Medicare for People Turning 65

Decision 1 — Should I Enroll in Part A?

For most people turning 65, the answer is yes — and it is easy. If you or your spouse worked and paid Medicare taxes for at least 10 years, your Part A premium is $0. Enrolling in premium-free Part A costs you nothing and adds hospital coverage immediately.

The main exception: if you are still working and actively contributing to a Health Savings Account (HSA), enrolling in Part A — even premium-free — makes you ineligible to continue contributing to your HSA. If maximizing your HSA matters to you, delay Part A until you stop contributing.

If you are already receiving Social Security benefits when you turn 65, you are automatically enrolled in Part A — your Medicare card arrives in the mail without you having to do anything.

Decision 2 — Should I Enroll in Part B Now or Delay It?

This is the most consequential enrollment decision most people turning 65 will make — because getting it wrong results in a permanent late enrollment penalty of 10% per year on your Part B premium.

• Enroll in Part B now if: You are not covered by qualifying employer insurance through your own active employment or a spouse’s active employment at a company with 20+ employees. This includes retirees, people on COBRA, people on Marketplace plans, and anyone without active employer coverage.
• Delay Part B if: You are covered by a group health plan through your own active employment at a company with 20 or more employees — or through a spouse’s active employment at such a company. When that coverage ends, you have an 8-month Special Enrollment Period to sign up without penalty.

If you are unsure whether your current coverage qualifies to delay Part B safely, this is the most important question to resolve before your 65th birthday. Getting it wrong is expensive and permanent.

Decision 3 — Medicare Advantage or Original Medicare + Medigap?

Once you have Parts A and B, you choose how you receive your benefits — through Original Medicare alone, or through a Medicare Advantage plan that replaces Original Medicare.

• Original Medicare + Medigap: Higher monthly premium, lower out-of-pocket costs, complete freedom to see any Medicare-accepting provider nationwide, no network restrictions. The Medigap open enrollment window at 65 is the only time you are guaranteed the right to buy any Medigap plan without medical underwriting in Texas.
• Medicare Advantage: Lower monthly premium, copays at each visit, network-based, often includes extras like dental and vision, out-of-pocket maximum provides catastrophic protection.

The timing matters here — your six-month Medigap Open Enrollment Period starts when you are both 65 and enrolled in Part B. After this window closes, getting a Medigap plan in Texas may require passing medical underwriting. If you start with Medicare Advantage and later want to switch to Medigap, it may not be possible if your health has changed.

Decision 4 — Which Part D Drug Plan?

If you choose Original Medicare + Medigap, you will need a standalone Part D prescription drug plan. If you choose Medicare Advantage, drug coverage is usually already included in the plan.

For standalone Part D plans, do not just pick the cheapest premium. The plan that costs the least to own is the one that covers your specific medications at the lowest total cost — premium plus deductible plus copays for your actual drug list. Plans use different formularies with different tier structures, and the difference between plans can be hundreds of dollars per year for the same medications.

Use Medicare’s Plan Finder at Medicare.gov, enter every medication you take with the exact dosage and frequency, and compare total annual drug costs — not just premiums. A licensed local Medicare advisor can run this comparison for you at no cost.

Decision 5 — Do I Qualify for Extra Help or a Medicare Savings Program?

Before finalizing any Medicare decisions, check whether you qualify for programs that can significantly reduce your costs. In Texas, these include:

• Medicare Savings Programs (MSPs): State programs that help pay Part A and Part B premiums, deductibles, and coinsurance for beneficiaries with limited income and resources. Many people in the Rio Grande Valley qualify and never apply.
• Extra Help (Low-Income Subsidy): A federal program that helps with Part D drug costs — reducing or eliminating premiums, deductibles, and copays for prescriptions. Qualifying for Extra Help also usually qualifies you for an MSP automatically.

If your monthly income is at or below roughly $1,600 (individual) or $2,100 (couple) in 2026, you may qualify. A licensed Medicare advisor can check your eligibility and help you apply at no charge.