Medicare Basics: What You Need to Know Before You Turn 65

Introduction: Preparing for Medicare at 65

Turning 65 is a significant milestone that brings important healthcare decisions. Understanding Medicare basics before you reach this age can help you avoid costly mistakes, enrollment gaps, and lifetime penalties that could impact your retirement budget.

As the Inland Empire’s largest Independent Physician Association network, PromiseCare Medical Group has helped thousands of patients navigate the transition to Medicare. “The most common mistake I see is patients waiting too long to understand their options,” explains Dr. Michael Curley, a board-certified Family Medicine physician with over 37 years of experience serving the Hemet, Murrieta, and Temecula areas. “Starting your Medicare education six months before you turn 65 gives you time to make informed decisions without feeling rushed.”

This comprehensive guide covers everything you need to know about Medicare enrollment, coverage options, costs, and timing to ensure a smooth transition into Medicare at age 65.

Understanding the Four Parts of Medicare

Medicare is not a single insurance program but rather a combination of different coverage options. Understanding these parts is essential to making informed healthcare decisions.

Medicare Part A: Hospital Insurance

Medicare Part A provides coverage for inpatient care in hospitals, skilled nursing facility stays, hospice care, and limited home health care services. Most people qualify for premium-free Part A because they or their spouse paid Medicare taxes for at least 10 years (40 quarters) during their working years.

“Part A is often called ‘hospital insurance,’ but it covers more than just hospital stays,” notes Dr. Edivina Gonzales, an Internal Medicine specialist with PromiseCare Medical Group. “It includes skilled nursing facility care after a hospital stay, hospice care for terminal illnesses, and some home health services when you’re homebound and need skilled care.”

What Medicare Part A Covers:

• Inpatient hospital care, including semi-private rooms, meals, general nursing, and drugs as part of your inpatient treatment
• Skilled nursing facility care following a hospital stay of at least three consecutive days
• Hospice care for patients with terminal illnesses
• Home health care services when you’re homebound and need skilled nursing or therapy
• Inpatient care in a religious nonmedical health care institution

Medicare Part A Costs in 2026:

• Premium: $0 for most people (if you or your spouse paid Medicare taxes for 40+ quarters)
• Deductible: $1,676 per benefit period
• Coinsurance: $0 for days 1-60 of hospitalization; $419 per day for days 61-90; $838 per day for lifetime reserve days

If you haven’t worked long enough to qualify for premium-free Part A, you may still purchase it, though the monthly premium can be substantial ($518 in 2026 for those with fewer than 30 quarters of Medicare-covered employment).

Medicare Part B: Medical Insurance

Medicare Part B covers doctor visits, outpatient services, preventive care, medical equipment, and many other health services not covered by Part A. Unlike Part A, most people pay a monthly premium for Part B coverage.

“Part B is what covers your routine doctor visits, annual wellness exams, and preventive services like cancer screenings and vaccinations,” explains Dr. Michael Curley, who specializes in Geriatric Medicine. “This is the coverage that keeps you healthy through regular checkups and early disease detection.”

What Medicare Part B Covers:

• Doctor services, including office visits and consultations
• Outpatient care, including emergency department visits
• Preventive services such as flu shots, cancer screenings, and wellness visits
• Ambulance services when medically necessary
• Durable medical equipment like wheelchairs, walkers, and hospital beds
• Mental health services, including outpatient therapy
• Limited prescription drugs administered in a doctor’s office or hospital outpatient setting

Medicare Part B Costs in 2026:

• Standard monthly premium: $202.90 (higher for individuals earning over $109,000 or couples earning over $218,000 annually)
• Annual deductible: $283
• Coinsurance: Typically 20% of Medicare-approved amounts for most services
• Some preventive services have no coinsurance or deductible

Medicare Part C: Medicare Advantage Plans

Medicare Advantage Plans, also called Medicare Part C, are comprehensive health plans offered by private insurance companies approved by Medicare. These plans combine Part A and Part B coverage and often include Part D prescription drug coverage in one bundled plan.

“Medicare Advantage can be attractive for patients who want all their coverage in one place,” notes Dr. Ratan Tiwari, a board-certified Cardiologist with PromiseCare Medical Group. “These plans often include benefits Original Medicare doesn’t cover, like dental, vision, and hearing services. However, they typically require you to use doctors within the plan’s network.”

