New to Medicare, the four things to know before you sign up

Your Initial Enrollment Period is seven months long: the three months before the month you turn 65, your birthday month, and the three months after. This is the window to sign up without a penalty, and it is the one deadline that carries a lasting price. Miss it without a valid reason and you can face a late-enrollment penalty on Part B that is added to your premium for as long as you have Medicare, not a one-time fee but for life.

Two practical notes. Enroll in the first three months of the window if you want coverage in place the day you turn 65, because signing up later pushes your start date back. And if you are still working with employer coverage, there is a legitimate way to delay (item four); this penalty is for people who simply miss the window, not for people who delay correctly.

This is the decision that matters most, and the reason to think about it now is that one direction is much easier to enter than to leave. There are two broad paths: Original Medicare plus a Medigap supplement plus a standalone drug plan (wide provider access and predictable costs, at a higher monthly premium), or a Medicare Advantage plan (bundled coverage, often including drugs and extras, usually at a lower premium but within a network).

Neither is the universal right answer. The reason to decide deliberately is the underwriting trap: when you first enroll you generally have a guaranteed right to buy a Medigap policy, but if you start on Advantage and later want to switch to Original Medicare with a supplement, you may have to pass medical underwriting and can be turned down. The door is wide open at the start and can narrow later.

People miss their window because they are waiting for a signal that never comes. If you are already receiving Social Security before 65, you are usually enrolled in Parts A and B automatically and a card arrives in the mail. If you are not yet drawing Social Security, nothing happens on its own: no card, no letter, no prompt, and the responsibility to enroll during your window is entirely yours. If you are not certain which group you are in, assume you have to act.

The last surprise is what Medicare leaves out. Original Medicare has no annual cap on what you can pay out of pocket, which is the main reason most people add either a Medigap supplement or an Advantage plan rather than going with Parts A and B alone. It also does not cover routine dental, vision, or hearing, and it does not cover long-term custodial care. None of these gaps is a reason to panic, but each is a reason to plan, because the time to arrange coverage for a gap is before you are standing in it.

One more thing: there is free, unbiased help. Every state has a SHIP (State Health Insurance Assistance Program) that offers no-cost Medicare counseling, and a licensed agent can walk you through the choices at no cost. Using that help is how a lot of people get the first decision right.