Medicare 2026

Medicare Deadlines in Houston: Avoid a Lifetime Penalty

HOUSTON — Choosing between Original Medicare with a Medigap policy and a Medicare Advantage plan is one of the biggest decisions a new beneficiary makes. But the deadlines around that choice can matter just as much as the choice itself. Miss a key window, and the cost can follow you for the rest of your life.

That's because Medicare is built around specific enrollment periods. Some are one-time-only. Others repeat each year. And the two paths — Original Medicare plus Medigap, or Medicare Advantage — have very different timing rules baked in.

The one deadline most people don't know about

If you plan to pair Original Medicare with a Medigap (Medicare Supplement) policy, pay close attention to your Medigap Open Enrollment Period. It's a six-month window that starts the month you turn 65 and are enrolled in Part B.

During that window, insurers in Texas must sell you any Medigap policy they offer at their best available rate, regardless of your health history. Once it closes, that protection generally goes away. Outside the window, an insurer can ask health questions, charge you more, or turn you down altogether — with limited exceptions.

That's why the "I'll just switch later" plan doesn't always work. A person who picks Medicare Advantage at 65 and later wants to move to Original Medicare with Medigap may find that Medigap coverage is harder — or more expensive — to get.

Part B: sign up on time or pay for life

Most people become eligible for Medicare during a seven-month Initial Enrollment Period — the three months before the month you turn 65, your birthday month, and the three months after.

Skip Part B during that window without other qualifying coverage (like an employer group health plan based on active work), and you may owe a Part B late enrollment penalty. That penalty is 10% of the standard Part B premium for each full 12-month period you could have had Part B but didn't. It's added to your premium for as long as you're on Medicare.

If you missed your Initial Enrollment Period, the General Enrollment Period runs January 1 to March 31 each year, with coverage starting the month after you sign up.

Part D: even a short gap counts

The Part D late enrollment penalty works differently but hits the same way — permanently. If you go 63 or more days in a row without Part D or other "creditable" drug coverage after you were first eligible, Medicare adds roughly 1% of the national base beneficiary premium for every month you were uncovered, and that amount is added to your Part D premium going forward.

This matters even if you don't take medications now. Signing up for a plan when you're first eligible protects you from the penalty later.

Part D has firmer guardrails in 2027: a maximum deductible of $700, an out-of-pocket cap of $2,400, and the option to spread drug costs across the year through the Medicare Prescription Payment Plan.

How the yearly windows interact

Once you're in Medicare, two annual periods let you adjust course:

• Annual Enrollment Period (Oct. 15 – Dec. 7): Switch between Original Medicare and Medicare Advantage, change Advantage plans, or join/change/drop a Part D plan. Changes take effect Jan. 1.
• Medicare Advantage Open Enrollment Period (Jan. 1 – March 31): If you're already in a Medicare Advantage plan, you can switch to a different Advantage plan once, or drop it and return to Original Medicare (and pick up a Part D plan).

Neither of these windows guarantees you can pick up a Medigap policy on favorable terms. That's the piece people often overlook. Moving back to Original Medicare during the Advantage Open Enrollment is allowed — but getting a Medigap policy to go with it may still involve underwriting.

Special situations that reset the clock

A few life events open a Special Enrollment Period, which can let you enroll or switch outside the usual windows without penalty. Common examples include losing employer coverage, moving out of your plan's service area, or qualifying for Extra Help. If any of those apply to you, contact Medicare quickly — most Special Enrollment Periods have short deadlines of their own.

There are also limited "guaranteed issue" rights that protect your ability to buy certain Medigap policies in specific situations, such as when an Advantage plan leaves your area.

What Houston readers should know locally

Medicare Advantage and Part D availability is set at the county level. Houston sits in Harris County, and the number of plans offered there is large compared with many parts of the country. That's context, not a reason to rush a decision.

If you're weighing your first choice — or thinking about switching this fall — the safest move is to compare plans on medicare.gov using your own doctors and prescriptions, and to check whether a Medigap policy is available to you on the terms you expect.