Medicare Advantage Plan Features:

• Must cover everything Original Medicare (Parts A and B) covers
• Often include prescription drug coverage (Part D)
• May offer extra benefits like dental, vision, hearing, and fitness programs
• Usually require using network doctors and hospitals
• May require referrals for specialist care
• Have yearly out-of-pocket spending limits
• Monthly premiums vary by plan (some have $0 premiums beyond your Part B premium)

Types of Medicare Advantage Plans:

• Health Maintenance Organizations (HMOs)
• Preferred Provider Organizations (PPOs)
• Private Fee-for-Service (PFFS) plans
• Special Needs Plans (SNPs) for specific health conditions or circumstances

Medicare Part D: Prescription Drug Coverage

Medicare Part D provides coverage for prescription medications. You can get Part D coverage either through a stand-alone prescription drug plan (if you have Original Medicare) or as part of a Medicare Advantage Plan that includes drug coverage.

“Prescription coverage is critical, even if you’re currently healthy and don’t take many medications,” emphasizes Dr. Edivina Gonzales. “Besides avoiding the late enrollment penalty, having Part D means you’re protected if you develop a condition requiring expensive medications.”

Medicare Part D Coverage:

• Prescription drugs for outpatient use
• Some vaccines not covered by Part B
• Coverage varies by plan, but all plans must cover a broad range of medications
• Each plan has a formulary (list of covered drugs) organized into tiers
• Plans must cover at least two drugs in each category and class

Medicare Part D Costs in 2026:

• Monthly premiums vary by plan
• Annual deductible: Up to $615 (varies by plan; some have no deductible)
• Copayments or coinsurance for each prescription
• Out-of-pocket maximum: $2,100 in 2026 (after which you pay $0 for covered drugs)

Critical Enrollment Periods You Must Know

Understanding when to enroll in Medicare can save you from costly late enrollment penalties and coverage gaps. There are three main enrollment periods you need to know.

Initial Enrollment Period (IEP)

Your Initial Enrollment Period is your first opportunity to sign up for Medicare. This seven-month window begins three months before the month you turn 65, includes your birth month, and extends three months after.

Initial Enrollment Period Timeline:

• 3 months before your 65th birthday month
• Your 65th birthday month
• 3 months after your 65th birthday month

“I always tell patients to mark their calendar six months before turning 65,” advises Dr. Michael Curley. “This gives you time to research plans, compare costs, and ask questions without the pressure of a deadline. Enrolling during the first three months of your Initial Enrollment Period means your coverage starts the month you turn 65.”

When Your Coverage Starts:

• Enroll 3 months before your birthday month: Coverage starts your birthday month
• Enroll during your birthday month: Coverage starts the following month
• Enroll 1 month after your birthday month: Coverage starts 2 months later
• Enroll 2 months after your birthday month: Coverage starts 3 months later
• Enroll 3 months after your birthday month: Coverage starts 3 months later

Special Note: If your birthday falls on the first day of the month, your Initial Enrollment Period actually begins four months earlier, and your coverage can start the month before you turn 65.

Special Enrollment Period (SEP)

A Special Enrollment Period allows you to enroll in Medicare outside your Initial Enrollment Period without paying late enrollment penalties if you have qualifying coverage through an employer or meet other specific criteria.

Common Special Enrollment Period Qualifications:

• You have health coverage through your own or your spouse’s current employer
• You’re covered by a group health plan from a company with 20 or more employees
• Your employer coverage ends
• You move out of your current plan’s service area
• You lose other coverage (with some exceptions)

“Many of my patients continue working past 65 and maintain their employer health insurance,” explains Dr. Edivina Gonzales. “If you work for a company with 20 or more employees, you can delay Medicare Part B enrollment without penalty. However, you should still sign up for Part A if it’s premium-free—it can act as secondary insurance.”

