If you are already drawing Social Security and about to turn 65, something happens automatically that a lot of people do not expect. Medicare signs you up — and your check gets smaller.
What happens at 65
Because you are already drawing Social Security, Medicare enrolls you automatically. Part A and Part B just show up in the mail, and nobody asks you first.
Why your check changes
Part A is the hospital side, and it costs you nothing if you worked and paid Medicare taxes for at least ten years — which covers most people.
But Part B is $202.90 a month in 2026, and it comes right out of your Social Security check. So the deposit you have gotten used to lands roughly two hundred dollars lighter, every month.
The part you actually control
That package in the mail comes with a way to say no to Part B. If you or your spouse has coverage through a job, and that employer has 20 or more employees, you can turn Part B down and pick it up later with no penalty when the job coverage ends.
But you have to call Social Security and do it. It will not happen on its own.
Under 20 employees, this flips completely
If the employer has fewer than 20 employees, Medicare becomes your primary payer and the job plan pays second. Turn Part B down in that situation and you can get stuck with bills you thought were covered.
Ask your benefits office which plan pays first before you say no to anything.
If you do decline, know your two clocks
When that job coverage ends, you get 8 months to sign up for Part B. Miss it and the next enrollment window is January 1 through March 31, with coverage starting the first of the month after you sign up — plus a late penalty that follows you for life.
But that 8 months is only for Part B. Part D, your drug coverage, gives you 63 days from the day your job’s drug coverage ends. And do not use all 63, because your drug plan does not start until the first of the next month.
Two very different clocks — and the drug one runs out first.
Make the decision on purpose
Keep Part B, or turn it down because you have real job coverage behind you. Just do not let the automatic enrollment make that call for you.
Common questions
Am I automatically enrolled in Medicare at 65?
Yes, if you are already receiving Social Security. Parts A and B start automatically unless you decline Part B.
Can I decline Part B if I am still working?
Yes, if the employer has 20 or more employees. Under 20, declining can leave you with unpaid bills.
How long do I have to sign up for Part B later?
Eight months from when the job coverage ends. Part D gives you only 63 days.
I am Rick Caso, an independent Medicare advisor with Falcon Life and Health, based in Port Charlotte, Florida and licensed in 24 states. If you want to walk through your own situation, call or text 941-412-2362.
Falcon Life and Health is not connected with or endorsed by the United States government or the federal Medicare program. We do not offer every plan available in your area. Any information we provide is limited to those plans we do offer in your area. Please contact Medicare.gov or 1-800-MEDICARE to get information on all of your options.