How to Apply for Medicare in 2026: Enrollment, Deadlines, and Dental Coverage Gaps

Navigating how and when to apply for Medicare can be challenging, especially considering all the coverage conditions, requirements, and other fine print details. For example, did you know that Medicare does not cover regular dental care? And that Medicare Advantage dental insurance may only cover basic care? Sadly, it’s true – but you do have inexpensive options, like dental savings plans, that can help reduce the cost of dental care by an average of 50%*.

So, if you’re planning on enrolling for Medicare, don’t worry. We’re here to help you understand what you need to do to get on Medicare and how to make the most of your coverage.

When to Apply for Medicare

Generally, you should apply for Part A (hospital insurance) and Part B (medical insurance) Medicare as soon as you’re eligible. The enrollment period begins three months before your 65th birthday, including your birthday month, and extends three months after your birthday month, meaning you have seven months to apply for Medicare.

However, if you fail to sign up for Medicare during this seven-month window, you’ll have to wait to enroll and go months uncovered. You may also have to pay a monthly penalty for as long as you have Part B; the penalty increases the longer you wait to enroll.

If you’re still working and have health insurance via your employer, or if your spouse’s employer covers you, you might be able to delay enrolling in Medicare. However, you’ll need to follow the rules and sign up for Medicare within eight months of losing your coverage to dodge substantial penalties when you eventually enroll.

How to Apply for Medicare

You’ll automatically be enrolled in Part A and Part B if you receive Social Security benefits at least four months before you become eligible for Medicare. However, if you’re about to turn 65 or recently turned 65 and haven’t received Social Security benefits yet, here’s what you should do according to the Medicare website:

• Online – Signing up via Social Security is the easiest, fastest way to apply for Medicare and get the financial aid you need. You must create a Social Security account to sign up for Medicare or apply for benefits.
• Phone – Call Social Security at 1-800-772-1213. Teletypewriter (TTY) users may call 1-800-325-0778.
• Visit your local Social Security office – You can find your nearest location via the Social Security office locator.
• Call the Railroad Retirement Board – Call the Railroad Retirement Board at 1-877-772-5772 if you or your spouse worked for a railroad company.

About two weeks after you apply for Medicare, you’ll get a welcome package with your Medicare card and program details.

What are the requirements to qualify for Medicare?

If you’re 65 or older, you’re eligible for Medicare if you meet one of these requirements:

• You’re a United States citizen or a permanent legal resident who’s lived in the U.S. for at least five years.
• You’re getting Social Security or railroad retirement benefits or have worked long enough to receive them but have not yet secured them.

• You or your partner is or was a government employee and paid Medicare payroll taxes during you or your partner’s tenure.

If you’re under 65, you may still qualify for Medicare if:

• You’ve been eligible for Social Security disability for at least 24 months (doesn’t need to be consecutive).
• You’re eligible to collect a disability pension from the Railroad Retirement Board and meet specific criteria.
• You’ve been diagnosed with amyotrophic lateral sclerosis (ALS) — also known as Lou Gehrig’s disease. This automatically qualifies you to receive Medicare benefits.

• You have permanent kidney failure that requires routine dialysis or a kidney transplant. Also, depending on your age, you or your partner must have paid Social Security taxes for a certain period.

Do I have to sign up for Medicare when I am 65?

While turning 65 often feels synonymous with enrolling in Medicare, the necessity of signing up immediately is not a one-size-fits-all requirement. For many, timely enrollment is crucial to avoid lifelong penalties. However, certain circumstances, primarily related to other health insurance coverage, can allow for a penalty-free delay.

The general rule of thumb is to enroll in Medicare during your Initial Enrollment Period (IEP). This seven-month window begins three months before the month you turn 65, includes your birth month, and extends for three months after. Missing this window without having other qualifying health coverage can lead to late enrollment penalties for Medicare Part B and Part D, which are added to your monthly premiums for as long as you have coverage. For Part A, a penalty may apply if you are not eligible for premium-free Part A and do not enroll when first eligible.

Enrollment in Medicare at 65 is recommended if:

• You do not have health insurance: If you are uninsured when you turn 65, enrolling in Medicare is essential to secure healthcare coverage and avoid late enrollment penalties.
• You have retiree health coverage: Retiree health plans are typically secondary to Medicare. This means that once you are eligible for Medicare, your retiree plan may pay only for services that Medicare doesn’t cover. If you fail to enroll in Medicare, you could be left with significant gaps in your coverage.
• You have COBRA coverage: COBRA is also generally secondary to Medicare. If you are on COBRA when you turn 65, you should enroll in Medicare to ensure you have primary health coverage. Relying on COBRA alone after becoming Medicare-eligible can result in your claims not being paid.
• Your employer has fewer than 20 employees: In this case, Medicare is considered the primary payer, and your employer’s group health plan is the secondary payer. Failing to enroll in Medicare could mean your employer’s plan will not cover your medical costs.
• You are receiving Social Security or Railroad Retirement Board benefits: If you have been receiving these benefits for at least four months before you turn 65, you will be automatically enrolled in Medicare Part A and Part B. You will receive your Medicare card in the mail about three months before your 65th birthday.