Important Special Enrollment Period Rules:

• You have an 8-month window to enroll after your employment ends or your group coverage terminates (whichever happens first)
• COBRA coverage and retiree health insurance do NOT qualify you for a Special Enrollment Period
• Missing your Special Enrollment Period means waiting for the General Enrollment Period and paying late enrollment penalties
• You must be actively working (or your spouse must be) to qualify—simply having retiree coverage doesn’t count

General Enrollment Period (GEP)

If you miss your Initial Enrollment Period and don’t qualify for a Special Enrollment Period, you can sign up during the General Enrollment Period, which runs from January 1 through March 31 each year.

General Enrollment Period Drawbacks:

• Coverage doesn’t start until July 1 (creating a coverage gap)
• You’ll likely face late enrollment penalties
• These penalties last as long as you have Medicare coverage (potentially for life)

Understanding Late Enrollment Penalties

Late enrollment penalties are permanent surcharges added to your Medicare premiums if you don’t sign up when you’re first eligible and don’t qualify for a Special Enrollment Period. These penalties are designed to encourage people to enroll on time.

Part A Late Enrollment Penalty

If you’re not eligible for premium-free Part A and don’t buy it when first eligible, you may pay a penalty of 10% added to your monthly premium. You’ll pay this penalty for twice the number of years you delayed enrollment.

Part B Late Enrollment Penalty

The Part B late enrollment penalty is more common and can be significant. Medicare adds 10% to your monthly premium for each full 12-month period you could have had Part B but didn’t sign up.

Part B Penalty Example:

• If you delayed enrollment for 2 years, your penalty would be 20% (10% × 2 years)
• Standard Part B premium in 2026: $202.90
• Your monthly premium with 20% penalty: $243.48
• This penalty continues for as long as you have Part B coverage

“I’ve seen patients who delayed enrollment for just two years end up paying hundreds of dollars more per year in premiums for the rest of their lives,” cautions Dr. Michael Curley. “That 10% penalty per year adds up quickly and never goes away.”

Part D Late Enrollment Penalty

The Part D late enrollment penalty applies if you go 63 days or more without Medicare prescription drug coverage or other creditable coverage after your Initial Enrollment Period ends.

Part D Penalty Calculation:

• 1% of the national base beneficiary premium ($38.99 in 2026) for each month you delayed
• Penalty amount is rounded to the nearest $0.10
• Added to your monthly Part D premium for as long as you have Part D coverage

Part D Penalty Example:

• If you waited 14 months to enroll: $38.99 × 0.14 = $5.46, rounded to $5.50/month
• This $5.50 monthly penalty continues as long as you have Part D
• The penalty amount can increase each year as the national base beneficiary premium changes

Automatic Enrollment vs. Active Enrollment

Whether you’re automatically enrolled in Medicare or need to actively sign up depends on your Social Security benefit status.

Automatic Enrollment

If you’re already receiving Social Security retirement benefits or Railroad Retirement Board benefits at least four months before you turn 65, you’ll be automatically enrolled in Medicare Parts A and B. Social Security will mail your Medicare card about three months before your coverage starts.

What to Know About Automatic Enrollment:

• You’ll receive your red, white, and blue Medicare card in the mail
• Your Part A and Part B coverage starts the first day of the month you turn 65
• You’re still responsible for enrolling in Part D if you want prescription coverage
• If you don’t want Part B (perhaps because you have employer coverage), you can opt out—but consider carefully, as you may face penalties later

Active Enrollment

If you’re not receiving Social Security benefits when you turn 65, you must actively sign up for Medicare by contacting Social Security.

How to Enroll Actively:

• Online at www.ssa.gov (fastest method)
• By phone: 1-800-772-1213 (TTY 1-800-325-0778)
• In person at your local Social Security office

“Don’t assume Medicare will just find you,” warns Dr. Edivina Gonzales. “If you’re not receiving Social Security benefits, you need to take action during your Initial Enrollment Period. Missing this window can result in coverage gaps and penalties.”

Medicare While Still Working Past 65

Many people continue working past age 65, which creates unique Medicare enrollment considerations. Your decisions depend on your employer’s size and the quality of your employer coverage.

