Enrolling in Medicare doesn't have to be complicated. This guide walks you through each step—from signing up for Original Medicare to choosing additional coverage—so you can make informed decisions about your healthcare.
Your first step is to enroll in Original Medicare, which consists of Part A (hospital insurance) and Part B (medical insurance). At a minimum, you should ensure you're signed up for Part A, which covers inpatient hospital care, skilled nursing facility care, hospice care, and some home health care.
Understanding Your Initial Enrollment Period (IEP)
Your Initial Enrollment Period is a 7-month window around your 65th birthday when you can first enroll in Medicare. This is the most important enrollment period because missing it can result in late enrollment penalties and gaps in coverage.
Your IEP includes:
3 months before your 65th birthday month
Your 65th birthday month
3 months after your 65th birthday month
Example: If you turn 65 on June 15, your IEP runs from March 1 through September 30.
Important: If your birthday falls on the 1st of the month, your IEP is calculated as if you were born on the last day of the previous month. For example, if you turn 65 on June 1, your IEP runs from February 1 through August 31.
You may also qualify for Medicare before age 65 if you've received Social Security disability benefits for 24 months or have certain conditions like ALS (Lou Gehrig's disease) or End-Stage Renal Disease (ESRD).
Automatic Enrollment in Part A and Part B
You may be automatically enrolled in Medicare Part A and Part B if:
You're already receiving Social Security retirement benefits
You're receiving Railroad Retirement Board benefits
You've been receiving Social Security disability benefits for 24 months
If you're automatically enrolled, you'll receive your red, white, and blue Medicare card in the mail approximately 3 months before your 65th birthday. Your coverage will begin on the first day of the month you turn 65.
Should You Delay Part B Enrollment?
You may want to delay enrolling in Medicare Part B if you're still working and have health coverage through your employer (or your spouse's employer) with 20 or more employees. This is called "creditable coverage."
Why delay? Part B has a monthly premium ($185 in 2025, $202.90 in 2026 for most beneficiaries). If your employer coverage is comparable or better, you may save money by waiting.
Important: If you delay Part B and later lose your employer coverage, you'll qualify for a Special Enrollment Period (SEP) to sign up without penalty. However, if you don't have creditable coverage and delay Part B, you may face a late enrollment penalty of 10% for each full 12-month period you could have had Part B but didn't.
If you're considering delaying Part B, talk to your employer's benefits administrator and one of our NC Medicare agents to understand your options.
If you're not automatically enrolled, you'll need to sign up for Medicare through the Social Security Administration. The best time to enroll is during your Initial Enrollment Period (IEP) to avoid coverage gaps and penalties.
Three Ways to Enroll:
Online: Visit SSA.gov and enroll online (fastest method)
By Phone: Call Social Security at 1-800-772-1213 (TTY 1-800-325-0778), Monday–Friday, 8 AM – 7 PM local time
In Person: Visit your local Social Security office
What If You Miss Your IEP?
If you miss your Initial Enrollment Period and don't qualify for a Special Enrollment Period, you'll need to wait for the General Enrollment Period (GEP):
When: January 1 – March 31 each year
Coverage Starts: July 1 of that year
Penalties: You may have to pay late enrollment penalties that last for as long as you have Medicare
2025-2026 Medicare Part B Premiums and Costs:
2025 Part B premium: $185/month (most beneficiaries)
2026 Part B premium: $202.90/month (most beneficiaries)
2025 Part B deductible: $257/year
2026 Part B deductible: $283/year
Part A premium: $0 for most beneficiaries (if you or your spouse worked and paid Medicare taxes for 40+ quarters)
Higher-income beneficiaries pay more through the Income-Related Monthly Adjustment Amount (IRMAA). In 2026, if your income exceeds $109,000 (single) or $218,000 (married filing jointly), your Part B premium will be higher. About 7% of Medicare beneficiaries pay IRMAA surcharges.
Once you're enrolled in Part A and Part B, you have two main options for how you receive your Medicare benefits:
Option 1: Original Medicare + Additional Coverage
With this option, you receive your benefits directly through the federal government. You can see any doctor or hospital that accepts Medicare anywhere in the U.S.
To fill gaps in Original Medicare coverage, you can add:
Medicare Part D: A standalone prescription drug plan to cover medications (required if you want drug coverage with Original Medicare)
Medicare Supplement (Medigap): Helps pay deductibles, coinsurance, and copays not covered by Original Medicare. Plan G is the most popular option, covering nearly all out-of-pocket costs except the Part B deductible.
