Can I enroll in Medicare anytime of the year?

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No, you cannot apply for Medicare at any time of the year; you must enroll during specific designated enrollment periods unless you qualify for an exception.

Key Enrollment Periods

  • Initial Enrollment Period (IEP): A 7-month window that begins 3 months before the month you turn 65, includes your birthday month, and ends 3 months after.
  • General Enrollment Period: Runs from January 1 to March 31 each year if you missed your initial window, though late enrollment penalties may apply.
  • Annual Open Enrollment Period: Runs from October 15 to December 7 each year, allowing you to switch, join, or drop Medicare Advantage and prescription drug plans.
  • Special Enrollment Periods (SEPs): Available at various times throughout the year only if you experience specific life events, such as losing job-based health coverage or being released from incarceration.

You can learn more about official deadlines through the Social Security Administration.

What is the earliest you can apply for Medicare?

The earliest you can apply for age-based Medicare is 3 months before the month you turn 65. This 7-month window is known as your Initial Enrollment Period, which includes the 3 months before your birthday, your birthday month, and the 3 months after.

Early Eligibility Exceptions

If you are under 65, you can qualify and apply earlier under specific medical conditions:

  • ALS (Lou Gehrig's Disease): Coverage begins the exact month you receive Social Security disability benefits.
  • Disability: You are automatically enrolled after receiving Social Security Disability Insurance (SSDI) for 24 months.
  • End-Stage Renal Disease (ESRD): Coverage usually starts on the fourth month of dialysis or the month of a kidney transplant.

What are the biggest mistakes people make with Medicare?

The biggest mistake people make with Medicare is missing enrollment windows, which can lead to permanent financial penalties and coverage gaps.

Timing and Enrollment Mistakes

  • Missing Deadlines: Failing to sign up during your Initial Enrollment Period (IEP) around age 65 triggers lifelong financial penalties for Part B and Part D.
  • Misjudging Work Coverage: Assuming you can delay enrollment while working past 65 without checking if your employer plan is "creditable coverage" (plans with fewer than 20 employees often require Medicare to go first).
  • Missing the Medigap Window: Waiting past your 6-month Medigap Open Enrollment Period (which starts when you turn 65 and enroll in Part B) means you may have to pass medical underwriting to get a supplemental plan.

Plan Choice and Cost Mistakes

  • Focusing Only on Premiums: Choosing a plan with a low or $0 monthly premium without checking deductibles, copays, or maximum out-of-pocket costs.
  • Ignoring Annual Changes: Not reviewing your plan’s Annual Notice of Change (ANOC) or skipping the Annual Enrollment Period, which leads to surprise costs as drug formularies and doctor networks shift yearly.
  • Assuming Doctors are In-Network: Failing to verify if your preferred physicians and hospitals accept your specific Medicare Advantage or Part D network.
  • Thinking Medicare is Free: Forgetting that Original Medicare has monthly premiums, deductibles, and coinsurance, and does not cover routine dental, vision, or hearing care.

What disqualifies you from Medicare?

You are disqualified from Medicare if you do not meet basic age, citizenship, or residency requirements.

Disqualifying Factors

  • Age under 65: If you are under 65 and do not have a qualifying disability, End-Stage Renal Disease (ESRD), or ALS (Lou Gehrig's disease), you cannot get Medicare.
  • Lack of citizenship or legal residency: You are disqualified if you are not a U.S. citizen or a permanent legal resident who has lived in the U.S. continuously for at least five consecutive years. People on temporary visas do not qualify.
  • Incarceration: While prison does not permanently erase base eligibility, active incarceration in a federal, state, or local facility suspends Medicare's payment of medical bills during the sentence.
  • Living abroad: Medicare does not pay for healthcare services delivered outside the United States.

Note: Having a low income or a poor work history does not disqualify you. If you lack the work credits for premium-free Part A, you can simply pay a monthly premium to buy into it.

Is it necessary to enroll in Medicare every year?

No, it is not necessary to enroll in Medicare every year.

Once you are enrolled, your coverage—whether it is Original Medicare, a Medicare Advantage plan, or a prescription drug plan—renews automatically from year to year as long as you continue to pay your required premiums.

Exceptions and Important Rules

  • Premium Payments: To keep Original Medicare active, you must keep paying your monthly Part B premiums.
  • Plan Cancellations: If your private Medicare Advantage or Part D plan decides to stop offering coverage or leaves the Medicare program, your coverage will not renew, and you will receive a non-renewal notice requiring you to choose a new plan.

Why Review Your Plan Annually

Even though re-enrollment is automatic, your costs, benefits, and healthcare needs can change. You should review the Annual Notice of Change (ANOC) mailed by your plan provider each fall. If you want to make adjustments, you can change, drop, or switch your coverage during the Annual Enrollment Period from October 15 to December 7. You can explore official details or manage your options through Medicare.

Medicare: Why you need to sign up when you're 65, even if you're still working

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How much does Medicare cost per month?

For most beneficiaries, the standard monthly cost for Medicare is $202.90.

Because Medicare is divided into different parts, your exact monthly costs will vary depending on your work history, your income, and the specific plans you choose.

The breakdown of monthly premium costs includes:

1. Medicare Part A (Hospital Insurance)

  • Standard Cost: $0 per month for more than 99% of beneficiaries. You qualify for premium-free Part A if you or your spouse worked and paid Medicare taxes for at least 10 years (40 quarters).
  • If you don't qualify: If you have a shorter work history, you can buy into Part A for either $311 or $565 per month, depending on how many quarters you worked.