Employers with 20+ Employees

If you work for a company with 20 or more employees and have group health insurance:

• You can delay Medicare Part B enrollment without penalty
• You should typically enroll in premium-free Part A even while working
• Your employer coverage serves as primary insurance; Medicare Part A acts as secondary
• You have an 8-month Special Enrollment Period to sign up for Part B after employment ends

“For patients still working with good employer coverage from a large company, I usually recommend enrolling in Part A since it’s typically free, but you can safely delay Part B,” advises Dr. Ratan Tiwari. “This avoids paying the Part B premium while you have employer coverage.”

Employers with Fewer than 20 Employees

If your employer has fewer than 20 employees:

• Medicare becomes your primary insurance at age 65
• You must enroll in both Part A and Part B to avoid your employer plan paying less or nothing
• Delaying enrollment will result in late enrollment penalties
• Your employer plan may refuse to pay if they discover you’re Medicare-eligible but not enrolled

Health Savings Account Considerations

If you contribute to a Health Savings Account (HSA) through a high-deductible health plan, enrolling in any part of Medicare (including Part A) makes you ineligible for future HSA contributions.

HSA and Medicare Rules:

• You cannot contribute to an HSA once Medicare coverage begins
• You can still spend money already in your HSA
• Medicare enrollment includes retroactive coverage up to 6 months
• Stop HSA contributions 6 months before applying for Medicare to avoid tax penalties

Choosing Between Original Medicare and Medicare Advantage

One of your most important decisions is whether to get your coverage through Original Medicare or a Medicare Advantage Plan. Both have distinct advantages and trade-offs.

Original Medicare (Parts A and B)

Advantages:

• Freedom to see any doctor or hospital that accepts Medicare nationwide
• No network restrictions or referral requirements
• Consistent coverage no matter where you travel in the U.S.
• Ability to add a Medigap policy for additional coverage
• More predictable out-of-pocket costs

Considerations:

• No annual out-of-pocket spending limit (unless you buy Medigap)
• Typically no prescription drug coverage (must purchase separate Part D plan)
• Usually no dental, vision, or hearing coverage
• 20% coinsurance for Part B services adds up
• Multiple premiums (Part B, Part D, possibly Medigap)

“Original Medicare offers the most flexibility,” notes Dr. Michael Curley, whose PromiseCare practice accepts Medicare patients. “My patients with Original Medicare can see specialists without referrals and have complete freedom in choosing healthcare providers.”

Medicare Advantage Plans (Part C)

Advantages:

• Often include prescription drug coverage
• May offer extra benefits like dental, vision, hearing, and fitness programs
• Annual out-of-pocket spending limits protect against catastrophic costs
• Potentially lower monthly premiums (some plans have $0 premium)
• Coordinated care through one insurance company

Considerations:

• Must use network doctors and hospitals (except in emergencies)
• May need referrals to see specialists
• Coverage may not travel well outside your plan’s service area
• Plans can change networks, costs, and benefits annually
• Cannot purchase Medigap with Medicare Advantage

“Medicare Advantage plans work well for patients who prefer coordinated care and want extra benefits,” explains Dr. Ratan Tiwari. “However, it’s important to verify your doctors are in the plan’s network before enrolling.”

Medigap (Medicare Supplement Insurance)

Medigap policies are supplemental insurance plans sold by private companies that help pay for out-of-pocket costs under Original Medicare, such as deductibles, coinsurance, and copayments.

Key Medigap Facts:

• Only works with Original Medicare (not Medicare Advantage)
• Standardized plans named by letters (Plan G, Plan N, etc.)
• Same benefits regardless of insurance company (though costs vary)
• Guaranteed issue period during the 6 months after enrolling in Part B at age 65
• Medical underwriting may apply if you purchase outside your guarantee issue period

Most Popular Medigap Plans:

• Plan G: Covers nearly everything except Part B deductible
• Plan N: Lower premiums but small copays for doctor visits and emergency room visits
• Plan F: Comprehensive coverage (only available if Medicare-eligible before 2020)

“Medigap can provide valuable peace of mind by covering the 20% coinsurance for Part B services,” notes Dr. Edivina Gonzales. “For patients with chronic conditions who see specialists regularly, that 20% can add up significantly.”

Costs and Financial Assistance Programs

Medicare involves various costs, but multiple programs exist to help those with limited income and resources.

