Medicare 2026

Grove City Medicare: First Steps and the Enrollment Window

GROVE CITY, Ohio — If your 65th birthday is coming up, you're about to get a lot of Medicare mail. Some of it looks urgent. Most of it can wait. What actually matters is knowing your Initial Enrollment Period and taking a few first steps in the right order.

Grove City is in Franklin County, where Medicare works the same way it does anywhere else in the country — the rules, the deadlines, and the parts of Medicare are set at the federal level by the Centers for Medicare & Medicaid Services (CMS). Here's how to think about your first decisions.

Step 1: Know your 7-month window

Your Initial Enrollment Period runs for seven months. It starts three months before the month you turn 65, includes your birthday month, and ends three months after.

For example, if you turn 65 in June, your IEP runs from March 1 through September 30. Enrolling in those first three months usually gives you the smoothest start — your coverage can begin the first day of your birthday month.

If you wait until your birthday month or after, your coverage start date gets pushed back. That gap can matter if you need care right away.

Step 2: Decide about Part A and Part B

Original Medicare has two parts:

• Part A covers hospital stays, skilled nursing, and some home health care. Most people get Part A premium-free because they (or a spouse) paid Medicare taxes while working.
• Part B covers doctor visits, outpatient care, and preventive services. Part B has a standard monthly premium set each year by CMS.

If you're already getting Social Security benefits before 65, you'll usually be enrolled in Parts A and B automatically. If not, you need to sign up yourself through the Social Security Administration at ssa.gov or by calling 1-800-772-1213.

Still working at 65? If you have health coverage through a current employer (yours or a spouse's) with 20 or more employees, you may be able to delay Part B without a penalty. Talk to your benefits office before you decide — the rules around "creditable coverage" are strict.

Step 3: Think about drug coverage (Part D)

Even if you don't take any prescriptions today, you generally need to enroll in some form of drug coverage when you're first eligible. If you skip it and don't have other creditable drug coverage, you can face a late-enrollment penalty that's added to your premium for as long as you have Part D — for life.

A few 2026 and 2027 figures to know:

• The Part D out-of-pocket cap is $2,100 in 2026 and $2,400 in 2027. Once you hit that, your covered drugs cost you nothing more for the rest of the year.
• The maximum Part D deductible is $615 in 2026 and $700 in 2027.
• The old "donut hole" coverage gap is gone — Part D now has three phases (deductible, initial coverage, and catastrophic).
• The Medicare Prescription Payment Plan is a free option that lets you spread your drug costs into monthly payments instead of paying big amounts at the pharmacy counter.

Step 4: Choose your path — Original Medicare or Medicare Advantage

Once you have Parts A and B, you have two main directions:

1. Stay with Original Medicare, and consider adding a stand-alone Part D drug plan and, if you want, a Medicare Supplement (Medigap) policy to help with out-of-pocket costs. 2. Choose a Medicare Advantage plan (Part C), which is offered by private insurers approved by Medicare. These plans bundle Part A, Part B, and usually Part D, and often include extras. You still have Medicare, but you get your benefits through the plan.

Franklin County residents typically have a wide range of Medicare Advantage and stand-alone Part D plans to choose from. The right fit depends on your doctors, your prescriptions, your budget, and how you like to get care. The Plan Finder at medicare.gov lets you compare options side by side using your own ZIP code and drug list.

Step 5: Watch for IRMAA if your income is higher

Most people pay the standard Part B and Part D premiums. But if your income is above a certain level, you'll pay an Income-Related Monthly Adjustment Amount (IRMAA) on top. For 2026, IRMAA surcharges start above $109,000 in income for a single filer (higher for married couples filing jointly). Social Security uses your tax return from two years ago to decide.

If your income has dropped since then — because you retired, for example — you can ask Social Security to reconsider.

Step 6: Mark the other enrollment periods

After your IEP, two more dates matter every year:

• Annual Enrollment Period: October 15 – December 7. This is when anyone with Medicare can join, switch, or drop a Medicare Advantage or Part D plan for the following year.
• Medicare Advantage Open Enrollment: January 1 – March 31. If you're already in a Medicare Advantage plan, you get one chance during this window to switch to another Advantage plan or go back to Original Medicare.

Where Grove City residents can get free help

You don't have to make these decisions alone, and you shouldn't rely on a sales call for the full picture. Free, unbiased help is available:

• Medicare.gov — the official site for comparing plans and looking up rules.
• 1-800-MEDICARE (1-800-633-4227) — available 24/7.
• Ohio Senior Health Insurance Information Program (OSHIIP) — Ohio's SHIP program offers one-on-one counseling from trained volunteers who don't sell insurance. Reach them at 1-800-686-1578.
• Social Security Administration at ssa.gov or 1-800-772-1213 for enrollment in Parts A and B.