Turning 65 in Texas: What to Do, and When

Start three months early

Your Initial Enrollment Period runs seven months in total: the three months before your 65th birthday month, that month itself, and the three months after. Enrolling in the first three months means coverage starts the month you turn 65. Waiting until after your birthday month delays the start date, which can leave a gap.

If you are already drawing Social Security, enrollment in Part A and Part B is automatic and your card arrives before your birthday. If you are not, you have to enroll yourself through Social Security, and a surprising number of Texas residents assume this happens for them when it does not.

The late-enrollment penalty is permanent

The Part B late enrollment penalty adds 10% to your premium for each full 12-month period you could have had Part B but did not, and you pay it for as long as you have Part B. On the 2026 standard premium of $202.90 a month, one missed year costs roughly $202.90 plus 10% every month thereafter, not a one-time charge.

There is a similar Part D penalty of 1% of the national base premium per month without creditable drug coverage. Both penalties are avoidable, and both are the single most common expensive mistake people make at 65.

The decision you actually have to make

Once you have Part A and Part B, you choose between two paths: Original Medicare with a Medicare Supplement (Medigap) policy and a standalone Part D drug plan, or a Medicare Advantage plan that bundles hospital, medical and usually drug coverage together.

That choice is easiest to make in the first six months after your Part B starts, because that is your Medigap open enrollment window. During it, Texas insurers cannot refuse you a Medigap policy or charge you more for health reasons. After it closes, they generally can.

What to have ready in Texas

Before comparing plans, list every prescription you take with dosage, and every doctor and hospital you want to keep. Plan availability in Texas is set at the county level, so the lineup in your county is the lineup you can buy from, not what a friend in another part of the state was offered.

In the larger markets around Houston, Dallas-Fort Worth, San Antonio and Austin you will usually see more Medicare Advantage plans and broader networks. In smaller counties there may be only a handful of options, which makes confirming your providers more important rather than less.

How this differs across Texas

Texas has 254 counties and Medicare Advantage availability is set county by county, so two people turning 65 in the same month can face very different menus. In Harris, Dallas, Bexar and Tarrant counties you will typically see a long list of plans and several carriers competing. In the rural counties of West Texas and the Panhandle, the list is shorter and the networks are narrower.

That difference changes the strategy rather than just the shopping. Where plan choice is thin, Original Medicare with a Medigap policy is often the more durable answer, because it works with any provider who accepts Medicare rather than depending on whether a particular carrier managed to contract with the one hospital within reasonable driving distance.

Questions people ask at 65

Do I have to take Part B if I have other coverage? Not always, but the exceptions are narrow. Active employer coverage at a company with 20 or more employees generally lets you delay safely. COBRA, retiree coverage and Marketplace plans do not.

Can I keep my Marketplace plan instead? You can, but premium tax credits generally end once you are eligible for Medicare, so the plan usually becomes far more expensive. Most people in Texas move to Medicare.

What if I miss the window? The General Enrollment Period runs January through March each year, with coverage starting the month after you enroll, and the late penalty applies. It is a fallback, not a plan.