2026 Medicare Costs at a Glance

Part A:

• Premium: $0 for most (or $284/$518 monthly for partial/no work credits)
• Deductible: $1,676 per benefit period
• Hospital coinsurance: $0 (days 1-60), $419/day (days 61-90), $838/day (lifetime reserve days)

Part B:

• Premium: $202.90/month (higher for incomes over $109,000/$218,000)
• Deductible: $283 annually
• Coinsurance: 20% for most services

Part D:

• Premiums: Vary by plan
• Deductible: Up to $615 (varies by plan)
• Out-of-pocket maximum: $2,100 in 2026

Medicare Savings Programs

State Medicare Savings Programs help pay Medicare premiums, deductibles, and coinsurance for those who qualify based on income and assets.

Program Types:

• Qualified Medicare Beneficiary (QMB): Pays Part A and B premiums, deductibles, and coinsurance
• Specified Low-Income Medicare Beneficiary (SLMB): Pays Part B premiums
• Qualifying Individual (QI): Pays Part B premiums (limited funding)

Extra Help (Low Income Subsidy)

The Extra Help program assists with Part D prescription drug costs, including premiums, deductibles, and copayments.

Extra Help Benefits:

• No Part D late enrollment penalty
• Lower prescription copayments
• No coverage gap
• Automatic enrollment if you qualify

Common Medicare Mistakes to Avoid

Missing Your Initial Enrollment Period

“The single biggest mistake I see is people not understanding their enrollment window,” emphasizes Dr. Michael Curley. “They think they can sign up anytime and then face penalties and coverage gaps.”

How to Avoid: Mark your calendar six months before turning 65 and start researching your options.

Assuming You’re Automatically Enrolled

If you’re not receiving Social Security benefits, you must actively enroll in Medicare—it doesn’t happen automatically.

How to Avoid: Contact Social Security 3-4 months before turning 65 to initiate your enrollment.

Confusing COBRA or Retiree Coverage with Active Employment

COBRA and retiree coverage do not qualify you for a Special Enrollment Period. If you rely on these, you should enroll in Medicare when first eligible to avoid penalties.

How to Avoid: Understand the difference between active employer group coverage and other coverage types.

Not Coordinating with Health Savings Accounts

Enrolling in Medicare while contributing to an HSA can trigger tax penalties due to retroactive Medicare coverage.

How to Avoid: Stop HSA contributions 6 months before applying for Medicare benefits.

Choosing Based on Cost Alone

The cheapest plan isn’t always the best value if it doesn’t cover your doctors, medications, or healthcare needs.

How to Avoid: Consider total costs including premiums, deductibles, copays, and out-of-network charges, not just the monthly premium.

Essential Steps to Take Before Turning 65

6 Months Before: Start Your Research

• Learn about Medicare parts and coverage options
• Review your current medications and doctor preferences
• Determine if you qualify for premium-free Part A
• Assess whether you’ll continue working past 65

3-4 Months Before: Contact Social Security

• If not receiving Social Security, schedule your Medicare enrollment
• Verify your Initial Enrollment Period dates
• Ask about your options if you’re still working

2-3 Months Before: Compare Plans

• Research Medicare Advantage plans in your area
• Compare Part D prescription drug plans
• Review Medigap policies if choosing Original Medicare
• Check which doctors and hospitals participate in different plans

1 Month Before: Make Your Enrollment Decisions

• Enroll in Medicare Parts A and B (if not automatic)
• Choose a Part D plan or Medicare Advantage plan
• Purchase Medigap if desired (during your guarantee issue period)
• Confirm your coverage start date

After Enrollment: Verify and Organize

• Receive your Medicare card and keep it secure
• Understand your effective coverage dates
• Schedule a Medicare Annual Wellness Visit with your doctor
• Keep records of all enrollment confirmations

Working with Your Doctor on Medicare

PromiseCare Medical Group physicians work extensively with Medicare beneficiaries and understand the unique healthcare needs of this population.

“The transition to Medicare is an excellent time to schedule a comprehensive health assessment,” suggests Dr. Edivina Gonzales. “Medicare covers an Annual Wellness Visit where we create a personalized prevention plan, review medications, and assess your risk factors for various conditions.”

