Key Takeaways

• Enrolling in Medicare on time can help you avoid late penalties and ensure continuous health coverage.

• Understanding the different parts of Medicare and how they interact helps you make informed decisions tailored to your medical and financial needs.

Understanding When You’re Eligible for Medicare

Most people qualify for Medicare when they turn 65. Your Initial Enrollment Period (IEP) begins three months before your 65th birthday, includes your birth month, and continues for three months afterward—a total of seven months.

If you miss this period, you may have to wait for the General Enrollment Period (GEP) from January 1 to March 31 each year, with coverage beginning July 1. This delay could result in late penalties and gaps in coverage.

Some people qualify before age 65 due to a disability or diagnosis like End-Stage Renal Disease (ESRD) or Amyotrophic Lateral Sclerosis (ALS).

Confirm Your Eligibility

Before starting the process, verify your eligibility using your Social Security account or by speaking with a licensed agent.

Decide Between Original Medicare and Medicare Advantage

Once you’re eligible, the next step is deciding how you want to receive your benefits. There are two primary options:

• Original Medicare: Includes Part A (hospital insurance) and Part B (medical insurance). You can also add Part D for drug coverage and a Medigap plan for out-of-pocket costs.

• Medicare Advantage (Part C): Offered by private companies approved by Medicare. These plans bundle Part A, Part B, and often Part D, and may offer extra benefits not covered by Original Medicare.

Understanding how each works can help you choose the one that best fits your health needs, budget, and preferred providers.

Review Medicare Part A and Part B Costs in 2025

You may get Part A premium-free if you or your spouse paid Medicare taxes for at least 10 years. If not, you’ll have to pay a monthly premium, which in 2025 can go up to $518.

Part A also includes:

• An inpatient deductible of $1,676 per benefit period

• Coinsurance: $419/day for days 61–90 of a hospital stay, and $838/day for lifetime reserve days

Part B has a monthly premium of $185 and an annual deductible of $257 in 2025. After meeting your deductible, you typically pay 20% of the Medicare-approved amount for most doctor services.

Understand Enrollment Periods That Apply to You

There are several enrollment periods you should be aware of:

1. Initial Enrollment Period (IEP)

Begins three months before your 65th birthday month and ends three months after.

2. General Enrollment Period (GEP)

If you miss your IEP, you can enroll between January 1 and March 31. Coverage begins July 1.

3. Special Enrollment Period (SEP)

You may qualify for an SEP if you lose employer coverage or experience another qualifying life event. There’s no late penalty if you qualify for SEP.

4. Annual Enrollment Period (AEP)

From October 15 to December 7 each year, you can make changes to your Medicare Advantage or Part D plans. New coverage starts January 1.

5. Medicare Advantage Open Enrollment Period

Between January 1 and March 31, if you’re already enrolled in a Medicare Advantage plan, you can switch to a different Medicare Advantage plan or return to Original Medicare.

Decide If You Need Prescription Drug Coverage (Part D)

If you enroll in Original Medicare and want drug coverage, you’ll need to join a separate Part D plan. Medicare Advantage plans often include Part D, but not always.

Failing to enroll in Part D when you’re first eligible, without having other credible drug coverage, can lead to a lifetime late enrollment penalty. The deductible for Part D in 2025 is $590. However, out-of-pocket drug costs are now capped at $2,000 annually, offering substantial relief compared to previous years.

Explore Options for Supplemental Coverage

Original Medicare doesn’t cover everything. You may be responsible for deductibles, copayments, and coinsurance. That’s where Medigap (Medicare Supplement Insurance) comes in. It helps cover those additional costs.

If you opt for a Medicare Advantage plan, you cannot buy a Medigap plan. Decide based on your medical needs, financial situation, and preference for flexibility versus bundled benefits.

Check If You Need to Coordinate With Employer or Retiree Coverage

If you’re still working or have retiree coverage through a union or former employer, check how it works with Medicare:

• If your employer has 20 or more employees: Your group health plan pays first, Medicare pays second.

• If fewer than 20 employees: Medicare usually pays first.

Carefully compare the costs and coverage of both options before delaying any part of Medicare.

Think About Medicare and HSAs

If you have a Health Savings Account (HSA) and plan to keep contributing to it, be cautious. Once you enroll in Medicare, you can no longer make contributions to your HSA. To avoid tax penalties, stop HSA contributions at least six months before enrolling in Medicare.

Pay Attention to Income-Related Monthly Adjustment Amounts (IRMAA)

In 2025, if your modified adjusted gross income (MAGI) from two years ago (2023) exceeds $106,000 (individual) or $212,000 (joint), you may pay more for Part B and Part D due to IRMAA.

You’ll receive a notice if IRMAA applies. If your income has dropped due to a life event such as retirement, you can file an appeal with Social Security.

Know What Medicare Doesn’t Cover

Medicare doesn’t cover everything. Some of the services not included are:

• Long-term care

• Most dental care

• Eye exams for prescription glasses

• Hearing aids and exams

• Cosmetic surgery

You can explore standalone plans or Medicare Advantage plans that may include some of these services, but always verify coverage before enrolling.

Keep Track of Key Medicare Deadlines in 2025

Here’s a snapshot of the most important dates to mark on your calendar:

• January 1 – March 31: General Enrollment Period and Medicare Advantage Open Enrollment Period

• October 15 – December 7: Annual Enrollment Period

• January 1: New coverage begins if you made plan changes during the AEP

Ask for Help If You’re Unsure

Medicare can feel overwhelming, especially with all the parts and rules involved. You’re not alone. Licensed agents can guide you through the enrollment process, explain the differences, and help compare options based on your needs.

What Really Matters When Choosing Your Medicare Coverage

The best Medicare decisions come down to what’s right for you. Think about your health status, your doctors, your prescriptions, and your budget. Then consider how each part of Medicare can help—or fall short.

To avoid unwanted surprises, revisit your choices annually. Medicare plans, rules, and costs change, and staying informed can help you stay protected.

If you’re unsure or want professional support, get in touch with a licensed agent listed on this website who can help you make the right decisions for 2025 and beyond.