What Happens to Your Health Insurance When You Turn 65

Medicare becomes available when you turn 65, and you have a limited window to sign up without penalties

When you turn 65, you become may be able to access for Medicare, the federal health insurance program for people 65 and older. You do not have to wait until your birthday month—you can sign up starting three months before you turn 65. The enrollment window runs from three months before through three months after your birthday month, giving you a seven-month window total. If you miss this window, you may face a permanent penalty on your premiums, so timing matters.

You have choices within Medicare itself. Original Medicare (Part A for hospital care and Part B for doctor visits) is run by the federal government. Medicare Advantage (Part C) is offered by private insurance companies and bundles hospital, doctor, and often prescription drug coverage into one plan. Most people also need Part D, which covers prescription drugs. Understanding these pieces before your birthday helps you avoid gaps in coverage or unexpected costs.

Key Takeaways

• You can sign up for Medicare starting three months before you turn 65, and you have until three months after your birthday month to enroll without penalty.
• Original Medicare (Parts A and B) is federal coverage; Medicare Advantage (Part C) is private insurance that bundles hospital and doctor care.
• Most people need Part D for prescription drug coverage, which you can add to Original Medicare or get bundled with Medicare Advantage.
• If you delay signing up past your enrollment window, you will pay a permanent increase on your premiums for as long as you have Medicare.
• You can change your plan once a year during the annual enrollment period from October 15 through December 7.

How to sign up for Medicare

You can sign up through three main routes: online at Medicare.gov, by phone at 1-800-MEDICARE (1-800-633-4227), or in person at your local Social Security office. Online is usually fastest—you log in with your Social Security number and create a Medicare.gov account. The phone line has wait times but staff can walk you through the process step by step. Social Security offices handle Medicare enrollment in person, though you may need an appointment.

You will need your Social Security number, proof of citizenship or legal residency, and information about any current health insurance you have. If you are still working and covered by your employer's plan, bring details about that coverage—it affects which parts of Medicare you need right away. Have your doctor's name and pharmacy information handy if you want to check whether they accept your chosen plan.

The process itself takes 15 to 30 minutes online or over the phone. You will choose between Original Medicare and Medicare Advantage, decide on prescription drug coverage, and pick your effective date. Your Medicare card arrives in the mail within two weeks, though you can use a temporary number right away.

Original Medicare versus Medicare Advantage

Original Medicare is two parts: Part A covers hospital stays, skilled nursing facilities, and hospice; Part B covers doctor visits, outpatient care, and preventive services. You pay a monthly premium for Part B (the amount varies by income), and you also pay a deductible and coinsurance when you use services. Original Medicare works nationwide—any doctor or hospital that accepts Medicare accepts you. There are no networks to navigate.

Medicare Advantage is a private insurance alternative. Insurance companies contract with Medicare to provide all the same coverage as Parts A and B, usually with lower out-of-pocket costs and no separate Part B premium. The trade-off is that you must use doctors and hospitals in the plan's network, except in emergencies. Many Medicare Advantage plans include Part D (prescription drugs) and dental or vision coverage at no extra cost. Plans vary widely by county—what is available in Charleston differs from what is available in Greenville.

Original Medicare is simpler if you travel or move frequently, or if you have a doctor you want to keep who may not be in a Medicare Advantage network. Medicare Advantage makes sense if you want lower premiums, predictable costs, and extra benefits like dental. Neither is "better"—it depends on your health, your doctors, and what you value.

Prescription drug coverage through Part D

Part D is separate from hospital and doctor coverage. If you choose Original Medicare, you add Part D through a private insurance company—you pick a plan from a list of options available in your area. If you choose Medicare Advantage, most plans include Part D automatically, though you can sometimes choose a different Part D plan if you want.

Part D plans differ in which drugs they cover and what you pay. Each plan has a formulary—a list of covered medications—and you can search your drugs on Medicare.gov to see which plans cover them and at what cost. Costs change every year, and plans change which drugs they cover, so you should review your coverage each fall during the annual enrollment period.

If you do not sign up for Part D when you first turn 65, and you do not have other prescription drug coverage, you will pay a penalty for every month you go without it. The penalty is added to your Part D premium permanently, even if you sign up later. The only exception is if you have coverage through an employer or union that is at least as good as Part D.

