Medicare 2026

Took Social Security Early? Here's How Medicare Enrollment Works When You Turn 65

If you started Social Security before 65, your path into Medicare looks a little different from someone who waited. The short version: the government signs you up automatically, and a few decisions land in your lap whether you want them or not. Here's what to expect, and what to think about before your card arrives.

Why early filers get automatic enrollment

Social Security retirement benefits taken before full retirement age are permanently reduced — by 5/9 of 1 percent for each of the first 36 months early and 5/12 of 1 percent for each additional month. For someone whose full retirement age is 67 and who claims at 62, that works out to a 30 percent reduction (36 months × 5/9% = 20%, plus 24 months × 5/12% = 10%).

Once you're receiving Social Security or RRB benefits, Medicare enrollment happens on autopilot. You're placed in both Part A (hospital) and Part B (medical) starting the first day of the month you turn 65, and your Medicare card shows up in the mail about three months beforehand. You don't have to apply.

What to do when the card arrives

Open the envelope promptly. The welcome packet explains how coverage will start, when Part B premiums will begin coming out of your benefit payment, and how to decline Part B if you don't want it.

• Keep the card = keep Part B. The Part B premium will be deducted from your Social Security or RRB payment.
• Don't want Part B? Follow the instructions in the packet and send the card back before the coverage start date printed on it. Act early; once coverage begins, dropping Part B gets more complicated.

One rule often catches early filers off guard: if you're entitled to monthly Social Security benefits, you can't turn down Part A and keep the checks. According to Social Security's operating rules, the only way to refuse Part A is to withdraw your original benefit application entirely — which means paying back every dollar of Social Security and Part A benefits you've already received. For most people, that isn't realistic, so Part A stays.

The good news: Part A has no premium for people with enough work history, so keeping it usually costs nothing and can coordinate with other coverage.

Still working at 65? You have options

If you (or a spouse) are still working and you're covered by a group health plan based on current employment, you can decline Part B at 65 and sign up later without penalty. You'll have a Special Enrollment Period any time you're still covered through that job, plus the 8 months that begin the month after the job ends or the group coverage ends — whichever comes first.

Part A is a different story if you're on Social Security: as noted above, you generally can't refuse it without unwinding your benefits.

The earnings test and Part B billing

If you're under full retirement age and still working, Social Security's earnings test may withhold part of your benefit. For 2026, Social Security withholds $1 for every $2 you earn above $24,480. In the year you reach full retirement age, it withholds $1 for every $3 above $65,160, counting only earnings in the months before you hit full retirement age.

Why does this matter for Medicare? Because your Part B premium normally comes out of your benefit check. If benefits are suspended long enough that Medicare can't collect the full Part B premium from what's payable that year, Medicare will bill you directly — usually every three months. If your benefits are scheduled to restart within the same tax year, you won't get a bill.

Social Security also announced on October 14, 2026 a 3.6 percent cost-of-living adjustment for benefits payable beginning January 2027, which will adjust the amount coming to you (and, by extension, what's available to cover your Part B premium).

Choosing how to get your Medicare coverage

Once you have Part A and Part B, you decide how to receive your benefits. The two main paths:

• Original Medicare (Parts A and B), often paired with a stand-alone Part D drug plan and, for some people, a Medigap policy. You can generally see any provider that accepts Medicare. Medigap can help with Part A and B cost-sharing but has its own premium.
• A Medicare Advantage plan (Part C), which bundles Part A, Part B, and usually Part D. These plans typically use provider networks and may include extra benefits, but rules and costs vary plan by plan.

Neither path is "better" — they involve different trade-offs around provider access, out-of-pocket costs, and paperwork. Compare specifics for your area on Medicare.gov before deciding.

Part D program facts worth knowing

Prescription drug coverage has national rules that apply everywhere, even though individual plan premiums vary:

• The Part D out-of-pocket cap is $2,100 in 2026 and $2,400 in 2027.
• The most any Part D plan may charge as a deductible in 2027 is $700.
• The Part D base beneficiary premium for 2027 is $41.33, the figure used to calculate any late-enrollment penalty. Actual plan premiums are set plan by plan.

The 2027 Part B standard premium and deductible, and the 2027 IRMAA income brackets, had not been announced at the time of writing. CMS typically releases those numbers in the fall. Watch Medicare.gov for the official figures.

If you have Medicaid or Extra Help

Since 2025, people with Medicaid or the Extra Help low-income subsidy have a monthly Special Enrollment Period to move to Original Medicare with a stand-alone Part D plan, or to switch stand-alone Part D plans. Full-benefit dual-eligible individuals can also enroll in an integrated Dual Eligible Special Needs Plan (D-SNP) in any month of the year.

Key dates to put on the calendar

• About 3 months before your 65th birthday: Watch the mail for your Medicare card.
• Before coverage starts: Decide whether to keep or decline Part B.
• October 15 – December 7, 2026: Annual Enrollment for 2027; new choices take effect January 1, 2027.

Where to go next

Medicare.gov is the official place to compare drug and health plans available where you live, check whether your doctors are in-network, and see what any plan will cost you specifically. You can also call 1-800-MEDICARE (1-800-633-4227) 24 hours a day, 7 days a week.

Taking Social Security early doesn't change the Medicare rules — but it does mean the system comes looking for you. Knowing what the envelope in the mail means, and what your choices are before coverage begins, puts you in the driver's seat.