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You become eligible for Medicare when you turn 65. As you get closer to your 65th birthday, Medicare will send you information about how to sign up and your options.

You can choose a Medicare plan during that initial enrollment period, which runs from three months before your 65th birth month until three months after your birth month. You have seven months to sign up.

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Do you automatically get Medicare when you turn 65?

Medicare eligibility is automatic, but you should choose a Medicare plan. Medicare will automatically enroll you in Original Medicare if you don’t select a plan.

People can choose an Original Medicare plan or a Medicare Advantage plan:

  • Original Medicare is Parts A and B. Part A handles hospital coverage. Part B is for physicians, outpatient services and preventive care. Parts A and B don’t cover prescription drugs. Instead, Medicare beneficiaries with Original Medicare can get a Part D prescription drug plan. Private companies offer Part D plans.
  • Medicare Advantage is Part C. Private insurance companies like UnitedHealthcare and Humana offer these plans. The federal government pays the insurers to provide plans and the insurers, in turn, have contracts with providers to pay for services. Medicare Advantage plans cover both hospitals and physicians. Most Medicare Advantage plans also provide prescription drug benefits and supplemental benefits, such as dental and vision. Most Americans have dozens of Medicare Advantage options. However, metropolitan areas have more choices than rural areas. In fact, 77 counties don’t have a Medicare Advantage plan option in 2020. How many options you have will play a part in whether you choose Medicare Advantage or Original Medicare.

If you go with Original Medicare, you can turn down Part B coverage and keep Part A. People who get health insurance through another source, such as a spouse’s employer, may want to skip Part B coverage for now. If you don’t take Part B but later enroll in that coverage, you’ll pay a 10% fine on your Part B premium for every 12 months that you forgo Part B coverage.

Let’s look at an example:

You sign up for Part B two years after being eligible for Part B coverage. That would mean a 20% penalty on top of your Part B premiums. The penalty would add $28.86 each month to the standard Part B premium. So, in this case, you’d pay $173.16 per month rather than $144.30 because of the 20% penalty.

Is Medicare free at age 65?

Part A is free, as long as you paid Social Security taxes for at least 40 quarters. In other words, you would have needed to work and pay those taxes for at least 10 years.

If you didn’t pay the taxes, you will have to pay monthly Part A premiums. People who paid fewer than 30 quarters’ worth of Social Security taxes must pay $458 monthly for Part A. Those who paid taxes between 30 and 39 quarters pay $252 monthly.

How much does Medicare cost at age 65?

Medicare doesn’t base premiums on age. You pay the same amount whether you’re 65 or 95.

Part B’s monthly premiums are $144.30 for most Americans. However, Medicare beneficiaries with incomes more than $87,000 or $174,000 for joint filers pay higher Part B premiums. Both Parts A and B also have deductibles that you’ll have to pay before Medicare begins helping pay for care.

Part A’s deductible is $1,364. Part B’s deductible is $197. Once you reach a deductible, Medicare pays for a portion of your care. People with Original Medicare plans can get a Medigap plan that helps pay Medicare costs.

Medicare Advantage also has monthly premiums. The exact amount depends on the plan, but the average monthly Medicare Advantage premiums are $23. Deductibles also vary by plan but can be much higher than Original Medicare deductibles.

Part D additionally has premiums -- an average of $30 a month -- and deductibles. 

Before signing up for a Medicare Advantage or Part D plan, make sure to read the fine print to understand how much you’ll pay in premiums and your deductibles, coinsurance and out-of-pocket costs. These costs vary by plan, so run those numbers to figure out which one is better for you.

Find out more about Medicare costs.

What happens if you don’t sign up for Medicare at 65?

If you don’t choose a plan at 65, you’ll get put on Original Medicare -- Parts A and B.

As we mentioned, Part A is free to most Americans -- as long as you paid at least 10 years of Social Security taxes. You’d have to pay Part B premiums if you don’t deny that coverage or don’t choose a Medicare Advantage plan.

Can you make changes to Medicare after you turn 65?

Medicare has an open enrollment period between Oct. 15-Dec. 7. During that time, you can change plans.

You’re not locked into the Medicare plan for life. Instead, you can make changes each year during open enrollment.

Another time when you can make changes is if you experience a qualifying event for a special enrollment period. A special enrollment period could kick in if your spouse dies, you move to another state or you lose other health benefits.