Turning 65 in North Carolina: Your Medicare Timeline

Turning 65 brings a lot of mail, and much of it is about Medicare. It can feel like a lot at once, but the decisions follow a fairly predictable timeline. Here's a plain-English walk-through for North Carolina residents, from the first steps to your first year on Medicare.

This is general information. Your own dates and choices may vary depending on your birthday, whether you're still working and the coverage you have now.

The four parts of Medicare, briefly

• Part A (hospital insurance) helps cover inpatient hospital stays, skilled nursing facility care, hospice and some home health care. Most people don't pay a monthly premium for Part A if they or a spouse worked and paid Medicare taxes long enough.
• Part B (medical insurance) helps cover doctor visits, outpatient care, preventive services and medical equipment. Part B has a monthly premium.
• Part C (Medicare Advantage) is an alternative way to get your Part A and Part B benefits through a private plan approved by Medicare. Many plans include drug coverage, and some include extra benefits such as dental or vision. Benefits vary by plan.
• Part D (prescription drug coverage) is offered through private plans, either on its own alongside Original Medicare or built into many Medicare Advantage plans.

People who choose Original Medicare (Parts A and B) sometimes add a Medicare Supplement (Medigap) policy to help with out-of-pocket costs. That's a separate product with its own rules.

Your Initial Enrollment Period

Your first chance to sign up is your Initial Enrollment Period (IEP). It generally lasts seven months: the three months before the month you turn 65, your birthday month and the three months after.

When your coverage starts depends on when you sign up. If you enroll in the months before your birthday month, coverage generally starts the first day of your birthday month. If you enroll during your birthday month or later, it generally starts the first day of the following month. If your birthday falls on the first of the month, your dates shift one month earlier.

Want to see your own window? Try the enrollment window calculator on our homepage.

Are you signed up automatically?

If you already get Social Security or Railroad Retirement benefits, you're generally enrolled in Parts A and B automatically, and your Medicare card arrives in the mail a few months before you turn 65. If you're not getting those benefits yet, you'll usually need to sign up through Social Security, online, by phone or at a local office.

Still working at 65?

If you or your spouse are still working and have coverage through that employer, you may be able to delay Part B without a penalty, depending on the size of the employer and the type of coverage. When that job or coverage ends, you generally get a Special Enrollment Period to sign up. The rules can be tricky, so check with your employer's benefits office and Social Security before you decide.

Why timing matters

If you don't sign up for Part B when you're first eligible and don't have other qualifying coverage, you may pay a late enrollment penalty for as long as you have Part B. There's a similar penalty for Part D if you go without creditable drug coverage for too long. You may also have to wait for a later enrollment period to sign up.

When to start looking

A practical timeline many people follow:

1. About six months before your birthday month: gather your list of doctors, prescriptions and pharmacies, and find out what happens to any current coverage at 65.
2. About three months before: your Initial Enrollment Period opens. Confirm your Part A and B enrollment, and start comparing options.
3. Before your coverage start date: choose how you want to get your coverage, whether Original Medicare with a drug plan (and possibly a Medicare Supplement) or a Medicare Advantage plan, and enroll.
4. Your first fall on Medicare: review your coverage during the Annual Enrollment Period, October 15 to December 7. Our post on what to review before Annual Enrollment has a checklist.

Get help from a local broker

Medicare.gov and 1-800-MEDICARE can answer questions, and North Carolina's Seniors' Health Insurance Information Program (SHIIP) offers unbiased counseling.

You can also sit down with Matt MacMillan, an independent broker based in Mooresville. He can walk you through your timeline, and if you're considering Medicare Advantage, he can compare the plans offered in Iredell County and nearby counties from the carriers he represents, checking your doctors and prescriptions against each one. There's never a fee for his help, and you can meet in person, by phone or by video. For more, see our North Carolina Medicare Advantage page.

If we discuss Medicare Advantage plans, we'll first confirm the products you want to talk about (Scope of Appointment).

We do not offer every plan available in your area. Currently we represent 8 organizations which offer 1,210 products in your area. Please contact Medicare.gov, 1-800-MEDICARE, or your local State Health Insurance Program (SHIP) to get information on all of your options. The MacMillan Agency is not connected with or endorsed by the U.S. government or the federal Medicare program. Plan availability, benefits and costs vary by county and plan.