Medicare 2026

Brick at 65: how to work your 7-month Medicare window without missing a step

If you live in Brick and your 65th birthday is on the horizon, you're about to meet Medicare for the first time. The good news: you don't have to figure it all out in a single afternoon. Medicare gives you a seven-month stretch — called the Initial Enrollment Period, or IEP — to make your first decisions. Knowing what that window looks like, and what to weigh inside it, can save you from late penalties and coverage gaps later on.

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What the Initial Enrollment Period actually is

Your IEP is a seven-month window built around your 65th birthday. It includes the three months before your birthday month, your birthday month itself, and the three months after. For most people in Brick, this is the first and easiest chance to enroll in Medicare Part A (hospital) and Part B (medical).

If you sign up during the three months before you turn 65, your coverage generally starts the first day of your birthday month. Sign up during or after your birthday month, and your start date shifts later — which can leave a gap you didn't plan for. Per CMS guidance on medicare.gov, timing your enrollment early in the window is usually the cleanest path.

Are you enrolled automatically, or do you need to act?

It depends on your situation:

• If you're already collecting Social Security or Railroad Retirement benefits before 65, you're typically enrolled in Part A and Part B automatically. Your red, white and blue card arrives in the mail about three months before your birthday.
• If you're not yet drawing Social Security — common for people still working — you need to sign up yourself. You can do that at ssa.gov, by calling Social Security, or by visiting a local office.

Don't assume it happens on its own. Check the mail around three months before your birthday, and if no card appears, take the next step.

Still working at 65? Read this carefully

Plenty of Brick residents work past 65, often with employer health coverage. Whether you should enroll in Part B right away depends on the size of the employer and how that plan coordinates with Medicare.

• If the employer has 20 or more employees, your job-based plan usually stays primary, and you may be able to delay Part B without a penalty.
• If the employer has fewer than 20 employees, Medicare often becomes primary at 65, and delaying Part B could leave you underinsured.
• COBRA and retiree coverage do NOT count as active employer coverage for delaying Part B. This trips people up every year.

When you eventually leave that job, you get a Special Enrollment Period to sign up for Part B without a late penalty — but you have to use it. If you're unsure how your specific plan works with Medicare, your employer's HR or benefits administrator is the right first call, followed by New Jersey's free SHIP counselors.

Part D and prescription drug coverage

Even if you don't take many medications today, Medicare expects you to have creditable drug coverage once you're eligible. That can come through a stand-alone Part D plan, a Medicare Advantage plan that includes drugs, or another source (like some employer or veterans' coverage) that Medicare recognizes as creditable.

Skip drug coverage without a creditable alternative, and you can face a Part D late-enrollment penalty — a small monthly amount added to your premium for as long as you have Part D, for the rest of your life.

A few figures worth knowing:

• The Part D out-of-pocket cap is $2,100 in 2026 and $2,400 in 2027.
• The Part D maximum deductible is $615 in 2026 and $700 in 2027.
• The old coverage gap (the "donut hole") has been eliminated since 2025; Part D now has three phases.
• The Medicare Prescription Payment Plan lets you spread your drug costs across the year in monthly amounts, if that helps your budget.

Original Medicare or Medicare Advantage?

This is the big fork in the road during your IEP. In plain terms:

• Original Medicare (Parts A and B) is the federal program. Many people pair it with a stand-alone Part D plan and a Medigap (supplement) policy to help with out-of-pocket costs. You can generally see any provider in the country that accepts Medicare.
• Medicare Advantage (Part C) is offered by private insurers approved by Medicare. These plans bundle Parts A and B, usually include drug coverage, and often add extras. They typically use networks, and rules vary plan to plan.

Brick is in Ocean County, where the available Medicare Advantage plans and stand-alone Part D plans are set at the county level. Medigap options are regulated at the New Jersey state level. When you compare plans on medicare.gov's Plan Finder, entering your ZIP code will show you what's offered in your area.

There's no universally "right" answer — it depends on your doctors, your medications, your travel habits, and your budget. A key point about Medigap: when you first enroll in Part B at 65, you have a six-month Medigap Open Enrollment Period during which insurers can't turn you down or charge you more based on health. That window doesn't repeat automatically later.

A quick word on IRMAA

If your income is higher, you may pay more for Parts B and D. For 2026, IRMAA surcharges begin above $109,000 in income for a single filer (higher thresholds apply for joint filers). Medicare uses your tax return from two years earlier to decide. If your income has dropped since then — say, because you retired — you can ask Social Security to reconsider using a life-change form.

Dates to keep in your back pocket

Even after your IEP ends, Medicare has other windows:

• Annual Enrollment Period: October 15 – December 7 each year, for changes to Medicare Advantage and Part D.
• Medicare Advantage Open Enrollment Period: January 1 – March 31, for people already in a Medicare Advantage plan who want to switch or return to Original Medicare.

Your first decision isn't your last decision. But your first decision does shape your penalties, your Medigap access, and your start date — so it's worth thinking through carefully.