Medicare 2026

Turning 65 in Sevierville? Read This Before You Delay

SEVIERVILLE, Tenn. — If you are approaching 65 here in the foothills, one of the most important things to know about Medicare is not what it covers. It is when to sign up. Miss a key window for Part B or Part D, and the penalty can follow you every month for the rest of your life.

The good news: these penalties are avoidable once you understand the rules. Here is a plain-English walk-through for Sevier County residents.

Why these deadlines matter so much

Most Medicare rules give you a second chance. Miss an appointment, reschedule it. Pick the wrong Medicare Advantage plan, switch during the next Annual Enrollment Period from October 15 to December 7.

The late enrollment penalties for Part B (doctor and outpatient care) and Part D (prescription drugs) are different. They are not one-time fees. They are added to your monthly premium, and in most cases they stay there permanently.

That is why Sevierville residents nearing 65 — or anyone leaving job-based coverage — should mark their calendars carefully.

How the Part B late penalty works

Your Initial Enrollment Period is a seven-month window: the three months before the month you turn 65, the month you turn 65, and the three months after. If you do not sign up for Part B during that window and you do not have other qualifying coverage, the penalty clock starts ticking.

The Part B penalty is 10% of the standard Part B premium for each full 12 months you were eligible but not enrolled. So a two-year delay means a 20% surcharge — every month, for as long as you keep Part B.

There is one common way to avoid this: if you (or your spouse) are still working and covered by a group health plan from that job, you can usually delay Part B without penalty. When that coverage ends, you get an eight-month Special Enrollment Period to sign up.

Retiree coverage, COBRA, and VA benefits are not the same as active-employee coverage for this purpose. If you are unsure whether your plan counts, call Medicare or your local State Health Insurance Assistance Program (SHIP) before you make a decision.

How the Part D late penalty works

Part D is optional — but Medicare still expects you to have drug coverage, either through a stand-alone Part D plan, a Medicare Advantage plan that includes drugs, or another source considered "creditable" (meaning at least as good as basic Medicare drug coverage).

If you go 63 days or more without creditable drug coverage after your Initial Enrollment Period ends, you may owe a Part D late penalty when you finally enroll. The amount is 1% of the "national base beneficiary premium" for every month you were uncovered, rounded to the nearest 10 cents. It is added to whatever Part D plan you eventually choose, and it typically lasts for as long as you have Part D.

Employer and union plans are required to send you a Notice of Creditable Coverage each year. Keep those notices. They are your proof if a penalty is ever assessed later.

The 2026–2027 backdrop

Part D looks different than it did just a few years ago. The out-of-pocket cap for covered drugs is $2,100 in 2026 and $2,400 in 2027. The maximum deductible a plan can charge is $615 in 2026 and $700 in 2027. The old "donut hole" coverage gap is gone, replaced by a simpler structure. And the Medicare Prescription Payment Plan lets you spread your out-of-pocket drug costs across the year in monthly installments.

None of that changes the penalty rules — but it does mean that skipping Part D to save on a premium can cost more than it used to, because the value of the coverage itself has grown.

Higher earners should also know about IRMAA, an income-based surcharge that begins above $109,000 for a single filer in 2026 and applies to both Part B and Part D premiums.

Enrollment windows to remember

• Initial Enrollment Period: the seven months around your 65th birthday.
• General Enrollment Period: January 1 – March 31, for people who missed their initial window and do not qualify for a Special Enrollment Period.
• Special Enrollment Period: typically an eight-month window after employer coverage ends, for Part B, and a 63-day window for Part D.
• Annual Enrollment Period: October 15 – December 7, when anyone can change their Part D or Medicare Advantage plan.
• Medicare Advantage Open Enrollment: January 1 – March 31, for people already in a Medicare Advantage plan who want to switch or return to Original Medicare.

Sevierville is in Sevier County, where residents choose from the Part D and Medicare Advantage plans that carriers file with CMS for this county each year. Availability is set at the county level, so a neighbor in Knoxville may see a different lineup.

What to do if you think you were penalized unfairly

If Medicare assesses a Part D late penalty and you believe you had creditable coverage the entire time, you can request a reconsideration. Your plan will send you a form and instructions. This is why keeping those annual creditable coverage notices matters — they are the evidence.

For Part B, if you delayed because of a specific situation (such as active-employee coverage or certain volunteer service abroad), the Social Security Administration can review your enrollment.