Medicare

Medicare is a federal health insurance program for people age 65 and older. You may be eligible to get Medicare earlier if you have a disability, End-Stage Renal Disease (ESRD), or Amyotrophic Lateral Sclerosis (ALS) (also called Lou Gehrig's disease).

Each year, you can choose your health insurance coverage and add or change prescription drug coverage. It’s important to understand your options and compare them carefully so you can make an informed decision that’s right for you.

Transamerica Institute has developed this short reference guide to answer common questions about when and how to enroll in Medicare, available plan types, coverage options, and how to change coverage.

For detailed information, visit the official Medicare website (Medicare.gov).

Click on the links below to advance to specific topics about Medicare in this guide:

• When to Enroll?
• How Do I Enroll?
• How Do I Change My Coverage? 
• Which Medicare Plan Do I Choose?
• Understand Your Coverage: Skilled Nursing Facility Care
• Services & Items Not Covered by Part A & Part B Medicare
• Recent Changes to Medicare
• Get Help

When to Enroll? 

You can only enroll in Medicare during certain periods: 

• Initial Enrollment Period
• General Enrollment Period
• Special Enrollment Period 

Initial Enrollment Period

You must initially enroll in Medicare during the 7-month period that starts 3 months before the month you turn 65, includes the month you turn 65, and ends 3 months after the month you turn 65. If you are employed and covered under an employer’s health plan during this time period, consult with your employer’s health plan provider and Medicare to learn what action you must take, if any, at this time.

If you’re close to 65 and are receiving Social Security benefits or Railroad Retirement Board benefits, you’ll be automatically enrolled in Medicare Part A and Part B coverage once you're eligible. Because Part B coverage requires that you pay a monthly premium, you can choose whether to keep it or not.

To learn about coverage options for Medicare, scroll down to the "Which Medicare Plan Do I Choose?" section. 

If you missed your Initial Enrollment Period (IEP) and need to enroll in Medicare, you likely will have to enroll during either the General Enrollment Period (GEP) or a Special Enrollment Period (SEP). 

General Enrollment Period

If you did not enroll in Medicare when you originally became eligible for it (or during a Special Enrollment Period), you can sign up during the General Enrollment Period (GEP). The GEP takes place January 1 through March 31 each year, with coverage the month after you sign up. You may face a late penalty for enrolling during the GEP instead of when you first became eligible. 

Special Enrollment Period

If you missed the Initial Enrollment Period and the General Enrollment Period, you may qualify for coverage during a Special Enrollment Period under certain circumstances. Contact Medicare to determine if you are eligible.

How Do I Enroll?

There are a few ways to enroll in Medicare, depending on which plan you'd like to proceed with. For Original Medicare (Part A & Part B), you can enroll by: 

1. Applying online at Social Security
2. Calling Social Security at 1-800-772-1213. TTY users can call 1-800-325-0778.
3. Going in-person to your local Social Security office.
4. If you or your spouse worked for a railroad, call the Railroad Retirement Board at 1-877-772-5772.
5. Want to know what documents you'll need? Check out the Checklist for Online Medicare, Retirement, & Spouses Applications.
6. If you want to enroll in a Medicare Advantage Plan (Part C), enroll directly in the plan through the plan's website or at Medicare.gov.
7. If you want a Medicare Supplement Insurance plan (Medigap), you'll enroll directly in the plan through the plan's website.

How Do I Change My Coverage? 

Open Enrollment Period

After you've enrolled in Medicare, you can make changes to your health plan during the Open Enrollment Period.

The Open Enrollment Period runs annually from October 15 to December 7. During this seven-week period, you have the opportunity to change your health plan for the following year. You can switch between Original Medicare and Medicare Advantage (Part C), or add, change, or drop Medicare prescription drug coverage (Part D).

Visit Medicare.gov to change your Medicare plan during the Open Enrollment Period. 

