Reaching 65: A Milestone Worth Celebrating
Turning 65 is more than a birthday, it’s a gateway to new possibilities, including access to Medicare. Whether you’ve timed your retirement to coincide with Medicare eligibility or you’re already retired and ready to transition from private insurance, this guide is designed to help you navigate the process with clarity, confidence, and care.
At Martos Wealth, we believe informed decisions are empowered decisions. That’s why we’ve created this step-by-step overview to help you understand what Medicare covers, when to enroll, and how to avoid costly mistakes.
What Is Medicare and What Are You Enrolling In?
Medicare is a federal health insurance program with multiple components. Understanding each part is essential to building a coverage strategy that aligns with your health needs and financial goals. The main components of Medicare include:
- Part A (Hospital Insurance): Medicare Part A covers services like hospital inpatient care, hospice care, home health care, and some types of skilled, inpatient nursing home care (excluding long-term care).
- Part B (Medical Insurance): Medicare Part B covers preventive and medically necessary services that diagnose or treat medical conditions. Examples of these services include doctor’s visits, some outpatient services, some mental health services, and prescribed durable medical equipment.
- Part C (Medicare Advantage): Medicare Advantage plans offer an alternative way of getting the same coverage found under Parts A and B (Original Medicare) plus additional coverage, including coverage for the 20% that Parts A and B don’t cover. Medicare Advantage Plans, which are often bundled with Part D, are provided by Medicare-approved private insurance companies. Individuals typically have dozens of Medicare Advantage Plans to choose from depending on the state they live in.
- Medicare Supplement (“Medigap”): Medigap supplements Parts A & B (whereas a Medicare Advantage plan offers an alternative way to get Parts A & B) by paying for some of the costs for covered healthcare services and supplies, including copayments, coinsurance, and deductibles. Some Medigap policies also offer additional coverage on services not covered by Parts A & B.
- Part D (Prescription Drug Coverage): Medicare Part D aids in covering the cost of prescription medications. This coverage is optional (penalties will apply if you delay coverage) but is available to anyone with Original Medicare (Parts A & B). Most Medicare Advantage Plans bundle in prescription drug coverage.
When Should You Enroll?
Timing is everything. Missing key enrollment windows can result in penalties or coverage delays.
Initial Enrollment Period (IEP)
- Begins 3 months before your 65th birthday
- Ends 3 months after your birthday month
- Total window: 7 months
- Coverage typically begins the first day of your birthday month
Example: If your birthday is in August, your IEP runs from May through November.
Signing up for Medicare during the Initial Enrollment Period is not optional for most people. If you miss the Initial Enrollment Period, you might have to wait to sign up until the next General Enrollment Period, which may result in a delay in coverage and a lifetime late enrollment penalty. The longer you wait to sign up, the higher the penalty.
General Enrollment Period (GEP)
- Occurs annually from January 1 to March 31
- Coverage begins the first day of the month after you sign up
- Late enrollment may trigger lifetime penalties
Think of the GEP as a yearly catch-up period for Original Medicare if you missed your first opportunity to enroll and didn’t have a valid reason (like employer coverage) to delay. Sign up in January, and your coverage starts in February; sign up in March, and coverage starts in April, but be aware of potential penalties for waiting.
Open Enrollment Period (OEP)
- Runs from October 15 to December 7
- Allows changes to Medicare Advantage (Part C) and Part D plans
Special Enrollment Periods (SEPs)
- Triggered by life events such as:
- Moving outside your plan’s service area
- Losing employer coverage
- Employer plan changes
- Triggered by life events such as:
How to Enroll in Medicare
Now that we’ve covered what Parts of Medicare you can enroll in and when you can enroll, let’s review how to sign up for Medicare. Thankfully, the process for signing up for Original Medicare is relatively simple. If you’re already receiving Social Security benefits, you may be auto-enrolled in Parts A and B. If not, here’s how to get started:
- Apply Online: The easiest (and often fastest) way to sign up for Medicare is to sign up online on the Social Security website. You’ll need to create a secure Social Security account to get started. Note: If you’re already collecting Social Security, you’ll automatically be enrolled in Parts A and B.
- Phone Call: You can call Social Security at 1-800-772-1213 or 1-800-325-0778 if you’re using a teletypewriter. Individuals can also contact a local Social Security office in their area and reach out for assistance.
- In Person: Contact your local Social Security office
- Railroad Retirement Board: It’s worth noting that if you or your spouse worked for a railroad, you have the option of reaching out to the Railroad Retirement Board. The Railroad Retirement Board can be reached at 1-877-772-5772.
Enrolling in a Medigap, Medicare Advantage Plan, or a standalone Part D plan requires more effort. Because you likely have many plans available as options, this is a good opportunity to review your medical needs, research various plan options, and review potential costs.
What Costs Should You Expect?
Key 2025 Part A Costs:
- Premium: $0 per month (most people).
- Reduced Premium: $285/month (30–39 work quarters).
- Full Premium: $518/month (<30 work quarters).
- Inpatient Deductible: $1,676 per benefit period.
- Daily Coinsurance: $419/day for days 61–90; $838/day for lifetime reserve days.
- Skilled Nursing Facility Coinsurance: $209.50/day for days 21–100.
Key 2025 Part B Costs:
- Standard Premium: $185.00 per month.
- Annual Deductible: $257.00.
- High-Income Surcharge (IRMAA): Applies to individuals with 2023 modified adjusted gross income (MAGI) over $106,000 or couples over $212,000. IRMAA is calculated using a 2-year lookback on MAGI.
- Total Range: Depending on income, premiums can range from the $185 base up to $628.90 per month for the highest earners.
For Part B coverage, the standard premium for most individuals is $185 for 2025. However, you may pay a higher premium depending on your income. Additionally, you may also pay 20% of the Medicare-Approved Amount for most outpatient therapy, durable medical equipment, and doctor services (including ones rendered as a hospital inpatient), unless you have a Medigap or Medicare Advantage plan, which will provide a cap on total medical costs.
Monthly premiums vary by plan for Medigap, Medicare Advantage, and Part D. You can compare plan costs here.
Healthcare Planning with Martos Wealth
Medicare is a foundational piece of your retirement strategy. At Martos Wealth, we offer annual personalized Healthcare Planning to help you:
- Understand your coverage options
- Align your healthcare decisions with your financial plan
- Avoid gaps, penalties, and unexpected costs
In Summary
At Martos Wealth, Medicare planning isn’t a one-time conversation, it’s an ongoing commitment. Each year, we proactively guide our clients through Medicare decisions, from initial enrollment to annual reviews and plan adjustments. Whether you’re approaching age 65 or already enrolled, we ensure your coverage continues to align with your health needs, financial goals, and evolving life circumstances.
We specialize in guiding households through transitions with clarity, warmth, and fiduciary care. If you’re turning 65 soon, let’s talk about how to make this next chapter one of empowerment and ease.
Disclaimer: This article is provided for educational, general information, and illustration purposes only and is not exhaustive. Diversification and/or any strategy that may be discussed does not guarantee against investment losses but are intended to help manage risk and return. If applicable, historical discussions and/or opinions are not predictive of future events. The content is presented in good faith and has been drawn from sources believed to be reliable. Nothing contained in the material constitutes tax advice, a recommendation for purchase or sale of any security, or investment advisory services. We encourage you to consult a financial planner, accountant, and/or legal counsel for advice specific to your situation. Reproduction of this material is prohibited without written permission from Martos Wealth Management, LLC, and all rights are reserved.
