Medicare Moments | Medicare's Enrollment Process in Simple Terms

Toni:

I'm turning 65 next March and have not had health insurance plan for over 2 years because I work part time. I do not know where to start or what to do. I am not receiving my Social Security check, and friends are advising me that if I do not sign up for Medicare when I turn 65 that I will be making a major Medicare mistake.

Can you please explain in simple terms how to enroll in Medicare when I turn 65? Thanks, Toni

–Sharon from Galveston, Texas

Hi Sharon:

I know how confusing turning 65 and enrolling in Medicare is because right now, there is an American turning 65 every 8 seconds. This means 10,000+ baby boomers are entering Medicare when turning 65 every day for the next 8-plus years. Simplifying enrollment and understanding Medicare is what I specialize in because no one wants to make the wrong Medicare decision which only adds stress to getting older.

Enrolling in Medicare is discussed on pages 17-19 of the 2026 Medicare & You handbook and also at www.medicare.gov. Simplifying enrolling in Medicare is explained below:

1. Remember to enroll at the right time:

1. If you are turning 65 and receiving your Social Security check: Your "Welcome to Medicare" kit will be mailed to you with your Medicare card 90 days before you turn 65. (Sharon, this is not your Medicare situation.)

2. If you are turning 65 and NOT receiving your Social Security check: Not working full time with employer group health insurance from either you or your spouse's work, you will want to enroll in Medicare Parts A and B online via www.ssa.gov. (Sharon, this is your Medicare enrolling situation.)

3. If you are turning 65, working full-time with employer group health insurance: Whether this is through you or your spouse's employer benefits, you may want to delay enrolling in Medicare until you or your spouse retires or is laid off. (Sharon, this is not your Medicare situation.)

2. Medicare is NOT free: There is a cost associated with Medicare Parts A and B. The premium for Part A is at no cost if you worked 10 years or 40 quarters and paid Medicare taxes. But Medicare Part B has a premium which is means-tested depending on your annual income. In 2026, most Medicare beneficiaries pay $202.90 each month for their Part B premium. The Medicare Part A (hospital) deductible for 2026 is $1,736, not once a year but every 60 days or 6 times a year. The 2026 Medicare Part B deductible is $283 once a year with Medicare paying 80% of the Medicare-approved amount and you paying the remaining 20%.

3. Learn the different Medicare Parts (A, B, C and D): Original Medicare is Medicare Parts A and B, which covers hospital, medical and provider expenses. Medicare Part C, known as Medicare Advantage plan, is another way of receiving your Medicare benefits. Part D is the Medicare Prescription Drug plan that can be a stand-alone plan with Original Medicare and a Medicare Supplement, or with a Medicare Advantage plan that includes a prescription drug plan.

4. Original Medicare covers a lot: Medicare Part A covers in-patient hospital, skilled nursing facility care, home health, and hospice care. Medicare Part B covers physicians' services, outpatient surgery/services, lab/X-rays, MRIs, durable medical equipment, and preventive services, etc.

5. Medicare doesn't cover: Services not covered under Medicare include vision, hearing, or dental expenses as well as long-term care.

6. There is no Network with Original Medicare (with Medicare Supplement): Your healthcare professional or facility bills Medicare directly.

7. Medicare Advantage May Be a Good Option: Know that you can choose between Original Medicare (Parts A & B), or Medicare Advantage HMO/PPO plans offered by private insurance companies. Sharon, talk with your doctor about which Medicare Advantage plan the office is associated with and is a good option for you.

Sharon, when one visits with me whether in person at the Toni Says office or by an online consultation, I advise them to forget everything they know about their old health insurance plans because Medicare is different!

Remember, with Medicare, what you don't know WILL hurt you!

Email your Medicare questions to [email protected] or call 832-519-8664. Sign up for the Toni Says newsletter at www.tonisays.com to download Toni's new Medicare 2026 First Steps guide.