Getting Started with Medicare: A Guide for People Turning 65
Understanding your Medicare options is one of the most important steps you'll take as you approach retirement. This guide explains everything you need to know — from understanding the parts of Medicare to enrolling on time and avoiding costly penalties. (Turning 65 · New to Medicare · Florida Residents · About to Retire)
What Is Medicare?
Medicare is the federal health insurance program for people age 65 or older, as well as certain younger people with disabilities or specific conditions. It is administered by the Centers for Medicare & Medicaid Services (CMS) and available to U.S. citizens and legal permanent residents who have lived in the United States for at least five years.
Medicare is made up of different parts, each covering different types of health care services. Most people qualify for premium-free Part A if they (or a spouse) paid Medicare taxes for at least 10 years while working.
Source: Medicare.gov — Get Started with Medicare
The Parts of Medicare Explained
Think of Medicare as a puzzle — different parts fit together to give you the coverage you need. Here is what each part covers:
Part A — Hospital Insurance: 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 worked and paid Medicare taxes for 10+ years.
Part B — Medical Insurance: Covers doctor visits, outpatient care, preventive services (like screenings and vaccines), and durable medical equipment. Standard 2026 premium: $202.90/month. May be higher based on income.
Part C — Medicare Advantage: A private plan alternative that bundles Parts A and B, and often includes Part D drug coverage plus extras like dental, vision, and hearing. Many $0-premium plans available in Florida.
Part D — Drug Coverage: Covers prescription medications, either as a standalone plan or included in a Medicare Advantage plan. 2026 out-of-pocket cap for covered drugs: $2,100. Delaying enrollment may trigger a lifetime penalty.
Original Medicare (Parts A + B) is provided directly by the federal government. Medicare Advantage (Part C) is offered by private insurers and often combines all coverage into one plan. You choose one path or the other; you cannot have both.
Source: Medicare.gov — What Medicare Covers
How to Sign Up for Medicare
Whether you sign up automatically or need to enroll yourself depends on your situation. Follow these steps to make sure you get enrolled on time:
Find Out If You're Automatically Enrolled — If you are already receiving Social Security retirement or Railroad Retirement Board benefits at least 4 months before your 65th birthday, you will be automatically enrolled in Medicare Parts A and B. Your Medicare card arrives about 3 months before your birthday.
Sign Up on Your Own (If Not Automatic) — If you are not yet receiving Social Security benefits, you must actively enroll. Apply online at ssa.gov/medicare, call Social Security at 1-800-772-1213, or visit your local office. You can apply up to 3 months before your birthday month.
Decide Between Original Medicare and Medicare Advantage — Original Medicare gives you access to any doctor or hospital that accepts Medicare nationwide. Medicare Advantage plans bundle your coverage through a private insurer and often include extra benefits like dental, vision, and hearing.
Add Drug Coverage (Part D) — If you choose Original Medicare, enroll separately in a standalone Part D plan. If you choose Medicare Advantage, drug coverage is usually included. Enroll in Part D as soon as you're eligible — even without medications — to avoid a lifetime penalty.
Consider a Medicare Supplement (Medigap) Plan — Adding a Medigap plan helps cover out-of-pocket costs like deductibles and coinsurance. Florida residents benefit from "issue-age" pricing, meaning your premium is locked in based on your age when you first buy.
Source: Medicare.gov — Get Started with Medicare · SSA.gov — Apply for Medicare
Medicare Enrollment Periods
Enrolling at the right time is critical. Missing your window can result in gaps in coverage and permanent monthly penalties. Here are the enrollment periods you need to know:
Don't miss your Initial Enrollment Period — enrolling during the first 3 months guarantees coverage starts on the first day of your birthday month. Waiting until after your birthday month may delay your coverage start date.
Initial Enrollment Period (IEP): 7-month window — 3 months before your birthday month, your birthday month, and 3 months after. Sign up for Parts A, B, and D for the first time, and purchase a Medigap plan with guaranteed acceptance.
Special Enrollment Period (SEP): Up to 8 months after losing employer coverage. Enroll in Part B without penalty if you delayed because you had employer or union health coverage from active work.
Annual Open Enrollment (AEP): October 15 – December 7 each year. Switch between Medicare Advantage and Original Medicare, or change your Part D drug plan. Changes take effect January 1.
Medicare Advantage Open Enrollment: January 1 – March 31 each year. Switch Medicare Advantage plans or return to Original Medicare. One change allowed per year.
General Enrollment Period (GEP): January 1 – March 31 each year. Sign up for Parts A/B if you missed your IEP and don't qualify for an SEP. Coverage starts July 1, and a late enrollment penalty will apply.
Source: Medicare.gov — When Can I Join a Health or Drug Plan
Late Enrollment Penalties
One of the most important reasons to enroll on time is to avoid late enrollment penalties — which are permanent and added to your monthly premium for as long as you have Medicare.
Part B Penalty: If you don't sign up for Part B when first eligible (and don't have a qualifying Special Enrollment Period), your monthly premium increases by 10% for each full 12-month period you waited. This penalty lasts for life.
Part D Penalty: If you go 63 or more consecutive days without creditable drug coverage after becoming eligible, you'll pay 1% of the national base beneficiary premium for each month you went without coverage — added to your Part D premium for life.
No Penalty If You Have Employer Coverage: If you or your spouse is still working and you have health coverage through an active employer's group plan, you may be able to delay Medicare enrollment without penalty. Always confirm with your HR department and a licensed Medicare advisor before delaying.
Source: Medicare.gov — Avoid Late Enrollment Penalties
Your Medicare To-Do List When Turning 65
Find out when your Initial Enrollment Period begins (3 months before your birthday month)
Determine if you will be automatically enrolled or need to apply through Social Security
Make a list of your current doctors and prescriptions before comparing plans
Decide between Original Medicare + Medigap, or Medicare Advantage
Enroll in Part D drug coverage — even if you take no medications — to avoid a lifetime penalty
If keeping employer coverage, confirm in writing that it qualifies as "creditable coverage" to delay without penalty
Speak with a licensed Medicare advisor to compare plan options in your Florida county
About This Page & Get Your Free Medicare Review
This page is provided for educational purposes by Afinius Health, a licensed Medicare insurance specialist in Florida. Information on this page is sourced from Medicare.gov and CMS.gov. Medicare rules and costs are updated annually. Always verify current information at Medicare.gov or speak with a licensed Medicare professional. Afinius Health is not affiliated with or endorsed by the U.S. government or Medicare.
Turning 65 soon? Let us compare every plan available in your Florida county — at no cost to you. Call 1-800-000-0000 or email info@afiniushealth.com for your free Medicare review.
2026 Medicare Costs at a Glance: Part A Premium — $0 for most people. Part B Premium — $202.90/mo. Part B Deductible — $283/year. Part D Max Deductible — $615/year. Part D Out-of-Pocket Cap — $2,100. Florida Advantage Plans — 611 available, including $0-premium options in every county.
Florida SHINE Program: Florida's free SHINE program (Serving Health Insurance Needs of Elders) offers unbiased, free Medicare counseling from trained volunteers statewide. Visit shine.elderaffairs.org to learn more.
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Afinius Health, LLC’s license insurance agent(s) are appointed by health insurance companies to help clients with Medicare Advantage plans and Medicare Supplement plans (Medigap). Afinius Health and its licensed insurance agent(s) are not affiliated with the Federal nor state governments. We do not offer every plan available in your area. Currently we represent ten (10) organizations. The number of carriers or products offered in your area is contingent on the area you live. Please, contact Medicare.gov, 1-800-MEDICARE, or your local State Health Insurance Program to get information on all of your options.