Key Takeaways

• Turning 65 in 2025 means you are now eligible for Medicare, but understanding the different parts and enrollment timelines is critical to avoid late penalties and coverage gaps.

• Knowing what each part of Medicare covers and how they work together helps you make informed decisions about your health and financial needs.

Welcome to Medicare: What Turning 65 Really Means

If you just turned 65 in 2025, you’ve reached an important milestone: you’re now eligible for Medicare. This federal health insurance program is designed to support older adults and certain individuals with disabilities. But signing up isn’t as simple as checking a box. You need to understand what’s available, what you need, and when to act.

Let’s break down what Medicare means for you right now and what steps you should be taking.

The Four Main Parts of Medicare

Medicare is divided into different parts, each serving a specific role. Here’s what each part covers:

Medicare Part A: Hospital Insurance

• Covers inpatient hospital stays, skilled nursing facility care, hospice, and some home health care.

• Most people don’t pay a monthly premium for Part A if they or their spouse paid Medicare taxes for at least 10 years (40 quarters).

• In 2025, the inpatient hospital deductible is $1,676 per benefit period.

Medicare Part B: Medical Insurance

• Covers doctor visits, outpatient care, preventive services, and durable medical equipment.

• You pay a standard monthly premium, which in 2025 is $185.

• The annual deductible for Part B is $257 in 2025.

• After meeting the deductible, you typically pay 20% of the Medicare-approved amount for services.

Medicare Part C: Medicare Advantage

• Offered by private insurers, Medicare Advantage plans combine Parts A and B and often include Part D and additional benefits.

• These plans vary in coverage, costs, and networks.

• You must still pay the Part B premium, even if you enroll in a Medicare Advantage plan.

Medicare Part D: Prescription Drug Coverage

• Helps cover the cost of prescription drugs.

• You can get Part D through a standalone plan or a Medicare Advantage plan that includes drug coverage.

• In 2025, the maximum deductible for Part D plans is $590.

• Once your out-of-pocket costs reach $2,000, you enter catastrophic coverage, and your plan covers the rest of your drug costs.

Initial Enrollment Period: Your First Window

The Initial Enrollment Period (IEP) is your first opportunity to sign up for Medicare. It lasts for seven months:

• Begins three months before the month you turn 65

• Includes your birthday month

• Ends three months after the month you turn 65

If you miss this window, you could face late enrollment penalties and a delay in coverage.

Avoiding Late Penalties

• Part B Penalty: If you delay enrollment and don’t have other creditable coverage, your premium may increase by 10% for each 12-month period you were eligible but didn’t enroll.

• Part D Penalty: If you go 63 days or more without creditable prescription drug coverage, you may pay a lifetime penalty added to your premium.

Special Enrollment Periods (SEPs)

If you’re still working or covered by a spouse’s employer group health plan when you turn 65, you may qualify for a Special Enrollment Period to sign up for Part B and/or Part D later without penalties.

• SEP for Part B usually lasts for 8 months after you lose employer coverage.

• SEP for Part D usually lasts for 2 months after losing drug coverage.

Make sure the coverage you have is considered “creditable” by Medicare.

General Enrollment Period

If you miss your IEP and don’t qualify for a SEP, the General Enrollment Period runs from January 1 to March 31 each year. Coverage begins July 1, and late penalties may apply.

What About Medicare and Employer Insurance?

If you’re still employed when you turn 65, Medicare coordination with employer insurance depends on the size of your employer:

• 20 or more employees: Your group plan pays first, Medicare is secondary.

• Fewer than 20 employees: Medicare becomes your primary payer.

You might choose to delay Part B and Part D if your employer coverage is creditable. Confirm with your HR department.

Medigap: Supplemental Coverage for Original Medicare

Original Medicare (Parts A and B) doesn’t cover everything. That’s where Medigap comes in:

• Sold by private companies to help cover deductibles, coinsurance, and copayments.

• You must have Part A and Part B to enroll.

• Best time to enroll is during your 6-month Medigap Open Enrollment Period, which starts the first month you’re 65 and enrolled in Part B.

• After this window, you may be subject to medical underwriting or denial of coverage.

Coordinating Medicare With Other Benefits

Some individuals qualify for both Medicare and Medicaid (dual eligibility). Others may receive retiree insurance or veterans’ benefits.

• Always review how these programs work with Medicare.

• Some benefits may affect how you choose Part D or a Medicare Advantage plan.

Prescription Drug Costs and Changes in 2025

In 2025, Medicare introduces a $2,000 cap on annual out-of-pocket prescription drug costs under Part D. This is a major shift from previous years and offers significant protection if you take expensive medications.

Another 2025 improvement: the Medicare Prescription Payment Plan. This option allows you to spread your drug expenses over the year in monthly installments rather than paying a large amount all at once.

Important Preventive Services to Use Now

Medicare covers many preventive services at no cost to you. These include:

• Annual Wellness Visit

• Cardiovascular screenings

• Mammograms

• Colonoscopies

• Vaccines (flu, COVID-19, shingles, hepatitis B)

Taking advantage of these services early helps you stay ahead of health issues and manage chronic conditions better.

Coverage Gaps and What’s Not Included

Medicare doesn’t cover everything. Some services are only partially covered or not covered at all:

• Routine dental, vision, and hearing care

• Long-term custodial care

• Most care outside the U.S.

You’ll need to consider whether to buy separate coverage or choose a Medicare Advantage plan that may offer some of these extras.

Key Dates to Remember in 2025

• January 1 – March 31: General Enrollment Period for Medicare Part A and B

• October 15 – December 7: Annual Open Enrollment Period for changing Medicare Advantage and Part D plans

• Initial Enrollment Period: 7-month window around your 65th birthday

Mark these dates to avoid missing critical opportunities.

Making Medicare Work for You

You’ve earned Medicare, but it still takes effort to make it work the way you need. Comparing your options, reviewing costs, and checking whether your providers accept Medicare are all part of the process. Understanding the benefits and limits of each part of Medicare empowers you to take control of your healthcare in retirement.

Ready to Take the Next Step?

Understanding Medicare after turning 65 can feel overwhelming, but taking it step by step makes it more manageable. Pay attention to your enrollment timelines, review coverage options carefully, and consider how your health needs might evolve.

If you need guidance, reach out to a licensed agent listed on this website for professional advice tailored to your situation.