Medicare Advantage Open Enrollment Period

 January 1 – March 31 is the Medicare Advantage Open Enrollment Period. If you’ve enrolled in a Medicare Advantage Plan during the Open Enrollment Period and change your mind, you can switch to Original Medicare (Parts A and B) or to a different Medicare Advantage Plan at this time. 

Which Medicare Plan Do I Choose? 

When you first enroll in Medicare, you can choose how you get your Medicare coverage. There are two options for you to pick from:

Original Medicare 

Original Medicare includes Hospital (Part A) and Medical (Part B) insurance. To add drug coverage, you can add Part D. Additionally, adding a Medicare Supplement Insurance (Medigap) policy will help lower your out-of-pocket costs.

Medicare Advantage

Medicare Advantage (Part C) is an alternative to Original Medicare, and is purchased through private insurance companies. These plans include Part A, Part B, and usually Part D. Most plans have additional benefits — hearing, vision, dental, and more.

Medicare Plan Finder

The Medicare Plan Finder is an online resource that can help you compare Medicare coverage options, including their covered benefits, premiums, deductibles, and out-of-pocket costs.

The graphic below provides a high-level comparison of original Medicare and Medicare Advantage in terms of coverage, cost, and provider chose.

The illustration below is a high-level summary of Part A, Part B, Medicare Advantage (Part C), and Part D.

There are many choices when it comes to picking a Medicare plan that works for you. The Medicare Plan Finder can guide you through the process of shopping for and comparing plans.

Understand Your Coverage: Skilled Nursing Facility Care

Medicare covers skilled nursing facility care, but its coverage is limited and does not include long-term care. It is important to understand these limitations so that you can financially prepare for long-term care should it become necessary.

The graphic below provides a high-level summary of Medicare coverage for skilled nursing facility care.

Services & Items Not Covered by Original Medicare (Parts A & B) 

• Long-term care (also known as “custodial care” and includes activities like bathing, dressing, using the bathroom, and eating)
• Most dental care and dentures
• Eye exams related to prescribing glasses
• Routine foot care
• Cosmetic surgery
• Massage therapy
• Routine physical exams
• Hearing aids and exams to fit them
• Concierge care (also called concierge medicine, retainer-based medicine, boutique medicine, platinum practice, or direct care)

Recent Changes to Medicare 

Lowering your prescription drug costs

There will be a 2027 cap on prescription drugs. If you have Medicare Part D (drug coverage), your annual out-of-pocket costs will be capped at $2,400. Once you reach that cap, you'll pay nothing for covered Part D medications for the rest of the year. The maximum Part D deductible will be $700 in 2027. The $35 monthly cap on insulin costs is still in effect, and most vaccines will be covered under Part D. 

Note: Medicare is negotiating with drug companies to lower the price of certain prescription drugs. Check Medicare.gov for the latest information and to learn whether your out-of-pocket prescription drug costs may be affected.

Prescription drug payment plan

The Medicare Prescription Payment Plan is a voluntary option that can help you spread your out-of-pocket prescription drug costs throughout the year. If you have Medicare prescription drug coverage, you may be eligible to enroll. There is no cost to participate. See Medicare.gov for more information.

The federal government is implementing measures to increase awareness and use of health care services via telehealth. Medicare-covered telehealth services are available across the United States. Visit Medicare.gov for the latest information.

Get Help

• Medicare.gov is the official government site for Medicare. 
• Medicare Plan Finder. The online tool that guides you through the process of shopping for and comparing plans.
• State Health Insurance Assistance Program (SHIP). Free, unbiased counseling is available in every state.
• Insurance brokers. They give free advice; however, they may receive financial compensation for the plans they represent. 
• Fee-based consultants. These consultants have no ties to health insurance companies or health care providers and are compensated per hour or project.
• Ask Claire. A free Medicare resource that connects you with licensed representatives for general Medicare questions.

Last updated: November 7, 2026