Medicare 2026

First Medicare Decisions in Albany: A Step-by-Step Guide

# Turning 65 in Albany? Your first Medicare decisions, step by…

ALBANY, Ore. — If a 65th birthday is on your calendar in the months ahead, you have a seven-month window to make your first Medicare choices. It opens three months before your birthday month, includes the month itself, and closes three months after. Miss it, and you could face lifelong late penalties and a wait to get covered.

Here is how to walk through your Initial Enrollment Period without guesswork.

What the Initial Enrollment Period actually is

The IEP is your first chance to sign up for Original Medicare — Part A (hospital) and Part B (medical). For most people turning 65, it runs for seven months around your birthday. If your birthday falls on the first of the month, the window shifts one month earlier.

If you are already getting Social Security benefits, you are usually enrolled in Parts A and B automatically. Everyone else needs to sign up through the Social Security Administration at ssa.gov or by calling Social Security directly.

Step 1: Decide about Part A and Part B

Most people get Part A premium-free because they or a spouse paid Medicare taxes for at least 10 years. Part B has a monthly premium set by Medicare each year.

If you are still working at 65 and have solid health coverage through a large employer, you may be able to delay Part B without penalty. But if your employer has fewer than 20 employees, or if you have retiree or marketplace coverage, the rules are different — and delaying can trigger a lifetime penalty. This is the moment to double-check with your benefits office or a SHIBA counselor.

Step 2: Choose your coverage path

Once you have Parts A and B, you pick one of two paths:

• Original Medicare, often paired with a standalone Part D drug plan and, if you want, a Medigap (Medicare Supplement) policy to help with out-of-pocket costs.
• Medicare Advantage (Part C), a private plan that bundles Parts A and B and usually includes drug coverage.

Albany is in Linn County, where residents can choose from a range of Medicare Advantage and standalone Part D plans offered by private insurers. Availability and specifics are set at the county level, so a plan available across the river or down in Lane County may not be offered here.

One note about Medigap: in most states, you get a one-time, six-month Medigap Open Enrollment window that begins when you are 65 and enrolled in Part B. During that window, insurers cannot turn you away or charge more for health reasons. Miss it, and future Medigap purchases may require medical underwriting.

Step 3: Line up your drug coverage

Even if you take no prescriptions today, signing up for Part D — or getting drug coverage through a Medicare Advantage plan — during your IEP protects you from a late-enrollment penalty later. The penalty is added to your premium for as long as you have Part D.

A few figures worth knowing:

• Part D out-of-pocket spending is capped at $2,100 for the year.
• The Part D deductible cannot exceed $615.
• The old coverage gap, or "donut hole," is gone as of 2025. Part D now has three phases: deductible, initial coverage, and catastrophic.
• If your drug bills are uneven month to month, the Medicare Prescription Payment Plan lets you spread out-of-pocket drug costs across the calendar year.

Higher-income beneficiaries pay an added amount called IRMAA on top of Part B and Part D premiums. For 2026, IRMAA begins above $109,000 in income for a single filer (higher for joint filers), based on your tax return from two years ago.

Step 4: Know the dates after your IEP

Your Initial Enrollment Period is a one-time window, but Medicare has other yearly dates:

• Annual Enrollment Period: Oct. 15 – Dec. 7, 2026. You can join, drop, or switch Medicare Advantage and Part D plans for 2027.
• Medicare Advantage Open Enrollment: Jan. 1 – March 31. If you are already in a Medicare Advantage plan, you can switch to another one or return to Original Medicare once during this window.

If you missed your IEP and don't qualify for a Special Enrollment Period, the General Enrollment Period (Jan. 1 – March 31) is a backup for Part B, though penalties may apply.

Where Albany residents can get unbiased help

You do not have to figure this out alone, and you do not have to talk to an insurance agent to get answers.

• medicare.gov — plan comparisons, enrollment, and the official handbook.
• 1-800-MEDICARE (1-800-633-4227) — 24/7 help from Medicare.
• SHIBA (Senior Health Insurance Benefits Assistance) — Oregon's SHIP program offers free, one-on-one counseling from trained volunteers who do not sell insurance.
• Social Security Administration — for enrolling in Parts A and B.