What Is Medicare? Do I Need to Enroll at Age 65?
Medicare is a federal health insurance program designed primarily for people age 65 and older, as well as certain individuals under 65 who have received Social Security disability benefits for 24 months.*
What Does Original Medicare Cover?
Original Medicare consists of two parts:
Medicare Part A – Hospital Insurance
Medicare Part A covered charges are paid after deductibles and/or copays: most people enroll in either a Supplement or an Advantage plan to limit these out of pocket expenses.
Part A covers:
- Inpatient hospital careÂ
- Skilled nursing facility careÂ
- HospiceÂ
- Some home health care
Medicare Part B – Medical Insurance
Medicare Part B covered charges are paid at 80% and you would be responsible for the other 20% plus an additional 15% if your provider doesn't accept the allowable amount. Most people enroll in either a Supplement or an Advantage Plan to limit these out of pocket expenses.
Part B covers:
- Doctor visitsÂ
- Outpatient careÂ
- Lab workÂ
- Preventive servicesÂ
- Durable medical equipment
How Much Does Medicare Cost in 2026?
Medicare Part A
Most people qualify for premium-free Part A if:
- They worked and paid Medicare taxes for at least 40 quarters (10 years), orÂ
- They qualify through a spouse’s work historyÂ
You may also qualify through:
- A current spouse after one year of marriageÂ
- A divorced spouse (married at least 10 years)Â
- A deceased spouse (married at least 9 months before death)Â
Medicare Part B
- Standard 2026 premium: $202.90/monthÂ
- Higher-income individuals may pay more due to IRMAA (Income-Related Monthly Adjustment Amount), based on adjusted gross income from two years prior.
- Maximum 2026 Part B premium: $689.90/month (based on 2024 income)Â
In California, individuals who qualify for Medi-Cal may have their Part B premium paid through a Medicare Savings Program.
Medicare Part D – Prescription Drug Coverage
Medicare Part D provides prescription drug coverage through private insurance companies approved by Medicare.
Part D coverage may be:
- A standalone Prescription Drug Plan (PDP), orÂ
- Included in a Medicare Advantage Prescription Drug Plan (MAPD)Â
Do I Have to Enroll in Medicare at Age 65?
Most people turning 65 who are not actively working for an employer with 20+ employees should enroll in Medicare when first eligible.
If you are already collecting Social Security benefits, you will typically be automatically enrolled in:
- Medicare Part AÂ
- Medicare Part BÂ
If you are actively working and covered under a large employer group health plan, you may be able to delay Part B and avoid paying the premium while your employer coverage remains primary.
Important Medicare Enrollment Facts
- You can enroll in Medicare starting 3 months before your 65th birthdayÂ
- Coverage typically begins the first day of your birth monthÂ
- If your birthday falls on the 1st of the month, coverage usually begins the month beforeÂ
If you receive premium assistance through Covered California and become eligible for Medicare but do not enroll on time, you may be required to repay subsidies when filing your taxes.
Avoid Penalties, Coverage Gaps & Costly Mistakes
Enrolling correctly—and choosing the right coverage—can save you thousands of dollars over time.
We can help you:
- Determine when to enrollÂ
- Review employer coverage rulesÂ
- Set up your Social Security accountÂ
- Enroll in Medicare onlineÂ
Carriers We Represent
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Anthem Blue Cross (Elevance)
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Aetna
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Alignment Health Plan
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Beam
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Blue Shield of CA
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Cigna
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Delta Dental
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Health Net
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HealthSpring
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Humana
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Kaiser
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Imperial Health Plan of California
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LA Care
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Medico/Wellabe
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Molina
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SCAN
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Sutter Health
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UCLA Health Medicare Advantage
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United Concordia
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UnitedHealthcare / AARP
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VSP
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WellCare / Centene
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