Medicare 2026

Boone retirees, here's how a missed Medicare sign-up can follow you for life

BOONE, N.C. — If you live in the High Country and are getting close to 65, the calendar matters more than most people realize. Missing a Medicare enrollment window for Part B (doctor visits and outpatient care) or Part D (prescription drugs) can add a surcharge to your premium every month — and in most cases, that surcharge sticks with you for as long as you have the coverage.

Medicare 2027Boone, NC

The good news: the rules are clear, and the fixes are usually simple if you know them ahead of time.

How the Part B penalty works

Part B has a monthly premium. If you don't sign up when you're first eligible, and you don't qualify for an exception, Medicare adds 10% to that premium for each full 12-month period you were eligible but not enrolled.

That extra amount isn't a one-time fee. In most cases, you pay it every month for as long as you have Part B. Someone who waits three years, for example, could end up paying an extra 30% on top of the standard premium.

The most common way people get caught is by assuming they can sign up whenever they want after 65. Outside of a Special Enrollment Period, you generally can only enroll during the General Enrollment Period (Jan. 1 – March 31), with coverage starting the month after you sign up.

How the Part D penalty works

Part D — prescription drug coverage — has its own separate penalty. If you go 63 days or more in a row without "creditable" drug coverage after you're first eligible, Medicare can charge you 1% of the national base beneficiary premium for every month you were without it.

That amount is added to your Part D premium and, like the Part B penalty, generally continues for as long as you have Part D coverage. The national base premium changes each year, so the exact dollar amount can shift, but the percentage keeps climbing the longer you wait.

"Creditable" is the key word. Coverage from an employer, union, or the VA often counts as creditable, meaning it's at least as good as a standard Part D plan. Your plan should send you a notice each year telling you whether your drug coverage qualifies. Keep those notices — they're your proof.

Who can delay without a penalty

Not everyone has to sign up at 65. If you or your spouse are still working and you have health coverage through that job, you may qualify for a Special Enrollment Period when the job or the coverage ends. That lets you enroll in Part B (and Part D) without a late penalty.

A few things to know:

• COBRA and retiree coverage do not count as active employer coverage for Part B purposes. Many people learn this the hard way.
• You generally have eight months after your employment or group coverage ends to sign up for Part B without a penalty.
• For Part D, the window is shorter — usually 63 days after creditable drug coverage ends.

If you're not sure whether your current plan counts, ask your benefits administrator in writing.

What Boone-area residents should know

Boone is in Watauga County, where residents have access to Original Medicare plus a range of Medicare Advantage and stand-alone Part D options offered by private insurers. The enrollment deadlines and penalty rules are federal, so they apply the same way here as anywhere else in the country.

For 2026, a few program-level figures are worth marking down:

• The Part D out-of-pocket cap is $2,100.
• The Part D maximum deductible is $615.
• The coverage gap (the old "donut hole") is gone as of 2025, replaced by three phases.
• IRMAA income-based surcharges begin above $109,000 for a single filer.
• The Medicare Prescription Payment Plan lets you spread drug costs across the year in monthly installments.

Key dates to keep on the fridge

• Initial Enrollment Period: The seven months around your 65th birthday — three months before, your birthday month, and three months after.
• General Enrollment Period: Jan. 1 – March 31 (for people who missed their initial window).
• Annual Enrollment Period: Oct. 15 – Dec. 7 (to join, switch, or drop Part D and Medicare Advantage plans).
• Medicare Advantage Open Enrollment: Jan. 1 – March 31 (for people already in a Medicare Advantage plan who want to switch once).