2. Medicare Part B (Medical Insurance)

  • Standard Cost: $202.90 per month. This is the base amount that most people pay.
  • High Earners: If your modified adjusted gross income from two years prior (your 2024 tax return) was above $109,000 (single filing) or $218,000 (joint filing), you will pay an Income-Related Monthly Adjustment Amount (IRMAA). This can bump your monthly Part B premium up to somewhere between $284.10 and $689.90.

3. Medicare Part C (Medicare Advantage)

  • Standard Cost: Varies by plan, but the nationwide average premium is projected to be around $11.00 to $14.00 per month.
  • Many Medicare Advantage plans offer a $0 premium, meaning you pay nothing extra on top of your standard $202.90 Part B premium.

4. Medicare Part D (Prescription Drug Plans)

  • Standard Cost: Varies by plan, but the average standalone premium is roughly $34.50 per month.
  • Like Part B, high earners may face an IRMAA surcharge that adds an extra $14.50 to $91.00 per month depending on income.

Deductibles & Out-of-Pocket Costs

Beyond monthly premiums, keep in mind these annual out-of-pocket thresholds before coverage kicks in:

  • Part A Deductible: $1,736 per benefit period (not per year).
  • Part B Deductible: $283 per year.
  • Part D Cap: There is a strict $2,100 annual out-of-pocket cap on covered prescription drugs.

Note: If you stick with Original Medicare (Parts A & B) and add a standalone Part D plan along with a supplemental Medigap policy to cover out-of-pocket costs, your total combined monthly premium will typically range from $388 to $458 per month.

What are the three requirements for Medicare?

Most people qualify for Medicare through one of three main eligibility categories: age, disability, or specific medical conditions.

Medicare Eligibility Requirements

  • Age 65 or older: You must be a U.S. citizen or a legal permanent resident who has lived in the United States continuously for at least five years.
  • Disability: You must be under age 65 and have received Social Security Disability Insurance (SSDI) or Railroad Retirement Board disability benefits for at least 24 months.
  • Specific Conditions: You qualify immediately if you are diagnosed with End-Stage Renal Disease (permanent kidney failure requiring dialysis or a transplant) or Amyotrophic Lateral Sclerosis (ALS, also known as Lou Gehrig's disease).

You can learn more about qualifying on the official Medicare Eligibility Guidance page.

What are the five things that Medicare will not cover in 2026?

Original Medicare (Parts A and B) does not cover routine dental care, routine vision care, hearing aids, long-term custodial care, and health care received overseas.

Major Uncovered Services in 2026

  • Most dental care: Original Medicare does not pay for routine cleanings, checkups, fillings, tooth extractions, root canals, or dentures.
  • Routine vision care: Regular eye exams, eyeglasses, and contact lenses are excluded, though treatments for medical eye conditions like cataracts or glaucoma are covered.
  • Hearing aids: Original Medicare does not cover hearing aids or routine exams used to fit them.
  • Long-term care: Extended nursing home care or custodial care (help with daily personal activities like bathing or dressing) is not covered outside of limited short-term skilled nursing rehabilitation.
  • Overseas coverage: Medical care received outside of the United States and its territories is generally excluded, with rare exceptions like emergencies on cruise ships close to a U.S. port.

Why do doctors not like to take Medicare?

Some doctors choose not to accept Medicare because government reimbursement rates are often lower than what private insurance pays.

Main Reasons Providers Decline Medicare

  • Lower Reimbursement Rates: Medicare payments often fail to keep pace with the rising costs of running a medical practice and inflation.
  • High Administrative Burden: The strict billing rules, paperwork, and requirements for prior authorization demand significant time and staff resources.
  • Cash Flow Delays: Processing claims and receiving payments from the government can take longer, affecting a practice's financial stability.
  • Business Model Preference: Some providers choose to opt out entirely or switch to a concierge model to set their own fees and work outside government regulations.

You can verify whether a specific provider takes the program by checking the Official Provider Locator or calling their office directly.

What are the worst states for Medicare?

According to the Commonwealth Fund Medicare Scorecard, Louisiana, Mississippi, and Kentucky rank as the worst states for Medicare performance.

Lowest-Ranked States

The bottom-performing states struggle heavily across multiple healthcare categories:

  • Louisiana: Ranks lowest overall due to limited provider access, infrastructure and transportation hurdles, and high rates of high-risk medication prescriptions.
  • Mississippi: Faces severe challenges with lower life expectancy at age 65 and restricted care access.
  • Kentucky: Struggles with high rates of preventable hospitalizations and difficulties accessing timely outpatient care.
  • Other low-scoring states: Arkansas and Oklahoma round out the bottom five (ranking 49th and 50th).

Key Factors Driving Poor Rankings

The Becker's Payer Issues Report on Medicare highlights why these states lag behind:

  • Access to Care: Beneficiaries face physical hurdles reaching doctors due to rural isolation and transportation deficits.
  • Quality of Outpatient Management: Higher rates of avoidable hospital admissions occur because chronic conditions are managed less effectively before turning into acute emergencies.
  • Prescription and Medication Risks: Southeastern states see a higher prevalence of older adults being prescribed potentially high-risk or unnecessary medications.
  • Prior Authorizations: Lower-performing regions often feature more administrative hurdles and stricter plan rules.