Turning 65 in Washington

Your turning-65 checklist at a glance

6 months before your 65th birthday

Health Savings Account (HSA)? You can't contribute to an HSA for any month you have Medicare. If you sign up for Medicare after 65, Part A is backdated up to 6 months (but never before the month you turned 65), so stop contributing 6 months before you plan to sign up to avoid a tax penalty. If you sign up at 65, stop with the month your Medicare starts. See HSAs and Medicare.

Still working? Ask your employer's benefits office how many employees it has and how its plan works with Medicare. That answer decides whether you can delay Part B (see below). If you're a state, school or higher-education employee, read the Health Care Authority's PEBB or SEBB rules now.

Start gathering: your Social Security work record (from your my Social Security account), any creditable coverage letters from your current insurance, your list of prescriptions with doses, and the doctors, clinics and hospitals you want to keep.

3 months before your birthday: your Initial Enrollment Period opens

The Initial Enrollment Period (IEP) is 7 months: the 3 months before your birthday month, your birthday month, and the 3 months after. Sign up in the first 3 months and coverage starts the first day of your birthday month (or the month before, if your birthday is on the 1st). Sign up later in the IEP and coverage starts the first day of the month after you sign up.

If you already get Social Security benefits, you'll be enrolled in Part A and Part B automatically, and your red, white and blue Medicare card arrives about 3 months before your birthday. If you don't, sign up with Social Security online at ssa.gov/medicare, by phone at 1-800-772-1213 (TTY 1-800-325-0778), or at a Social Security office in Washington.

Decisions to make:

• Part A: almost everyone takes Part A. It has no premium if you or your spouse paid Medicare taxes for at least 40 quarters (about 10 years).
• Part B: take it on time unless you can delay it (next section). The standard premium is $202.90 a month in 2026. The late penalty is 10% of the standard premium for each full 12-month period you went without Part B when you could have had it, for as long as you have Part B.
• Your coverage path: Original Medicare (Parts A and B) with a Medigap policy and a standalone Part D drug plan, or a Medicare Advantage plan that covers Part A, Part B and usually Part D in one plan. See Original Medicare vs. Medicare Advantage.
• Drug coverage: if you don't have creditable drug coverage from a job, the VA, TRICARE or another source, join a Part D plan (or a Medicare Advantage plan with drug coverage) during your IEP to avoid the Part D late penalty. See Part D in Washington.

Part B when you have job-based coverage

When you later sign up for Part B after delaying it, Social Security asks your employer to complete Form CMS-L564 confirming your coverage. Keep records of your employer coverage. See working past 65 in Washington and small employers and Medicare.

Your Medigap open enrollment period

If you choose Original Medicare, your best chance to buy a Medigap policy is your 6-month Medigap open enrollment period. It starts the first month you're both 65 or older and enrolled in Part B, and it happens only once. During it, any company selling Medigap in Washington must sell you any policy it offers, and can't charge you more or turn you down because of your health.

If you delay Part B because you're still working, your Medigap open enrollment waits until your Part B starts. Washington has its own rules for people who already have a Medigap policy and want to change it; see Medigap in Washington before you buy.

Apple Health, Medicare Savings Programs and Extra Help

If you have Apple Health now: Apple Health coverage for adults is for people under 65 who don't have Medicare, so it ends when you become eligible for Medicare. You may then qualify for Apple Health for people 65 and older, or a Medicare Savings Program that pays your Part B premium and, for some people, Medicare deductibles and coinsurance. Programs for people 65 and older have their own income and resource rules. Apply or renew through Washington Connection or your local DSHS Community Services Office a few months before your birthday so there's no gap. See Apple Health and Medicare.

Extra Help: if you qualify for Apple Health or a Medicare Savings Program, you also get Extra Help with Part D drug costs automatically. In 2026 Extra Help covers people with incomes up to $23,940 a year (single) who meet the resource limit.

D-SNPs: people with both Medicare and Apple Health may be able to join a Dual-Eligible Special Needs Plan, which coordinates the two.

If you have a Washington Healthplanfinder plan

Marketplace coverage doesn't let you delay Medicare without a penalty. Sign up for Medicare during your IEP, then end your Healthplanfinder plan so it stops when Medicare starts. Once you're eligible for Part A with no premium, you can no longer get premium tax credits for a marketplace plan, so keeping it would mean paying full price.

Washington-specific considerations

State, school and higher-education retirees (PEBB and SEBB): to keep PEBB retiree insurance, retirees and covered dependents who are eligible for Medicare must enroll in Medicare Part A and Part B and stay enrolled, and send the Health Care Authority proof. School employees who retire generally move to PEBB retiree insurance. HCA has strict deadlines for electing retiree coverage when you retire, so contact HCA before your last day of work. See our PEBB and SEBB pages.

Military retirees and veterans: TRICARE For Life requires Part A and Part B. VA care and Medicare are separate systems; many veterans in Washington have both. See TRICARE For Life and veterans and Medicare.

Federal employees: FEHB lets you delay Part B while you're working, but think about Part B when you retire. See FEHB and Medicare.

Tribal members: you can keep using Indian Health Service and tribal clinics and also enroll in Medicare. See tribal health and Medicare.

Moving to Washington around 65? See moving to Washington with Medicare.