Medigap Open Enrollment: Your 6-month Medigap Open Enrollment Period starts the first month you're 65 AND enrolled in Part B. During this window, you're guaranteed the right to buy any Medigap plan sold in your state—no health questions, no denial for pre-existing conditions. After this period, insurers can use medical underwriting, which may result in higher premiums or denial.
What Original Medicare + Medigap Does NOT Cover:
Prescription drugs (need Part D)
Routine vision exams and eyeglasses
Routine dental care
Routine hearing exams and hearing aids
Option 2: Medicare Advantage (Part C)
Private insurance companies approved by Medicare offer Medicare Advantage plans. These plans bundle Part A, Part B, and usually Part D into one plan, often with extra benefits.
Medicare Advantage often includes:
Prescription drug coverage (Part D)
Dental, vision, and hearing coverage
Fitness programs (like SilverSneakers)
Transportation to medical appointments
Over-the-counter (OTC) allowances
Annual out-of-pocket maximum (Original Medicare has no cap)
2025 Statistics: More than 34 million Medicare beneficiaries (54%) are enrolled in Medicare Advantage. In 2026, the average beneficiary has access to 32 Medicare Advantage plans.
Important to Know: Most Medicare Advantage plans have provider networks (HMO or PPO). Make sure your doctors and hospitals are in-network before enrolling. You also need to continue paying your Part B premium.
Before making any decisions, take time to compare your options. Consider:
Your health needs: Do you have chronic conditions? Take expensive medications? See specialists regularly?
Are your doctors in the plan's network? Do they accept Original Medicare?
Are your medications on the plan's formulary? What tier are they on? What will you pay?
Total costs: Include premiums, deductibles, copays, coinsurance, and out-of-pocket maximums
Extra benefits: Do you need dental, vision, hearing, or fitness benefits?
Travel: Do you travel frequently? Original Medicare + Medigap works nationwide, while some Medicare Advantage plans have regional networks.
Our NC Medicare agents can help you compare plans, check if your doctors and medications are covered, and find the best option for your situation.
Once you've compared your options, it's time to enroll. Most plans require you to be enrolled in both Medicare Part A and Part B before you can join.
Enrollment Timing:
During your IEP, you can enroll in Part D or Medicare Advantage during your 7-month Initial Enrollment Period.
Annual Enrollment Period (AEP): October 15 – December 7 each year. Changes take effect January 1.
Medigap: Enroll during your 6-month Medigap Open Enrollment Period (starts when you're 65 and have Part B) for guaranteed issue rights.
Premiums:
Many Medicare Advantage plans have $0 monthly premiums (though you still pay Part B)
Part D plans and Medigap plans have varying premiums based on the plan and your location.
Paying a higher premium now may save you money later if you need significant care.
Your Medicare coverage isn't set in stone. You can make changes during specific enrollment periods each year.
Medicare Annual Enrollment Period (AEP)
When: October 15 – December 7 each year
Changes take effect: January 1
During AEP, you can:
Switch from Original Medicare to Medicare Advantage (or vice versa)
Switch from one Medicare Advantage plan to another
Join, switch, or drop a Part D prescription drug plan
Medicare Advantage Open Enrollment Period (MA OEP)
When: January 1 – March 31 each year
Changes take effect: The first of the month after you enroll
During MA OEP, you can:
Switch from one Medicare Advantage plan to another
Drop Medicare Advantage and return to Original Medicare (and add Part D)
Important: During MA OEP, you cannot switch from Original Medicare to Medicare Advantage, and you cannot join, switch, or drop a standalone Part D plan unless you're returning to Original Medicare.
Why Review Your Coverage Each Year?
Plans change annually—premiums, formularies, networks, and benefits can all change. Even if you're happy with your current plan, review your Annual Notice of Change (ANOC) each fall to see what's changing for the following year. You may find a better option.
2026 Note: About 2.6 million Medicare Advantage enrollees (13%) are in plans that have been terminated for 2026. If your plan is terminating, you'll have a Special Enrollment Period to choose new coverage.
Medicare enrollment can be confusing, but you don't have to navigate it alone. Our team of knowledgeable NC Medicare agents can help you:
Understand your enrollment periods and deadlines
Compare Medicare Advantage, Part D, and Medigap plans
Check if your doctors and medications are covered
Determine if you qualify for Special Needs Plans or Extra Help
Enroll in the plan that's right for you