What Happens to Your Health Insurance When You Turn 65?

Turning 65 is one of the most significant milestones in your financial and health life — and one of the most confusing. Your health insurance situation changes dramatically, and the decisions you make in the months surrounding your 65th birthday can affect your coverage and costs for years to come.

Whether you're currently covered through an employer, a spouse's plan, or the individual market, here's exactly what you need to know.

Your Current Health Insurance May Not Continue as-Is

If you have health insurance through your employer or your spouse's employer, you may be able to keep it after 65 — but there are important rules about how it coordinates with Medicare.

If you work for a company with 20 or more employees, your employer plan is the primary payer and Medicare is secondary. You can delay enrolling in Medicare Part B without penalty in this case.

If you're on a smaller employer plan (fewer than 20 employees), Medicare becomes primary and your employer plan secondary. In this situation, you should enroll in Medicare on time to avoid gaps in coverage.

If you're buying your own insurance through Covered California or the individual market, your plan ends when you become eligible for Medicare. You'll need to transition to Medicare — and you'll want to do it on time.

Understanding Medicare: The Four Parts

Medicare has four main parts, and understanding each one is essential before you enroll.

Part A — Hospital Insurance

Part A covers inpatient hospital stays, skilled nursing facility care, hospice, and some home health services. Most people don't pay a premium for Part A if they or their spouse worked and paid Medicare taxes for at least 10 years.

Part B — Medical Insurance

Part B covers doctor visits, outpatient care, preventive services, and medical equipment. There is a monthly premium for Part B (the standard amount in 2026 is $185/month, though higher earners pay more). This is where most people need to make a decision about timing.

Part C — Medicare Advantage

Medicare Advantage plans are offered by private insurance companies approved by Medicare. They bundle Parts A and B (and usually Part D) into one plan, often with extra benefits like dental, vision, and hearing. These plans have networks, so you'll need to use in-network providers.

Part D — Prescription Drug Coverage

Part D covers prescription medications. You can get it as a standalone plan alongside Original Medicare, or it's often included in a Medicare Advantage plan. If you don't enroll when first eligible and don't have other creditable drug coverage, you'll face a permanent late enrollment penalty.

The Critical Enrollment Window

Your Initial Enrollment Period (IEP) is a 7-month window:

• 3 months before the month you turn 65
• The month you turn 65
• 3 months after the month you turn 65

Enrolling during the first 3 months of your IEP means your coverage starts the month you turn 65. If you wait until the month of or after your birthday, your start date is delayed.

Missing this window without a valid exception can result in permanent late enrollment penalties — a 10% surcharge on your Part B premium for every 12-month period you were eligible but didn't enroll.

What About Medicare Supplement (Medigap) Plans?

Original Medicare (Parts A and B) doesn't cover everything. There are deductibles, copays, and coinsurance that can add up quickly. That's where Medicare Supplement plans — also called Medigap — come in.

Medigap plans are sold by private insurers and help pay the "gaps" in Original Medicare coverage. The best time to buy a Medigap plan is during your Medigap Open Enrollment Period, which starts the month you're 65 and enrolled in Part B. During this 6-month window, insurers cannot deny you coverage or charge you more due to pre-existing conditions.

After this window closes, you may be subject to medical underwriting — meaning you could be denied or charged higher premiums based on your health history.

Common Mistakes People Make at 65

1. Missing the enrollment window. Even if you're still working, it's worth understanding whether you need to enroll in Part B now or can delay without penalty.

2. Not enrolling in Part D. Even if you don't take many medications today, enrolling in a low-cost Part D plan protects you from the late enrollment penalty and ensures coverage when you need it.

3. Choosing the wrong plan type. Medicare Advantage and Original Medicare + Medigap serve different needs. The right choice depends on your doctors, medications, travel habits, and budget.

4. Assuming all plans are the same. Plan premiums, networks, drug formularies, and out-of-pocket maximums vary significantly. Comparing plans before you enroll can save you hundreds or thousands of dollars per year.

5. Waiting until Open Enrollment to ask questions. October 15 – December 7 is Medicare's Annual Enrollment Period, when you can switch plans. But if you're turning 65, your Initial Enrollment Period is separate — don't wait.

How a Free Medicare Review Can Help

Navigating Medicare alone is overwhelming. The rules are complex, the plan options are numerous, and the stakes are high. A licensed Medicare insurance agent can:

• Walk you through your specific situation and timeline
• Compare Medicare Advantage, Supplement, and Part D plans side by side
• Help you understand how your current coverage interacts with Medicare
• Ensure you enroll on time and avoid penalties
• Answer your questions in plain language — no jargon

The best part? Working with a licensed agent costs you nothing. Agents are compensated by the insurance carriers, not by you.

Ready to Get Your Free Medicare Review?

If you're turning 65 in the next 12 months — or you're already 65 and unsure if you have the right coverage — now is the time to get clarity.

Nava Abramoff is a licensed California insurance agent (CA #0F45500) who specializes in helping people navigate Medicare with confidence. She offers a free, no-obligation Medicare review to walk you through your options and help you make the right choice for your health and budget.

Schedule your free Medicare review today — it only takes a few minutes, and it could save you thousands.

Prefer to meet in person? Starting October 5, Nava will be at a free Medicare kiosk at Ralph's Granada Hills every Monday & Thursday, 1:30–4:30 PM through December 7. Walk in — no appointment needed.