Medicare Starts Before 65: Why It Pays to Plan Early

It can be tempting to think about Medicare “later,” especially while it still feels far away. But the questions worth asking start well before your 65th birthday. And in my experience, the people who start early have more choices and fewer surprises.

Your First Window Opens Before You Turn 65

Your first chance to sign up for Medicare is a seven-month window around your 65th birthday. It includes the three months before your birthday month, the month itself, and the three months after.¹ The choices you make in that stretch are a lot easier to weigh when you’ve had some time to think them through.

Missing It Can Cost You for Years

If you don’t sign up for Part B when you’re first eligible, and you don’t have other qualifying coverage, you may pay a late enrollment penalty. It adds 10% to your Part B premium for each full 12 months you could have had Part B but didn’t. In most cases, you pay it for as long as you have Part B.²

That’s not a small thing, and a lot of people don’t see it coming:

•    About 900,000 people with Part B were paying a late penalty in 2024. The average penalty was $51 a month, and people paying one had been paying it for an average of more than 7 years.³

•    In a 2026 survey, 88% of adults ages 55 to 64 who weren’t yet on Medicare didn’t know about the 10% Part B penalty. Only 24% felt confident about their coverage options.⁴

•    Even people already on Medicare have gaps. In the same survey, 89% of Medicare beneficiaries said they felt confident about their coverage, but only 13% could correctly define all four main types of Medicare coverage.⁴

The Questions to Ask Now

Medicare decisions rarely come down to a birthday alone. A few questions can make a big difference:

•    When do you hope to retire? Does that land before or after you turn 65?

•    Will you still have health coverage through your own job or a spouse’s? If it’s coverage based on current work, you may be able to delay Part B without a penalty and sign up later during a special enrollment period. The rules depend on the type of coverage and the size of the employer, so it’s worth checking before you decide.²

•    If you retire before 65, how will you cover health care until Medicare starts?

•    How might Medicare costs fit into your monthly budget?

What Medicare May Cost You

Medicare isn’t free, and health care is one of the bigger costs in retirement. Fidelity estimates that a 65-year-old retiring in 2026 may spend about $185,500 on health care and medical expenses over the course of retirement.⁵ That includes Medicare premiums, deductibles, copays, and prescriptions, but not most dental care or long-term care.

Your Part B premium also depends on your income. In 2026, the standard Part B premium is $202.90 a month. Individuals with income above $109,000 and married couples filing jointly above $218,000 pay more, up to $689.90 a month at the highest income levels.⁶ The amount is based on your tax return from two years earlier.⁷ Medicare is expected to announce the 2027 numbers in November.

That means the cost side of Medicare can look very different from one household to the next. It also means the income decisions you make in your early 60s, like when you take retirement account withdrawals or sell investments, can affect what you pay for Medicare later. That’s one more reason to look at your own numbers well before enrollment begins.

Why I Like to Start This Conversation Early

Working through these questions early gives each choice more room. It also gives us time to see how Medicare fits with the rest of your retirement picture: when you retire, when you claim Social Security, how you draw income from your savings, and how all of that affects your taxes and your Medicare premiums.

Medicare is one decision, but it touches a lot of others. Looking at it as part of your full plan, instead of on its own, can help you avoid penalties and surprises and feel more confident heading into retirement.

Getting Close to 65?

If you’re in your early 60s and starting to think about retirement, I’d be glad to help you look at how Medicare fits into your plan.

Call 877-997-7113 or visit pereirawm.com to get started.

Sources

1.     Medicare.gov, “When does Medicare coverage start?” https://www.medicare.gov/basics/get-started-with-medicare/sign-up/when-does-medicare-coverage-start

2.     Medicare.gov, “Avoid late enrollment penalties.” https://www.medicare.gov/basics/costs/medicare-costs/avoid-penalties

3.     Medicare Payment Advisory Commission (MedPAC), “Late enrollment penalties,” October 2026 (2024 data). https://www.medpac.gov/wp-content/uploads/2026/10/Tab-F-Late-enrollment-penalties-Oct-2026.pdf

4.     eHealth, “New Survey: Americans are Confident They Understand Medicare but the Data Suggests Otherwise,” August 20, 2026. Survey of 1,000+ U.S. adults, July 15–25, 2026. https://s204.q4cdn.com/837903328/files/doc_news/New-Survey-Americans-are-Confident-They-Understand-Medicare-but-the-Data-Suggests-Otherwise-2026.pdf

5.     Fidelity Investments 2026 Retiree Health Care Cost Estimate, as reported by NAPA, July 2026. https://www.napa-net.org/news/2026/7/estimated-retiree-health-costs-climb-7.5-year-over-year

6.     Centers for Medicare & Medicaid Services, “2026 Medicare Parts B Premiums & Deductibles.” https://www.cms.gov/newsroom/fact-sheets/2026-medicare-parts-b-premiums-deductibles

7.     Social Security Administration, “Premiums: Rules for Higher-Income Beneficiaries.” https://www.ssa.gov/benefits/medicare/medicare-premiums.html