You Might Be Able to Delay Medicare Enrollment if:

• You are still working and have health insurance through your employer (or your spouse’s employer), and the employer has 20 or more employees. In this situation, the employer group health plan is the primary payer, and Medicare is the secondary payer. You can choose to delay enrolling in Medicare Part B (and Part A, if you would have to pay a premium for it) without penalty.
• Your employer’s prescription drug coverage is considered “creditable.” This means it is expected to pay, on average, at least as much as Medicare’s standard prescription drug coverage. If you have creditable drug coverage, you can delay enrolling in a Medicare Part D plan without incurring a late enrollment penalty. Your employer is required to notify you annually if your drug coverage is creditable.

It is important to note that even if you can delay Part B and Part D, most people still enroll in premium-free Part A at 65, as there is no monthly cost for most individuals. However, if you have a Health Savings Account (HSA), you cannot contribute to it once you are enrolled in any part of Medicare.

Enrolling Later: The Special Enrollment Period

If you delay Medicare enrollment because you have qualifying employer-sponsored health insurance, you will have a Special Enrollment Period (SEP) to sign up for Medicare later. This SEP allows you to enroll without penalty. The SEP begins when you (or your spouse) stop working or lose your employer-sponsored health coverage, whichever happens first. You will then have an eight-month window to enroll in Medicare Part A and Part B.

To enroll during your SEP, you will need to submit an application to the Social Security Administration, along with proof of your creditable health coverage.

While the default action for most Americans turning 65 is to enroll in Medicare, it is not a universal mandate. The decision hinges on your current health insurance situation. It is crucial to assess your coverage and understand the rules to avoid costly penalties and gaps in your healthcare. If you are unsure about your specific circumstances, it is always best to contact the Social Security Administration or the Centers for Medicare & Medicaid Services for personalized guidance.

Do I need supplemental insurance with Medicare?

Medicare doesn’t cover all costs, so getting supplemental insurance can help fill those coverage gaps and give you peace of mind when dealing with unexpected medical expenses. If you were left with a substantial medical bill without supplement insurance, you could risk being in debt and having your credit score ruined.

Consider looking into a Medigap plan. Medigap is a health insurance policy sold by private insurance companies to help cover co-pays, deductibles, coinsurance, and other remaining costs you’re responsible for. Typically, you must have Medicare Part A and Part B to buy a Medigap plan. Additionally, you’ll likely have to pay the monthly Medicare Part B premium and a premium to the Medigap insurance company.

What do I need to know about Original Medicare vs. Medicare Advantage?

Medicare Advantage (MA plans) are government-approved health insurance plans provided by private companies as an alternative to Original Medicare. These plans cover everything Original Medicare does (except for hospice care) and often include prescription drug coverage (Part D), as well as dental, vision, hearing, disability services, and other benefits not available through Original Medicare.

There are important differences between Medicare and Medicare Advantage plans. Many people choose an MA plan to access additional benefits such as dental, but that may not be the best option for everyone, it’s important to consider the long-term ramifications.

Does Medicare cover dental?

Medicare does not cover regular dental care. Medicare Advantage plansoften do include dental insurance. But it may not fit your needs, so review coverage details carefully.

• MA plans with no or low premiums may only include basic dental procedures such as cleanings and checkups (preventive care).
• An MA plan may also restrict your dental benefits to dentists near your home, which can be a concern for people who split their time between two locations.
• If you’re out of the coverage area, you may only get $100 coverage for emergency care only. Anything else, you’d pay out of pocket.

A Medicare Advantage plan can help fill in the gaps, but you may also want to consider another option — a dental savings plan.

Dental savings plans for Medicare recipients

A trusted alternative to dental insurance, a dental savings plan can help you save on a wide range of services, including preventive treatments, restorative care, dentures, and implants. Unlike standard dental insurance, there are no annual spending limits, delays in accessing specific treatments, or paperwork hassles. Many dental savings plans also include savings on vision and hearing screenings, chiropractic care, prescription drugs, and more.

You can use a dental savings plan to save on the majority of dental procedures if you are an Original Medicare recipient. You cannot use your Medicare Advantage dental insurance and your dental savings plan for the same procedure, in accordance with insurance policy rules. However, a dental savings plan can help fill gaps and provide savings on procedures that are not covered by your Medicare Advantage plan. Dental savings plans may also be used to reduce your out-of-pocket dental care costs once you’ve reached the annual maximum on your Medicare Advantage dental insurance. Talk to your dentist to understand how to maximize care.

Dental savings plan members report saving an average of 50%* on their dental care at thousands of dentists and specialists across the nation. It’s a great way to save on routine dental care and protect yourself against unexpected expenses. Have questions or want to learn more about using a dental savings plan while on Medicare/MA? Call us at 1-833-735-0399 or use our calculator below for a quick look at how much you can save.

*Discount Health Program consumer and provider surveys indicate average savings of 50%. Savings may vary by provider, location, and plan.