Medicare Preventive Services Covered at No Cost:

• Annual Wellness Visits
• Cardiovascular disease screenings
• Diabetes screenings
• Cancer screenings (colonoscopy, mammogram, prostate, etc.)
• Bone density measurements
• Vaccines (flu, pneumonia, COVID-19)
• Depression screenings

“Preventive care is one of Medicare’s greatest benefits,” adds Dr. Michael Curley, who specializes in Geriatric Medicine. “These services can catch health problems early when they’re most treatable, potentially preventing serious complications down the road.”

Conclusion: Take Action Early for Peace of Mind

Understanding Medicare basics before you turn 65 empowers you to make informed decisions that will impact your healthcare and finances for years to come. While the system can seem complex at first, taking the time to learn about enrollment periods, coverage options, and costs will help you avoid expensive penalties and choose coverage that meets your needs.

The physicians at PromiseCare Medical Group, the Inland Empire’s largest Independent Physician Association network, are here to support you throughout your Medicare journey. With over 60 primary care doctors and 400+ specialists serving Riverside and San Bernardino counties, PromiseCare provides comprehensive, coordinated care for Medicare beneficiaries.

Your Action Plan:

1. Start researching Medicare options 6 months before turning 65
2. Understand your Initial Enrollment Period dates
3. Determine if you’ll continue working and how it affects enrollment
4. Compare Original Medicare and Medicare Advantage plans
5. Choose Part D coverage to avoid late enrollment penalties
6. Schedule a Medicare Annual Wellness Visit with your primary care physician

Don’t wait until the last minute—early preparation ensures you’ll have the coverage you need when you need it.

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Frequently Asked Questions About Medicare at 65

Q: Do I automatically get Medicare when I turn 65?

A: You’ll automatically receive Medicare Parts A and B if you’re already receiving Social Security or Railroad Retirement Board benefits at least 4 months before turning 65. Social Security will mail your Medicare card about 3 months before your 65th birthday. If you’re not receiving these benefits, you must actively enroll by contacting Social Security during your Initial Enrollment Period, which begins 3 months before your birthday month. Waiting to enroll can result in coverage gaps and late enrollment penalties that last your lifetime.

Q: What happens if I miss my Medicare enrollment deadline?

A: Missing your Initial Enrollment Period can have serious consequences. You’ll face late enrollment penalties for Part B (10% increase for each 12-month delay) and Part D (1% of the national base premium for each month delayed), and these penalties typically last as long as you have Medicare. You’ll also experience a coverage gap until the General Enrollment Period (January 1-March 31), with coverage not starting until July 1. The only exception is if you qualify for a Special Enrollment Period due to current employer coverage or another qualifying event.

Q: Can I keep my employer insurance instead of enrolling in Medicare?

A: If you work for an employer with 20 or more employees and have group health coverage, you can delay Medicare Part B enrollment without penalty using a Special Enrollment Period. However, you should consider enrolling in premium-free Part A as it can serve as secondary insurance. For employers with fewer than 20 employees, Medicare becomes your primary insurance at 65, and you must enroll in both Parts A and B to avoid your employer plan paying reduced benefits or nothing at all.

Q: What’s the difference between Original Medicare and Medicare Advantage?

A: Original Medicare (Parts A and B) is traditional fee-for-service coverage that allows you to see any doctor or hospital that accepts Medicare nationwide without referrals or network restrictions. Medicare Advantage (Part C) is offered by private insurance companies and bundles Parts A, B, and usually D into one plan, often with extra benefits like dental and vision. However, Medicare Advantage typically requires using network providers and may require referrals for specialists. Original Medicare has no out-of-pocket maximum unless you buy Medigap, while Medicare Advantage plans have annual spending limits.

Q: Do I need both Medicare and Medigap?

A: Medigap (Medicare Supplement Insurance) is optional supplemental coverage that works only with Original Medicare to help pay deductibles, coinsurance, and copayments. While not required, Medigap can provide valuable protection from out-of-pocket costs, especially the 20% coinsurance for Part B services. The best time to purchase Medigap is during your 6-month guarantee issue period that starts when you’re 65 and enrolled in Part B—during this time, insurance companies cannot deny coverage or charge more due to health conditions. You cannot use Medigap with Medicare Advantage plans.

Q: How much does Medicare cost each month?

