Turning 65? Here is exactly what to do.
- Find out whether you must sign up now or can wait. It turns on one thing: whether you still have coverage from a job.
- Set up the hospital and doctor parts. Then decide, separately, how you cover the 20% Medicare will not pay.
- Choose a drug plan by matching your actual prescriptions to its list, not by its monthly price.
The same facts, twice
What Medicare actually covers
Medicare is not written for the people who use it. Here is the official wording, and underneath it, the version we would say to you on the phone.
How the handbook says it
- Part A
- Hospital Insurance helps cover inpatient hospital care, skilled nursing facility care, hospice care and some home health care. An inpatient deductible applies per benefit period, and coinsurance applies to days 61 through 90 and to lifetime reserve days.
- Part B
- Medical Insurance helps cover medically necessary services including physicians’ services, outpatient care, durable medical equipment and many preventive services. After the annual deductible you generally pay 20% coinsurance of the Medicare-approved amount.
- Part D
- Prescription Drug Coverage is offered through private plans approved by Medicare. Cost sharing varies by formulary tier and by pharmacy status. Once your true out-of-pocket costs reach the annual maximum you enter catastrophic coverage.
How we would say it
- Part A
- Part A is the hospital half. If you are admitted overnight, this is the part that pays. Most people pay nothing for it each month, because they already paid through payroll taxes while they worked.
- Part B
- Part B is the doctor half. Office visits, blood tests, scans, a walker, a wheelchair. You pay the first $283 each year, then Medicare pays 80% and you pay the other 20%. Nothing caps that 20%, which is the reason most people add a second plan.
- Part D
- Part D is the pill half. You buy it from a private company and each company covers a different list of drugs. In 2026, once you have paid $2,100 of your own money for covered drugs, you pay nothing more for the rest of the year.
Move your mouse over the panel, or press and drag on a touch screen, to read it in plain English through the window. Keyboard: focus the panel and use the arrow keys.
Four decisions, and we help with all of them
You do not have to understand Medicare to get it right. You have to get four things in the right order, and someone has to check the details.
Medicare Advantage
One private plan instead of Original Medicare. Lower monthly cost, a network to stay inside, and a yearly ceiling on what you can be charged.
Medigap supplements
A second policy that pays the 20% Original Medicare leaves you. Any doctor in the country, no referrals, a predictable year.
Part D drug plans
We match your actual prescriptions against every plan sold in your county, then tell you the yearly total. Not the monthly price.
Your yearly review
Plans change every January. Every fall we re-check the one you have against the ones you could have, and tell you if it still wins.
Your 7-month window, step by step
It opens three months before the month you turn 65 and closes three months after it. Open any step to see what happens in it. Each one has its own link, so you can send a step to someone else.
Sign up for Part A and Part B now and your coverage starts on the first day of your birthday month. Nothing you do later gets you an earlier start date.
You apply through Social Security, not through Medicare and not through us. It takes about fifteen minutes online, or you can do it on the phone.
One exception worth knowing: if your birthday is on the first of the month, Medicare treats you as turning 65 the month before, and everything shifts back by one month.
If you or your spouse still work somewhere with 20 or more employees and you are covered there, you can usually delay Part B with no penalty, and pick it up later through a Special Enrollment Period.
If the employer has fewer than 20 employees, Medicare usually needs to be your primary coverage from 65. Delaying can leave claims unpaid, and nobody will warn you until a bill arrives.
Most people still take Part A at 65 because it is free. One caution: you cannot contribute to a health savings account once any part of Medicare starts.
Sign up during your birthday month and coverage starts on the first day of the following month. That is a rule change from 2023, and it replaced a much worse one that could leave people waiting until July.
Nothing is broken. You have simply given up the neatest possible start date.
Original Medicare pays about 80% of Part B services and puts no ceiling on your share of the rest. You close that gap in one of two ways, and you cannot easily have both.
- Original Medicare plus a Medigap policy plus a drug plan. Any doctor in the country who takes Medicare. No referrals, no prior approvals. Higher monthly cost, very few surprises.
- A Medicare Advantage plan. Usually lower monthly cost, drugs and extras often included, a network to stay inside, and a yearly ceiling on what you can be charged.
Neither is the right answer for everyone. It depends on your doctors, your prescriptions, whether you travel, and how much uncertainty you can live with.
This one is separate from the seven-month window and it matters more than almost anything else on this page.
For six months, any Medigap company must sell you any plan they offer, at their standard rate, whatever your health history. They cannot ask health questions and they cannot say no.
After those six months, in most states they can ask, and they can decline. People who plan to “try Medicare Advantage for a year and switch to a supplement later” are often surprised to learn that later is not guaranteed.
