Medicare · by Katie Davis

Turning 65 in Sacramento or San Joaquin County? Your Medicare Checklist

Short answer: You can enroll in Medicare during the 7-month window around your 65th birthday: the 3 months before your birthday month, your birthday month, and the 3 months after. Sign up in the first 3 months and your coverage starts the first of your birthday month. If you're still working with employer coverage, you may be able to delay Part B without penalty — but the rules have exceptions worth checking. Here's the full checklist.

6 months before your birthday

1. Find your dates. Your Initial Enrollment Period (IEP) starts the first day of the month 3 months before you turn 65. Example: birthday June 15 → your window is March 1 through September 30. (Born on the 1st? Your window shifts a month earlier.)

2. Check whether you're automatically enrolled. If you're already collecting Social Security or Railroad Retirement benefits, you'll be enrolled in Part A and Part B automatically and a Medicare card arrives about 3 months before your birthday. If you're not collecting benefits yet, you have to sign up yourself at ssa.gov or by calling Social Security.

3. Decide about Part B if you're still working. If you or your spouse have coverage through a current employer with 20 or more employees, you can usually delay Part B without a late penalty and enroll later during a Special Enrollment Period. Fewer than 20 employees? Medicare becomes primary and you generally need Part B at 65. COBRA and retiree coverage do not count as "current employer" coverage — this is the mistake we see most.

4. Check your HSA. Contributions to a Health Savings Account must stop the month Medicare coverage starts (and Part A can be backdated up to 6 months when you enroll late). If you plan to keep contributing, this changes the timing.

3 months before your birthday

5. Sign up for Part A and Part B at ssa.gov/medicare, by phone at 1-800-772-1213, or at the Social Security office (the closest to Lodi is in Stockton; Sacramento has several). Online takes about 10 minutes.

6. Make the big decision: Medicare Advantage or a Medicare Supplement? - Original Medicare + a Supplement (Medigap) + a Part D drug plan. See any doctor who takes Medicare, anywhere in the country. Predictable costs. Higher monthly premium. - Medicare Advantage (Part C). A private plan (Kaiser, SCAN, Anthem, Blue Shield, UnitedHealthcare, Humana and others in our area) that replaces Original Medicare, usually bundles drug coverage, and often adds dental, vision, hearing or gym benefits for a low or $0 premium. You use the plan's network.

There is no universally right answer. It depends on your doctors, your prescriptions, how much you travel, and your budget. This is exactly what a free plan review is for.

7. List your doctors and prescriptions. Every Medicare Advantage plan has a network and every Part D plan has a formulary. Before choosing, confirm your doctors are in-network and your medications are covered at a reasonable tier. Around Sacramento and San Joaquin County, hospital systems like Sutter, Dignity, UC Davis, Kaiser and St. Joseph's participate in different plans — this is the single most common reason people switch plans in year two.

8. If you choose a Supplement, apply during your open enrollment. In California you have a 6-month Medigap open enrollment window starting the month your Part B begins, during which no health questions are asked. Miss it and insurers can decline you or charge more. California also has a unique "birthday rule" that lets you switch Supplement plans each year around your birthday without underwriting.

The month you turn 65

9. Confirm your coverage starts. Check that your Medicare card arrived, your Part D or Advantage plan is active, and your pharmacy has the new information.

10. Enroll in a Part D plan if you're on Original Medicare — even if you take no medications. Going 63 or more days without creditable drug coverage triggers a permanent late-enrollment penalty added to your premium for life.

11. Cancel or coordinate your old coverage. If you're leaving Covered California, an individual plan, or employer coverage, make sure the end date lines up with your Medicare start date so you're not double-paying or uncovered.

After 65: what happens each year

• Annual Enrollment Period, October 15 – December 7. The one time each year everyone can change Medicare Advantage or Part D plans for the following January.
• Medicare Advantage Open Enrollment, January 1 – March 31. If you're in an Advantage plan and it isn't working, you can switch once.
• Your birthday month. California's birthday rule for Supplement plans.

The 4 mistakes that cost people the most

1. Assuming COBRA or retiree coverage lets you delay Part B. It doesn't.
2. Skipping Part D because you take no medications. The penalty is permanent.
3. Picking a $0-premium Advantage plan without checking that your doctors are in it.
4. Missing the Medigap open enrollment window if you want a Supplement.

Get a free, no-pressure review

Katie Davis is an independent Medicare insurance agent and consultant based in Acampo, serving Sacramento, Lodi, Stockton, Galt, Elk Grove and the surrounding counties. She is contracted with multiple carriers, so she can compare plans across companies — and there is no fee to you. A 15-minute review by phone, video, or in person is usually enough to know which direction fits.

Book a free Medicare review or call or text (916) 619-5212.

Frequently asked questions

When exactly does my Initial Enrollment Period start? The first day of the month that is 3 months before your 65th birthday month. It runs 7 months total.

Do I have to sign up for Medicare at 65 if I'm still working? Not always. With current employer coverage from a company with 20+ employees, you can usually delay Part B without penalty. Under 20 employees, or on COBRA or retiree coverage, you generally need to enroll.

How do I sign up for Medicare? Online at ssa.gov/medicare, by phone at 1-800-772-1213, or in person at a Social Security office. If you already receive Social Security, enrollment is automatic.

Is there a cost to use a Medicare agent? No. Agents are paid by the insurance carrier; your premium is the same either way.

What's the deadline to avoid a Part B penalty? Enroll during your Initial Enrollment Period, or during the 8-month Special Enrollment Period after employer coverage ends. Miss both and the penalty is 10% per year you delayed, for life.

Katie Davis is a licensed independent insurance agent (CA). This article is general information, not personalized advice; contact Medicare at 1-800-MEDICARE (1-800-633-4227) or your local SHIP/HICAP office for free counseling. Plan availability and benefits vary by county and change annually.