A: Medicare costs vary based on the parts you choose and your income. In 2026, most people pay $0 for Part A (if they worked 40+ quarters), $202.90/month for Part B (higher for incomes over $109,000 for individuals or $218,000 for couples), and varying amounts for Part D and Medicare Advantage plans. You’ll also pay deductibles ($1,676 for Part A per benefit period, $283 annually for Part B), coinsurance (typically 20% for Part B services), and copayments depending on your coverage. Out-of-pocket costs can be reduced through Medigap policies or by enrolling in Medicare Advantage plans with out-of-pocket maximums.

Q: When should I sign up for Medicare Part D?

A: You should sign up for Medicare Part D prescription drug coverage during your Initial Enrollment Period when you first become eligible for Medicare, even if you don’t currently take many medications. Waiting more than 63 days after your Initial Enrollment Period ends results in a late enrollment penalty that’s calculated as 1% of the national base beneficiary premium ($38.99 in 2026) for each month you delayed. This penalty is added to your Part D premium for as long as you have prescription coverage and increases annually as the base premium changes.

Q: What happens to my Health Savings Account when I enroll in Medicare?

A: Once you enroll in any part of Medicare (including Part A), you can no longer contribute to a Health Savings Account (HSA), though you can continue using existing HSA funds for qualified medical expenses. Medicare enrollment includes retroactive coverage up to 6 months, which can create tax penalties if you contributed to your HSA during that time. To avoid penalties, stop HSA contributions 6 months before applying for Social Security or Medicare benefits. Your HSA funds never expire and can be used tax-free for qualified medical expenses throughout retirement.

Q: Can I switch from Medicare Advantage back to Original Medicare?

A: Yes, you can switch from Medicare Advantage to Original Medicare during the Annual Election Period (October 15-December 7) or Medicare Advantage Open Enrollment Period (January 1-March 31). However, buying a Medigap policy after leaving Medicare Advantage may be difficult because you’re past your guarantee issue period, and insurance companies can use medical underwriting to deny coverage or charge higher premiums based on your health conditions. Some states offer limited Medigap protections for people leaving Medicare Advantage, so check your state’s rules.

Q: Does Medicare cover prescription drugs?

A: Original Medicare (Parts A and B) provides very limited prescription drug coverage—only for medications administered during a hospital stay or in a doctor’s office. For outpatient prescription coverage, you need Medicare Part D, which you can get either as a stand-alone prescription drug plan (if you have Original Medicare) or bundled into a Medicare Advantage plan. Part D plans vary in costs and covered medications, so compare plans based on your specific prescriptions to find the best value.

Q: Should I enroll in Medicare if I have VA benefits or TRICARE?

A: Veterans with VA healthcare and those with TRICARE can benefit from enrolling in Medicare Parts A and B. Medicare can serve as your primary insurance while VA or TRICARE acts as secondary coverage, potentially reducing your out-of-pocket costs. For TRICARE beneficiaries turning 65, Medicare becomes your primary insurance, and you need Medicare Part A and B to keep TRICARE coverage. If you’re eligible for premium-free Part A, there’s little downside to enrolling. Part B enrollment depends on your individual situation and the comprehensiveness of your VA or TRICARE benefits.

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About PromiseCare Medical Group

PromiseCare Medical Group is the Inland Empire’s largest Independent Physician Association network, serving patients throughout Riverside and San Bernardino counties. With 60+ primary care physicians and 400+ specialists, PromiseCare provides comprehensive, coordinated healthcare with a focus on quality outcomes, patient safety, and exceptional service.

Contact Information:

• Main Office: 1545 W. Florida Ave., Hemet, CA 92543
• Phone: (951) 390-2840
• Website: https://promisecare.com

Medicare Services:
PromiseCare physicians accept Medicare and Medicare Advantage plans, providing comprehensive care for beneficiaries including Annual Wellness Visits, chronic disease management, preventive care, and specialist referrals. Our network includes primary care physicians, cardiologists, specialists in internal medicine, and experts in geriatric medicine to meet the unique healthcare needs of Medicare beneficiaries.

To find a PromiseCare physician near you or schedule an appointment, visit https://promisecare.com or call (951) 390-2840.