Medicare & Medicaid

Turning 65 in 2026? Medicare Enrollment Guide

Initial Enrollment Period, 2026 costs, plan choices, and the rules that are easy to confuse

The short answer: Your Initial Enrollment Period usually lasts seven months: the three months before the month you turn 65, your birthday month, and the three months after. Enroll before your birthday month when possible so Part B can begin without a gap.

1. Your Initial Enrollment Period

For most people becoming eligible at age 65, the Initial Enrollment Period (IEP) is the first opportunity to enroll in Medicare Part A (hospital insurance) and Part B (medical insurance).

  • If you enroll during the three months before your birthday month, Part B and premium-Part A generally start the first day of your birthday month.
  • If you enroll during your birthday month or one of the following three months, coverage generally starts the first day of the next month.
  • If your birthday is on the first day of a month, Medicare treats you as reaching 65 in the prior month; premium-free Part A generally starts in that prior month.

How to enroll

  • Automatic enrollment: If you are already receiving Social Security retirement benefits before age 65, you are generally enrolled automatically in Original Medicare (Parts A and B). Review the Medicare welcome materials and card you receive, especially if you are considering delaying Part B because of active employer coverage.
  • Manual enrollment: If you are not receiving Social Security benefits, apply through Social Security at SSA.gov/medicare or contact Social Security. You do not have to start Social Security retirement benefits to enroll in Medicare.
  • Railroad Retirement Board: If you receive Railroad Retirement Board benefits, follow the RRB enrollment instructions rather than applying through SSA.

If you are still working at 65

Do not assume that every employer, retiree, COBRA, Marketplace, VA, or TRICARE plan lets you delay Part B without consequences. Ask the employer benefits office how the plan coordinates with Medicare and whether your prescription coverage is creditable. An eight-month Part B Special Enrollment Period may be available after current-employment group coverage or the employment ends, whichever occurs first; COBRA does not extend that deadline.

HSA caution: Premium-free Part A can be retroactive for up to six months when you enroll after 65, but not earlier than the month you became eligible. Because HSA contributions are not allowed once Medicare begins, coordinate the timing with your employer and tax adviser.

2. What Changed for Medicare in 2026

The most important national updates for beneficiaries in 2026 involve Medicare costs and Part D prescription coverage. Your actual premium and cost sharing may differ by income, plan, location, drugs, and providers.

2026 Medicare amount What it means
Part B standard premium $202.90 per month; higher-income beneficiaries may pay more
Part B annual deductible $283
Part A inpatient deductible $1,736 for each benefit period, not once per calendar year
Part D maximum deductible $615; a plan may charge less or no deductible
Part D out-of-pocket cap $2,100 for covered Part D drugs; after that, $0 for covered Part D drugs for the rest of 2026

Part D protections and drug-price changes

  • The Part D coverage gap, often called the donut hole, is no longer a separate benefit phase. In 2026, the annual out-of-pocket threshold is $2,100 for covered Part D drugs.
  • The Medicare Prescription Payment Plan remains available through stand-alone Part D plans and Medicare Advantage plans with drug coverage. It can spread eligible out-of-pocket drug costs over the calendar year, but it does not reduce the total amount you owe.
  • Medicare-negotiated prices for the first 10 selected Part D drugs took effect January 1, 2026. Savings for an individual depend on the drug, plan design, pharmacy, and where the person is in the benefit cycle.

3. Choose How You Want to Receive Medicare

Original Medicare (Parts A and B)

  • You can generally use any doctor or hospital in the United States that accepts Medicare.
  • Original Medicare does not include most outpatient prescription drugs; you can add a stand-alone Part D plan.
  • Original Medicare has no annual out-of-pocket maximum for Part A and Part B services. A Medigap policy may help pay deductibles and coinsurance.

Medicare Advantage (Part C)

  • Private plans must cover all medically necessary services covered by Original Medicare. Most include Part D drug coverage and some offer extra benefits, but benefits vary by plan.
  • Provider networks, service areas, referrals, and prior authorization rules may apply. Confirm that your doctors, hospitals, drugs, and preferred pharmacies are covered.
  • Medicare Advantage plans set an annual out-of-pocket limit for covered Part A and Part B services. You must keep paying the Part B premium, plus any plan premium.
Medigap is not part of Annual Open Enrollment: Your federal Medigap Open Enrollment Period is a one-time six-month window that starts the first month you have Part B and are 65 or older. Outside that window, an insurer may use medical underwriting, charge more, or decline an application unless you have a guaranteed-issue right or additional state protection. Do not drop an existing Medigap policy until new coverage is confirmed.

4. Enrollment Periods That Are Often Confused

Enrollment period When What you can do
Initial Enrollment Period Seven-month window around age 65 Enroll in Parts A and B; join a Medicare Advantage or Part D plan when eligible
Annual Open Enrollment October 15-December 7, 2026 Join, drop, or switch Medicare Advantage or Part D coverage; changes generally start January 1, 2027
Medicare Advantage Open Enrollment January 1-March 31 for current members; also the first three months of Medicare for certain new enrollees Make one change to another Medicare Advantage plan, or return to Original Medicare and join a Part D plan
General Enrollment Period January 1-March 31 Enroll in Part B and premium-Part A after missing another enrollment opportunity; coverage starts the month after enrollment and penalties may apply
Special Enrollment Period Timing varies by qualifying event Enroll or change coverage after events such as loss of current-employment coverage, moving, or loss of Medicaid

5. How to Prepare for Open Enrollment

The Annual Open Enrollment Period from October 15 through December 7, 2026 is for reviewing or changing Medicare Advantage and Part D coverage for 2027. It is not the period for first enrolling in Part A and Part B.

  1. Read your plan’s Annual Notice of Change. Plans send it in September and it explains changes in premiums, copayments, benefits, drug coverage, and provider rules for January.
  2. List every prescription. Include the exact drug name, dosage, frequency, and preferred pharmacy; then check the plan’s formulary, tier, restrictions, and estimated annual cost.
  3. Verify providers directly. Check the plan directory and call doctors, hospitals, and the plan to confirm participation for the new year.
  4. Compare total cost, not only the premium. Include deductibles, copayments, coinsurance, maximum out-of-pocket exposure, and likely drug spending.
  5. Use Medicare Plan Finder. Compare plans at Medicare.gov/plan-compare, and keep confirmation of any enrollment request.

6. Getting Help

  • Medicare: 1-800-MEDICARE (1-800-633-4227), available 24 hours a day, 7 days a week; TTY 1-877-486-2048
  • Social Security: SSA.gov/medicare or 1-800-772-1213 for Part A and Part B enrollment
  • SHIP: Free, one-on-one Medicare counseling through your State Health Insurance Assistance Program at shiphelp.org
  • Licensed agent or broker: May help compare plans, but ask which insurers the person represents and how the person is compensated

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Official Sources

Important: Medicare rules can depend on work status, employer size, disability, ESRD, income, and state law. This article provides general educational information and is not individualized insurance, tax, legal, or medical advice. Verify your dates and options with Medicare, Social Security, your employer benefits office, or SHIP before making a coverage change.