Sign up in this stretch and coverage still starts the first of the month after you apply. Once it ends, if you have no other reason to delay, your next chance is the General Enrollment Period, January 1 to March 31, and a late-enrollment penalty is likely.
Before you accept a penalty, call us. Plenty of people qualify for a Special Enrollment Period they did not know existed.
2026 figures
What it costs, on one screen
| What | Who pays it | 2026 |
|---|---|---|
| Part A monthly premium | Most people, nothing | $0 |
| Part A hospital deductible | You, each benefit period | about $1,736 |
| Part B monthly premium | You, usually from your Social Security payment | $202.90 |
| Part B yearly deductible | You | $283 |
| Part B coinsurance | You, after the deductible | 20%, with no ceiling |
| Part D drug spending cap | Your plan, once you reach it | $2,100 |
Households with higher incomes pay more for Parts B and D. That surcharge is called IRMAA and it is based on your tax return from two years ago. See every cost explained.
Three calls, roughly as they happened
Shared with permission. Names and details used with the callers’ agreement.
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Caller said: I turn 65 in April and four different companies have called me this week. I cannot tell which one of them is Medicare.
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Plainspoken advisor replied: None of them. Medicare never cold-calls you. Let us start somewhere easier: are you still working?
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Caller said: I finish at the end of March.
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Plainspoken advisor replied: Then your window is already open and it closes at the end of July. We have time. Hospital and doctor parts this week, drug plan next week.
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Caller said: That is the first thing anyone has said to me about this that I understood.
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Caller said: My plan sent a letter. It is fourteen pages. I think my cardiologist is not in it any more but I honestly cannot tell.
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Plainspoken advisor replied: Send me the first two pages and his name. I will check the 2026 network and call you back today.
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Plainspoken advisor replied: He is out of network from January. Two other plans here in Lucas County still have him, and one of them keeps your pharmacy too.
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Caller said: Fourteen pages, and you got it down to two sentences.
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Caller said: I picked a supplement two years ago and now I would like a different one. Can I just switch?
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Plainspoken advisor replied: You can apply. But outside your first six months a company is allowed to ask health questions and say no. I want you to know that before you cancel anything.
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Caller said: Nobody told me that the first time.
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Plainspoken advisor replied: I know. So let us find out whether you would be accepted first, and only then decide.
You can just call and ask.
There is no form to fill in first, no quote engine, no follow-up campaign. A licensed agent picks up, you describe your situation, and you get an answer. If you do not need us, we will say so.
Questions people ask us most
I turn 65 soon. What is the very first thing I should do?
Work out whether you will still have health coverage from a job, yours or a spouse’s, after you turn 65. That single answer changes everything else.
If you will not, your seven-month Initial Enrollment Period starts three months before your birthday month, and signing up early means coverage starts on the first day of your birthday month. If you will, you may be able to delay Part B without penalty. Call us and we will tell you which one you are in, in about four minutes.
Do I get Medicare automatically?
Only if you are already receiving Social Security or Railroad Retirement benefits at least four months before you turn 65. Then Parts A and B arrive in the mail and start on their own.
Everybody else has to apply, through Social Security, online or by phone. Nobody sends you a reminder.
What is the actual difference between Medicare Advantage and a Medigap plan?
A Medigap policy sits behind Original Medicare and pays the bills Medicare leaves you. You keep the freedom to see any doctor in the country who takes Medicare, and you pay a monthly premium for that.
A Medicare Advantage plan replaces Original Medicare with a private plan. It usually costs less each month and often includes drugs, dental and vision, but you use a network, you may need referrals, and some services need approval in advance.
Neither is better. They are different trades, and which one fits depends on your doctors, your travel, your prescriptions and how you feel about surprises.
I am still working at 65. Do I have to take Medicare?
If your employer has 20 or more employees and you have coverage through that job, you can usually delay Part B without penalty and pick it up later through a Special Enrollment Period.
If the employer has fewer than 20 employees, Medicare usually needs to be primary and delaying can leave you with unpaid claims. Ask your benefits office to put the answer in writing, then call us before you decide.
What does your help cost me?
Nothing. If you enroll in a plan through us, the insurance company pays us a commission that it sets. Your premium is exactly the same as it would be if you enrolled directly or through anyone else.
Four people, one office, on Adams Street
Plainspoken Medicare has been in Toledo since 2011. We are licensed in Ohio, Michigan and Indiana. We are small on purpose: the person who helps you choose is the person who picks up when something goes wrong in March.
We are paid a commission by the insurance company when you enroll, at a rate the company sets. It costs you nothing and it does not change your premium.
