How To Enroll in Medicare
Enrolling in Medicare can seem like a daunting process, but it doesn’t have to be. Before you begin, it’s important to understand your options to help you determine the coverage you may need and ensure you receive it.
Understanding Medicare
Medicare is an American federal health insurance program administered by the Centers for Medicare & Medicaid Services (CMS) and is limited to qualified U.S. citizens and legal residents.
Medicare coverage has four parts:
- Part A covers inpatient hospital stays, skilled nursing service and eligible home care
- Part B covers outpatient services, including doctor visits, durable medical apparatus, lab investigations, ambulance services, mental health care and preventive services
- Part C, or Medicare Advantage, covers everything that parts A, B, and sometimes D cover, and may offer even more coverage depending on the plan
- Part D covers prescription drugs
Original Medicare vs. Medicare Advantage
Original Medicare refers to both parts A and B together. Medicare Advantage refers to Part C, where the federal government contracts with private health insurance companies to provide coverage. Unlike Original Medicare, Medicare Advantage plans may include an out-of-pocket maximum and additional benefits, such as hearing, dental, and vision coverage. Some Medicare Advantage plans include Part D, or prescription drug coverage.
Prescription Drug Coverage Under Medicare
Prescription drug coverage is not automatic under Medicare. If you want prescription drug coverage, you have two options that are offered through private health insurance companies:
- Standalone Part D plan (PDP): For those with Original Medicare (Part A and B) who want to add prescription coverage (Part D)
- Medicare Advantage plan with Prescription Drug (MAPD) coverage: Combines Parts A, B, and D all in one plan
Some people may choose to delay Medicare Part D enrollment; however, if you don’t sign up for prescription drug coverage when you become eligible for Part D, a late-enrollment penalty for signing up after that date may apply. You may owe a late enrollment penalty if you go without Part D or another creditable prescription drug coverage for 63 or more consecutive days after your Initial Enrollment Period (IEP) ends.
2026 Part D Updates:
- Annual Deductible: In 2026, this can be up to $615, depending on the plan
- Out-of-Pocket Cap: Starting in 2026, out-of-pocket costs for Part D prescriptions are capped at $2,100 annually, providing significant savings for beneficiaries with high drug costs
- Catastrophic Coverage: Once your out-of-pocket spending reaches $2,100, you’ll enter catastrophic coverage and pay nothing for the rest of the year for covered Part D prescription drugs
- Coverage Gap ("Donut Hole"): The traditional "donut hole" coverage gap has been eliminated as of 2025, making prescription drug coverage more predictable and affordable
Medigap (Medicare Supplement Insurance)
Medicare supplement insurance plans (or Medigap) are designed to cover costs that Original Medicare does not, like copayments and deductibles, and are offered through private health insurance companies. The best time to apply for a Medicare supplement insurance plan is during the six-month period that starts the date your Medicare Part B coverage becomes effective, because insurers cannot require a health screening to set the plan’s premium. After this Medigap open enrollment period, rules governing what insurers can require of applicants vary by state.
Enrolling in Medicare
When enrolling in Medicare, you will want to consider either Original Medicare (with optional Medigap and/or Part D prescription drug coverage) or a Medicare Advantage (Part C) plan.
A major consideration is that there is no out-of-pocket limit with Original Medicare, which means there is no cap to the amount you pay out-of-pocket for your health care. With Medicare Advantage (Part C) plans, there is a limit to how much you pay out-of-pocket each year for in-network medical services that are under Medicare Part A and Part B. This limit is called the maximum out-of-pocket amount for medical services. There may be exceptions if your Medicare Advantage plan is a preferred provider organization (PPO) plan.
Enrolling in Medicare can be done:
Former railroad workers can enroll in Medicare through the Railroad Retirement Board (RRB) by calling 1-877-772-5772 (TTY: 1-312-751-4701), Monday through Friday from 9 a.m. to 3 p.m.
Enrolling in a Medicare Advantage (Part C) Plan
Medicare Advantage plans offer a different way to get your Medicare benefits. These plans must cover everything that Original Medicare covers, but many go above and beyond with additional benefits like prescription drug coverage, dental, vision, and hearing benefits.
When choosing a Medicare Advantage plan, you'll want to consider your health care needs, preferred doctors, and budget. Unlike Original Medicare, Medicare Advantage plans have an annual out-of-pocket maximum, which means there's a limit to what you'll pay for covered services each year.
Enrolling in a Medicare Advantage plan can be done:
- Online through the Medicare.gov website
- Directly with a Medicare Advantage health insurance plan
- Through a licensed agent or broker who can help you compare your options
When to Enroll in Medicare
Qualified U.S. citizens and legal residents can enroll in Medicare during specific windows of time:
- If you are already receiving retirement benefits at the age of 65, you will be automatically enrolled in both Medicare parts A and B. However, if you live in a U.S. territory (like Puerto Rico, Guam, or the U.S. Virgin Islands), you'll only be automatically enrolled in Medicare Part A—you'll enroll yourself in Part B.
- If you are under the age of 65 and a recipient of disability benefits from Social Security or the Railroad Retirement Board (RRB), you will be automatically enrolled in both Medicare Parts A and B. Medicare enrollment due to disability occurs after receiving 24 months of monthly disability benefits.
Medicare Enrollment Periods
You can enroll in Medicare even if you’re not receiving retirement benefits. Here are the enrollment periods you should know about:
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A This is your first opportunity to enroll in Medicare when you turn 65:
- When: Starts 3 months before your 65th birthday and ends 3 months after your birthday month
- What you can do: Enroll in Medicare Parts A, B, and D, or choose a Medicare Advantage plan (Part C)
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A This is your yearly chance to enroll or change your Medicare coverage:
- When: October 15 to December 7 each year
- What you can do:
- Enroll in a Medicare plan
- Switch from Original Medicare to Medicare Advantage (or vice versa)
- Change from one Medicare Advantage plan to another
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A This period is only available if you're already enrolled in Original Medicare or a Medicare Advantage plan:
- When: January 1 to March 31 each year
- What you can do:
- Switch from your Medicare Advantage plan back to Original Medicare (or vice versa)
- Change from one Medicare Advantage plan to another
- Add or drop a Part D prescription drug plan
Take the Next Step Toward Better Health Care
At Alignment Health Plan, we're here to make your Medicare journey as simple as possible. Our Medicare Advantage plans combine medical and prescription drug coverage in one convenient package, plus you'll have access to our 24/7 support team whenever you need help.
Ready to explore your options? Use our online Plan Finder tool to see what's available in your area, attend a seminar, or give us a call at 1-888-293-8272 (TTY: 711). We are available from 8:00 a.m. to 8:00 p.m., 7 days a week (except Thanksgiving and Christmas) from October 1 through March 31 and Monday to Friday (except holidays) from April 1 through September 30.
Our team is here to make your enrollment process as smooth as possible. We'll help you understand your options and find the plan that's right for your needs, so you can focus on living your best life.