New to Medicare? Here’s What You Need to Know

By VWG Wealth Management on October 20, 2026

Ask yourself these five crucial questions when enrolling in Medicare for the first time

If you’re nearing 65, the age of eligibility to enroll in Medicare, you’ve probably begun to think about switching to the federal health insurance program from your current plan. The government’s annual guidebook Medicare & You is a great resource, but the number of new decisions to make can seem overwhelming. Carving out the time to sit down and consider these questions can go a long way toward helping you confidently transition to Medicare and enjoy all the benefits of your new coverage.

How is Medicare different from my prior insurance?

While you and your family may currently be covered under one policy, there is no family coverage plan with Medicare. If you are married, your spouse will have to enroll separately once reaching the age of eligibility. Furthermore, while you likely have always had a single plan that covers everything from prescription medications to major operations, Medicare has different parts that cover different aspects of your health care.

What are the different options, and how do I know which is right for me?

There are two main ways to get Medicare:

• Original Medicare is broken up into parts. Part A covers hospital-related expenses, including inpatient care and hospice. Part B covers doctors’ services, outpatient care, lab tests, and many preventive services. Both allow you to go to any doctor or hospital in the country that accepts Medicare without prior authorization. A supplemental private health insurance policy known as a Medigap can help cover “gaps” in this federally provided coverage, such as copayments and deductibles. Finally, Medicare Part D helps cover the cost of prescription medications.
• Medicare Advantage (also known as Part C) is an alternative to Original Medicare. It bundles all the benefits of Parts A, B, and usually D into one plan offered by a private health insurance company. Medigap policies aren’t needed and Advantage can also include benefits for vision, hearing, and dental services. However, you’re only covered for providers in your plan’s network, and you may need prior approval and a referral from your primary physician to see specialists.

If you want to have the flexibility to choose your own healthcare providers, or you split time between different states, Original Medicare may be best for you. If you’re looking to limit costs, Medicare Advantage may be a better option as it has a yearly limit to your out-of-pocket expenses and more options for extra benefits. 

If your retirement plans include international travel, you’ll need supplemental insurance whether you’re on Original Medicare or an Advantage plan, as you’re generally not covered for care outside the U.S.

When do I sign up — and how?

Your seven-month Initial Enrollment Period begins three months before the month you turn 65 and ends three months after your birthday month. Signing up during the three months before you turn 65 generally allows your coverage to begin on the first day of your birthday month. If you sign up during your birthday month or during the three months that follow, your coverage generally begins the first day of the month after you sign up.

If you miss your Initial Enrollment Period, you can still apply during the General Enrollment Period from January 1 through March 31. Your coverage will begin the first day of the month after you sign up, but you may have to pay a higher premium for late enrollment. Late enrollment penalties may also increase the longer you wait to sign up unless you qualify for a Special Enrollment Period, such as if you still have health insurance through your employer or your spouse’s employer. If you lose Medicaid coverage and didn’t sign up for Medicare when you first became eligible, you may also qualify for a Special Enrollment Period that allows you to sign up for Part A and Part B without paying a late enrollment penalty.

If you are collecting retirement benefits from Social Security, you’ll automatically get Medicare Parts A and B coverage the first day of the month you turn 65 (though you can request to drop the coverage in writing). If you’re turning 65 but not ready to begin collecting Social Security, you can still apply for Medicare online through the Social Security Administration, by calling 1-800-772-1213, or by visiting your local Social Security office.

What is the cost?

People who have paid Medicare taxes long enough (usually about 10 years) don’t have to pay a premium for Part A, but there is a deductible each time you are admitted to a hospital ($1,736 as of 2026). Part B has a monthly premium that varies by income, starting at $202.90 in 2026 for individuals with annual incomes up to $109,000, topping out at $689.90 for incomes over $500,000. Part C costs vary depending on what plan you have and can change each year while Part D varies by plan and can change based on income. All individuals with Medicare Part D will have their out-of-pocket prescription drug costs capped at $2,100.[1] If you receive Social Security benefits, certain Medicare premiums may be deducted directly from your monthly benefit— you can compare plans at Medicare.gov.

What do I need to do to maintain my coverage?

Medicare plans, including Advantage and supplemental coverage renew automatically each year unless you request a change during the Annual Enrollment Period, or your plan provider and Medicare terminate their contract.

Changes as of 2026

A change in the Inflation Reduction Act that could affect clients age 65 and up enrolled in employer health insurance plans. Currently, clients on group health plans with 20+ employees do not have to enroll in Medicare when they turn 65. They can stay on the company health plan until they retire, with their official retirement being a special qualifying event. The Inflation Reduction Act will change what is considered to be the “creditable” standard for drug benefit/coverage on some employer plans for 2026. If the coverage is as least as good as the Medicare Part D drug benefit, your coverage will be deemed “creditable” and no action is needed. If it is deemed “uncreditable”, you will receive a letter in the mail from your plan sponsor, and you may have to enroll in Medicare or make changes within the employer plan before the end of 2025. If this applies to you, check your mail. A letter from your plan sponsor that would initiate this process. We do not anticipate this to affect many clients.

Please reach out to your advisor if you have questions on how Medicare relates to you.

[1]Who pays what in Medicare part D. (2026, April 7). https://www.ncoa.org/article/who-pays-what-for-medicare-part-d-in-2026-a-guide/