Enrollment deadlines and penalties

Your Initial Enrollment Period is seven months long: three months before your birthday month, your birthday month itself, and three months after. If you sign up during this window, your coverage starts on the first day of your birthday month (or the first of the following month if you sign up after your birthday month). This is the only time you can sign up without a penalty.

If you miss this window, you enter a General Enrollment Period from January 1 through March 31 each year. You can sign up then, but your coverage does not start until July 1, leaving you uninsured for months. You also pay a permanent penalty: your Part B premium increases by 10 percent for each full year you were may be able to access but not enrolled. The same penalty applies to Part D if you delay prescription drug coverage.

There are exceptions. If you are still working and covered by your employer's health plan, you can delay Medicare without penalty as long as you are actively employed. When you leave that job, you have eight months to sign up for Medicare without penalty. If you have coverage through a spouse's employer, similar rules apply. You must tell Medicare about your employer coverage when you sign up, or the penalty clock starts anyway.

What Medicare costs in South Carolina

Part A (hospital insurance) is free for most people because they or their spouse paid Medicare taxes while working. Part B (doctor insurance) has a monthly premium that changes each year—in 2024 it ranges from $174.70 to $560.50 depending on your income. Higher earners pay more. You also pay a yearly deductible ($240 in 2024) before Part B coverage kicks in, then 20 percent coinsurance for most services.

Part D premiums vary by plan and change yearly. In South Carolina, plans range widely—some cost $5 to $10 per month, others $40 or more. Original Medicare has no network, so you can see any doctor, but you pay more out of pocket. Medicare Advantage plans often have $0 premiums (beyond Part B), but you pay copays for doctor visits and must use in-network providers.

All Medicare beneficiaries pay for some services out of pocket. Original Medicare covers preventive care (like annual wellness visits and cancer screenings) at no cost, but you pay for other services. Medicare Advantage plans vary—some cover more preventive services, some less. Review the plan's summary of benefits before you enroll.

Changing your plan after you sign up

You can change your Medicare plan once a year during Annual Enrollment Period, which runs from October 15 through December 7. Changes take effect January 1. This is your chance to switch from Original Medicare to Medicare Advantage, or vice versa, or to change your Part D plan if costs or coverage have shifted.

You can also make changes outside the annual period if you have a may have access to life event: you move out of your plan's service area, you lose other health coverage, you become may be able to access for Medicaid, or your plan leaves Medicare. You have 60 days from the event to make a change. If you move to a different county in South Carolina, check whether your current plan still serves your new area—many Medicare Advantage plans are county-specific.

Review your coverage every October, even if you do not plan to change. Drug formularies shift, premiums change, and new plans launch. Medicare.gov has a tool called "Plan Finder" where you enter your drugs and doctors to see which plans cover them and what you will pay.

Frequently Asked Questions

Do I have to sign up for Medicare when I turn 65?

If you are not working and not covered by an employer plan, yes—you should sign up during your Initial Enrollment Period to avoid penalties. If you are still working and covered by your employer's health plan, you can delay without penalty as long as you are actively employed. When you leave that job, sign up within eight months.

What if I am still working at 65?

If your employer has 20 or more employees, your employer's plan is primary and Medicare is secondary. You can delay Medicare without penalty. When you retire or lose that coverage, you have eight months to sign up. If your employer has fewer than 20 employees, Medicare is primary and you should sign up on time.

Can I keep my current doctor with Medicare?

With Original Medicare, yes—any doctor who accepts Medicare accepts you. With Medicare Advantage, your doctor must be in the plan's network. Before you choose a Medicare Advantage plan, use the plan's provider directory to confirm your doctor participates. If your doctor is not listed, you can call the plan to ask, or choose Original Medicare instead.

What happens if I miss my enrollment deadline?

You can still sign up during General Enrollment (January 1 through March 31), but coverage does not start until July 1. You also pay a permanent penalty on your Part B and Part D premiums—10 percent more for each full year you were may be able to access but not enrolled. The penalty stays with you for life.

How do I know which Medicare Advantage plans are available in my area?

Go to Medicare.gov and use the Plan Finder tool. Enter your zip code, and it shows all Medicare Advantage and Part D plans available where you live. Plans change by county and year, so availability in Charleston may differ from Greenville. You can compare premiums, deductibles, copays, and which doctors and hospitals each plan includes.