Turning 65? Here Is Everything You Need to Know About Medicare Health Plans

Turning 65 is a milestone worth celebrating — and one that comes with an important to-do list. At the top of that list: understanding your Medicare options and enrolling on time. Make the right moves now and you will have comprehensive, affordable health coverage for the rest of your life. Miss a deadline or choose the wrong plan, and you could face permanent premium penalties or gaps in coverage that are difficult to fix later.

At All Horizon Financial Services, we help West Palm Beach and South Florida residents navigate Medicare every day. Here is everything you need to know as you approach 65.

You become eligible for Medicare at age 65 — but eligibility and enrollment are two different things. You need to actively enroll to receive coverage.

If you are already receiving Social Security benefits when you turn 65, you will be automatically enrolled in Medicare Parts A and B. Your Medicare card will arrive in the mail about three months before your 65th birthday.

If you are not yet receiving Social Security, you must actively enroll in Medicare. You can do this through the Social Security Administration online, by phone, or in person.

Your Initial Enrollment Period is a seven-month window centered on your 65th birthday month:

• 3 months before your birthday month
• Your birthday month
• 3 months after your birthday month

When you enroll within this window affects when your coverage starts:

The takeaway: Enroll in the three months before your birthday month to ensure your coverage starts on the first day of the month you turn 65 — with no gap.

Part A covers inpatient hospital stays, skilled nursing facility care, hospice care, and some home health services. Most people pay $0 premium for Part A if they or their spouse worked and paid Medicare taxes for at least 10 years (40 quarters).

Part B covers doctor visits, outpatient care, preventive services, lab tests, and durable medical equipment. The standard Part B premium in 2026 is $185.00 per month. Higher-income beneficiaries pay more under the Income-Related Monthly Adjustment Amount (IRMAA).

Medicare Advantage plans are offered by private insurers and provide an alternative way to receive your Medicare benefits. Most plans bundle Parts A, B, and D (prescription drugs) into one plan and include extra benefits like dental, vision, and hearing. Many plans are available for $0 beyond your Part B premium.

Part D covers prescription medications. If you choose Original Medicare (Parts A and B), you need to add a standalone Part D plan to get drug coverage. Medicare Advantage plans typically include Part D.

One of the most important things to understand about Medicare is the late enrollment penalty. If you do not enroll in Medicare Part B when you are first eligible and do not have qualifying other coverage, you will pay a permanent premium surcharge for the rest of your life.

Part B late enrollment penalty: 10% added to your Part B premium for every 12-month period you were eligible but did not enroll. This penalty is permanent — it never goes away.

Part D late enrollment penalty: 1% of the national base beneficiary premium multiplied by the number of months you went without creditable drug coverage. Also permanent.

The only way to avoid these penalties is to either enroll on time or have qualifying employer coverage that allows you to delay Medicare enrollment without penalty.

If you are still working at 65 and covered by employer health insurance, you may be able to delay Medicare enrollment without penalty — but the rules depend on the size of your employer.

Employer with 20 or more employees: Your employer coverage is primary. You can delay Part B enrollment without penalty until you retire or lose your employer coverage. You then have a Special Enrollment Period to sign up.

Employer with fewer than 20 employees: Medicare is primary. You should enroll in Part B at 65 to avoid gaps in coverage and late enrollment penalties.

Important: COBRA coverage and retiree health coverage do not count as qualifying employer coverage for purposes of delaying Medicare enrollment. If you are on COBRA when you turn 65, enroll in Medicare on time.

Once you are enrolled in Parts A and B, you have three primary options for your overall Medicare coverage:

• Enroll in Original Medicare (Parts A and B)
• Add a Medigap (Medicare Supplement) policy to cover deductibles, coinsurance, and copays
• Add a standalone Part D plan for prescription drug coverage

Best for: People who want maximum provider flexibility, travel frequently, or have complex health needs requiring multiple specialists.

Cost: Higher monthly premiums (Medigap + Part D), but very predictable and low out-of-pocket costs when you use care.

• Enroll in Original Medicare (Parts A and B)
• Choose a Medicare Advantage plan that replaces Original Medicare
• Most plans include Part D drug coverage plus dental, vision, and hearing

Best for: Generally healthy people who want lower monthly premiums, extra benefits, and are comfortable with a provider network.

Cost: Often $0 beyond Part B premium, but copays and coinsurance apply when you use care. Annual out-of-pocket maximum provides financial protection.

• Enroll in Parts A and B with no supplemental coverage
• Pay all deductibles, coinsurance, and copays out of pocket

Not recommended for most people. Without a Medigap policy or Medicare Advantage plan, you have no cap on out-of-pocket costs. A serious illness could result in tens of thousands of dollars in uncovered expenses.

If you want a Medigap policy, the best time to enroll is during your Medigap Open Enrollment Period — the six months beginning the month you turn 65 and enroll in Part B. During this window, insurers must sell you any Medigap plan at standard rates regardless of your health history. No medical underwriting, no denials, no higher premiums based on pre-existing conditions.

After this window closes, Medigap insurers in Florida can use medical underwriting — meaning they can charge higher premiums or deny coverage based on your health. If you develop a serious condition after your initial window, you may find it difficult or impossible to get comprehensive Medigap coverage later.

This is one of the most important deadlines in Medicare. If you think you may want a Medigap policy at any point, enrolling during your initial window protects your options for life.

Original Medicare does not cover routine dental care, eyeglasses, or hearing aids. These are significant gaps — especially for seniors, who are more likely to need these services.

Medicare Advantage plans often include dental, vision, and hearing benefits, making them an attractive all-in-one option for many beneficiaries.

If you choose Original Medicare with a Medigap policy, you can purchase standalone dental and vision plans to fill these gaps. All Horizon Financial Services can help you find the right combination of coverage for your needs.

Navigating Medicare for the first time can feel overwhelming — but it does not have to be. Our licensed Medicare advisors have helped hundreds of West Palm Beach and South Florida residents turn 65 with confidence, choosing the right coverage for their health needs and their budget.

We will:

• Walk you through every Medicare option available in your area
• Compare Medicare Advantage plans side by side, including premiums, networks, drug formularies, and extra benefits
• Help you evaluate Medigap plans and lock in your coverage during your guaranteed issue window
• Make sure you enroll on time to avoid late enrollment penalties
• Answer every question you have — at no cost to you

Our services are completely free. We are compensated by the insurance carriers, not by you.

If you are turning 65 in the next few months — or if you have a family member approaching Medicare eligibility — now is the time to start planning. The decisions you make at 65 can affect your health coverage and your finances for decades.

Call us at 561-688-7300 or 561-301-5274 to schedule your free Medicare consultation. We are here to help you get Medicare right — the first time.