HSA and plan to enroll in Medicare, stop HSA contributions at least 6 months before you apply. Call us to plan the timing carefully.

The Part B late enrollment penalty is 10% of the standard monthly premium for every 12-month period you were eligible but didn't enroll. This penalty is permanent — it's added to your Part B premium for as long as you have Medicare. For example, if you delayed Part B for 3 years without qualifying coverage, your premium is permanently 30% higher. The standard 2026 Part B premium is $202.90/month — a 30% penalty adds $60.87/month, or $730/year, forever.

Yes. If you're already receiving Social Security benefits when you turn 65, you are automatically enrolled in Medicare Part A and Part B. You'll receive your Medicare card about 3 months before your 65th birthday. If you're still working and want to delay Part B, you must actively opt out by contacting Social Security before Part B starts. You can re-enroll during your Special Enrollment Period when you eventually retire.

Call or text us at 503-832-8555 or schedule a free 30-minute consultation at our Calendly link. We compare plans from multiple carriers at no cost to you — our compensation comes from the carriers, not from you.