Income and IRMAA at 65

Your Part B and Part D premiums depend on your income from two years earlier. For 2026, that's your 2024 tax return: if your modified adjusted gross income was more than $109,000 (individual) or $218,000 (joint), you pay an extra amount called IRMAA. That often catches people in their last high-earning years before retirement, or who sold a home, business or stock.

If your income has dropped because you stopped working or cut back, or because of another life-changing event, you can ask Social Security to use a more recent year with Form SSA-44. See IRMAA in Washington and the IRMAA calculator.

WA Cares Fund at 65

WA Cares is Washington's long-term care program. It isn't Medicare and doesn't change your Medicare choices. If you're still working at 65 with W-2 wages in Washington, the 0.58% WA Cares premium keeps coming out of your paycheck, whether or not you have Medicare. Benefits have been available since July 2026 and pay for long-term services and supports that Medicare doesn't cover, such as in-home care, up to a lifetime limit set by state law. Whether you can use them depends on how many years you've contributed. See WA Cares Fund.

Your birthday month and after

If you signed up early, your Medicare card arrives before your birthday month. Create an account at Medicare.gov to see your claims, your preventive services and your Part B deductible. Book your "Welcome to Medicare" preventive visit during your first 12 months with Part B; you pay nothing for it if your doctor accepts assignment.

Each fall, the Medicare & You handbook arrives, and if you're in a Medicare Advantage or Part D plan, your plan's Annual Notice of Change arrives by September 30. Review your coverage during the Annual Enrollment Period, October 15 to December 7.

Compare plans before you decide

Your county is the biggest factor in which Medicare Advantage plans you can choose. CMS's 2027 data shows 30 Medicare Advantage plans open to everyone in King County, but 6 in Ferry County. Standalone Part D plans are the same statewide: 8 for 2027. See your county's page.

Use Medicare's Plan Finder at Medicare.gov, or see plans in your ZIP code.

Talk to a licensed insurance agent

A licensed insurance agent who works in Washington can compare plans from the companies they work with, explain network differences, and help you avoid common mistakes, at no cost to you. Call (206) SENIORS (206-736-4677), TTY 711 to reach a licensed insurance agent with Benefits Life, or find a licensed insurance agent in Washington.

Sources

• Medicare.gov — When does Medicare coverage start?
• Medicare.gov — Working past 65
• Medicare.gov — When can I buy Medigap?
• Medicare.gov — Avoid late enrollment penalties
• CMS — 2026 Medicare Parts A & B premiums and deductibles
• Social Security — Sign up for Medicare
• Social Security — Premiums: rules for higher-income beneficiaries
• IRS — Publication 969, Health Savings Accounts
• HealthCare.gov — Medicare and the Marketplace
• Washington Health Care Authority — Apple Health (Medicaid) coverage
• Washington DSHS — Medicare Savings Program
• Washington Health Care Authority — Medicare and turning age 65 (PEBB retirees)
• WA Cares Fund — Fact sheet
• CMS — CY2027 Medicare Advantage and Part D Landscape files

Frequently asked questions

When does my Medicare coverage start if I sign up the month before my birthday?

Coverage starts on the first day of your birthday month. If your birthday is on the 1st, everything shifts a month earlier: coverage starts the first day of the month before. If you sign up in your birthday month or later in your Initial Enrollment Period, coverage starts the first day of the month after you sign up.

Do I have to take Part B at 65 if I have employer insurance?

Only if the employer has fewer than 20 employees, in which case Medicare usually pays first. If you or your spouse are still working for an employer with 20 or more employees and covered by its group plan, you can delay Part B without a penalty and sign up within 8 months after the job or the coverage ends. COBRA and retiree coverage don't count.

Can I keep my HSA after Medicare starts?

You keep the money in your Health Savings Account and can spend it without paying tax on qualified medical expenses, including Medicare premiums. But you can't make new contributions for any month you have Medicare. If you sign up after 65, Part A can start up to 6 months earlier (but not before the month you turned 65), so stop contributing 6 months before you sign up.

What if I miss my Initial Enrollment Period?

You can usually sign up during the General Enrollment Period (January 1 – March 31), with coverage starting the month after you sign up. You'll generally owe a Part B late penalty for life: 10% for each full 12-month period you could have had Part B but didn't, unless you had qualifying job-based coverage.

I have Apple Health. What happens at 65?

Apple Health coverage for adults under 65 ends when you become eligible for Medicare. You may then qualify for Apple Health for people 65 and older, or a Medicare Savings Program that pays your Part B premium and possibly more. Apply or renew through Washington Connection or your local DSHS Community Services Office a few months before your birthday.

Medicare in your Washington county

Plans, local agents and help, county by county: Adams · Asotin · Benton · Chelan · Clallam · Clark · Columbia · Cowlitz · Douglas · Ferry · Franklin · Garfield · Grant · Grays Harbor · Island · Jefferson · King · Kitsap · Kittitas · Klickitat · Lewis · Lincoln · Mason · Okanogan · Pacific · Pend Oreille · Pierce · San Juan · Skagit · Skamania · Snohomish · Spokane · Stevens · Thurston · Wahkiakum · Walla Walla · Whatcom · Whitman · Yakima