If you expect to become eligible for Medicare, it’s a good idea to understand how health insurance works. This includes how to enroll, your coverage options, and what to expect in terms of costs.
If you’re nearing 65 or you’re already 65 or older, you will need to answer a few basic questions to see if you’re eligible for Medicare:
- Are you a U.S. citizen or legal resident?
- Have you resided in the United States for a minimum of
five years? - Have you worked at least 10 years in Medicare-covered
employment or contributed the equivalent through self-employment taxes?
If you answered yes to all of these questions, you qualify to enroll in Medicare. That said, you’re still eligible for Medicare benefits if you meet the first two requirements. This is known as “voluntary enrollment.” People who choose this option must pay monthly premiums for Medicare Part A and Part B benefits.
Read on to learn more about enrollment, your coverage options, and what you should know about costs.
If you have had deductions taken from your paycheck, you’ll likely receive a Medicare card in the mail just before becoming eligible. Along with this will be information showing the benefits of both Part A and Part B.
Here’s what you need to know if you’re approaching eligibility and want to enroll in Medicare:
- Part A: You can sign up for Medicare Part A, which is hospital insurance, 3 months before or after your 65th birthday, the month of your birthday, and 3 months after your birthday month. In some cases, if you receive payments from Social Security or the Railroad Retirement Board, you’ll be automatically enrolled. If not, enrolling as soon as you turn 65 is best.
- Part B: At age 65, you’re also automatically enrolled in Part B, which is medical insurance. You can choose to drop it to avoid paying premiums by reading your Medicare card and following the instructions for canceling. You may not need Part B if you are still employed and covered, but you have eight months to enroll without penalties if you are retiring or losing healthcare benefits.
- Part C: Medicare Advantage plans (Part C) replace Parts A and B and are offered through private insurers. These plans may have higher premiums but may also offer benefits like prescription drug coverage and lower out-of-pocket costs. But you can see only local providers, while Original Medicare is accepted nationally. You can enroll during initial enrollment for Original Medicare or during special periods throughout the year.
- Part D: This covers prescriptions and helps you manage and potentially reduce your out-of-pocket expenses related to the cost of prescription drugs. Medicare Part D enrollment guidelines mirror those of Medicare Advantage Plans. You may have to pay a penalty fee if you do not sign up during your enrollment eligibility dates.
- Medigap: This is a supplemental plan that can help you offset the cost of copays and deductibles that original Medicare doesn’t cover. To enroll, you need to contact a licensed private insurer selling this coverage. Medigap doesn’t include prescription drug coverage and all members of your household need to apply separately.
Learn more:
What’s important to know about Medicare costs is that the costs of Original Medicare (Parts A and B), such as premiums and deductibles, are set annually and are the same across the United States.
The costs for 2025 are available on Medicare.gov. Most people don’t pay a premium for Part A if they’re worked and paid taxes for at least a decade. If you do have to pay it, the amount will depend on how long you or your spouse have worked in the United States.
On the other hand, Part D, Medicare Advantage, and Medigap costs vary. This is because they’re administered by private insurance companies, and your costs will depend on the specific plan you choose in your geographic area.
You can explore your available options for 2025 on Medicare.gov by inputting your zip code.
Learn more: What does Medicare cost?
Original Medicare usually doesn’t cover the following:
- eye exams for glasses
- long-term care
- cosmetic surgery
- massage therapy
- routine physical exams
- hearing aids and related exams
- concierge medicine
- items or services from non-participating providers.
- dental care
That said, some of these services may be covered by a Medicare Advantage plan with added benefits.
Learn more: 10 healthcare services Medicare doesn’t cover.
Enrolling in Medicare may seem difficult, but it doesn’t need to be. If you do your research before enrollment, you’ll be well informed.
If you still have questions about what coverage you will need and can afford, you can meet with a financial advisor or speak with a Medicare representative. Start planning early, and you’ll feel more confident once enrollment begins.