Turning 65? These are the Most Common Medicare Questions Answered

Turning 65 is one of the most significant healthcare milestones you will face. For most Americans, it marks the beginning of Medicare eligibility, and the decisions you make in the months surrounding your 65th birthday can affect your coverage and costs for years to come. This guide answers the questions people ask most often when they are new to Medicare, using 2026 figures throughout.

What Is Medicare and Who Qualifies for It?

Medicare is the federal health insurance program administered by the Centers for Medicare and Medicaid Services (CMS). It was established in 1965 and today covers more than 67 million Americans. Most people qualify for Medicare at age 65, but younger individuals with certain disabilities or end-stage renal disease (ESRD) may also be eligible.

To qualify at 65, you (or your spouse) must be a U.S. citizen or permanent legal resident who has lived in the country for at least five continuous years. You also need to have worked and paid Medicare taxes for at least 10 years (40 quarters) to receive premium-free Part A. If you already receive Social Security or Railroad Retirement Board benefits, you will be enrolled in Medicare Parts A and B automatically when you turn 65.

What Are the Different Parts of Medicare?

Medicare is divided into four parts, each covering a different category of care. Understanding what each part does is the foundation for making good coverage decisions.

Parts A and B together are called Original Medicare. You can add a Medicare Supplement plan to Original Medicare to limit your out-of-pocket exposure, or you can replace Original Medicare with a Medicare Advantage plan that bundles everything into one plan.

What Is the Difference Between Medicare and Medicaid?

Medicare and Medicaid are two separate programs that are often confused because their names sound similar. The key difference is eligibility: Medicare is based primarily on age (or disability), while Medicaid is based on income.

• Medicare is a federal program for people 65 and older (and certain younger individuals with disabilities or ESRD). Eligibility is not income-based.

• Medicaid is a joint federal and state program for people with low incomes and limited resources. Benefits and eligibility rules vary significantly from state to state.

• Some people qualify for both programs at the same time. These individuals are called dual eligibles, and Medicaid often helps pay their Medicare premiums, deductibles, and copayments.

Is Medicare Free?

Medicare is not entirely free, though some parts cost less than others. Here is what you can expect to pay in 2026:

• Part A: Premium-free for most people who worked and paid Medicare taxes for at least 10 years. If you have 30 to 39 work credits, the 2026 premium is $311/month. With fewer than 30 credits, it is $565/month.

• Part B: The standard monthly premium in 2026 is $202.90. Higher-income beneficiaries pay more due to IRMAA surcharges. There is also a $283 annual deductible.

• Part D: The average monthly premium in 2026 is $34.50, though costs vary widely by plan and the drugs you take. The maximum deductible is $615.

• Medicare Advantage: Many plans have $0 or low monthly premiums, but you still pay your Part B premium. Plans may have copays, coinsurance, and an annual out-of-pocket maximum (up to $9,250 in 2026).

• Medicare Supplement: Monthly premiums vary by plan letter and insurer, but these plans significantly reduce your unpredictable out-of-pocket costs.

When Should You Sign Up for Medicare?

Most people enroll during their Initial Enrollment Period (IEP), which is a 7-month window that starts 3 months before the month you turn 65, includes your birthday month, and ends 3 months after. Enrolling during the first 3 months of your IEP means your coverage starts on the first day of your birthday month.

If you miss your IEP, you can enroll during the General Enrollment Period (January 1 through March 31 each year), with coverage starting July 1. However, enrolling late may result in permanent premium penalties. Read more about Medicare enrollment periods and timing.

Can I Delay My Medicare?

Yes, you can delay Medicare in certain situations without facing a penalty. If you are still working at 65 and covered by a qualifying employer health plan through your own active employment (or your spouse's), you can delay Parts A and B without penalty. When that employer coverage ends, you will have a Special Enrollment Period (SEP) of 8 months to sign up for Part B.

Coverage through COBRA, retiree insurance, or a marketplace plan does not count as qualifying employer coverage for the purpose of delaying Medicare. Relying on those plans past your IEP can trigger late enrollment penalties.

What Are the Penalties for Not Signing Up on Time?

Late enrollment penalties are permanent and can add up to significant costs over time. There are separate penalties for Part B and Part D:

For example, if you delay Part B for 2 full years without qualifying coverage, your monthly premium increases by 20% permanently. At the 2026 standard premium of $202.90, that would add about $40.58 per month for life. Learn more about the Part B late enrollment penalty and the Part D late enrollment penalty.

Will Medicare Cover All of My Expenses?

Original Medicare (Parts A and B) covers a wide range of medical services, but it does not cover everything. There are also significant cost-sharing requirements that can add up quickly if you have frequent or serious medical needs.

Here is what Original Medicare typically does not cover:

• Routine dental care, dentures, and most dental procedures

• Routine vision exams and eyeglasses (except after cataract surgery)

• Hearing aids and routine hearing exams

• Long-term custodial care (such as nursing home care for daily activities)

• Most care received outside the United States

• Prescription drugs (unless you add Part D)

In addition, Original Medicare has no annual out-of-pocket maximum. You are responsible for 20% of the cost for most Part B services after meeting your deductible, and Part A has a $1,736 per-benefit-period deductible in 2026 with daily coinsurance after day 60 in the hospital.

Is Original Medicare the Right Fit for You?

Whether Original Medicare is the right choice depends on your health needs, budget, and preferences. Here is a brief comparison of your main options:

Original Medicare does not have an out-of-pocket spending cap. A Medicare Supplement plan fills in many of those gaps, covering coinsurance, copayments, and deductibles so your costs are more predictable. Medicare Advantage plans bundle Parts A, B, and usually D into one plan and often add dental, vision, and hearing benefits, but you will generally need to use a network of providers.

Frequently Asked Questions