The Medicare Rights Nobody Mentions at Enrollment

If you’re new to Medicare, the pile of deadlines and fine print can feel overwhelming. Most of it tells you what you’ll owe and when to sign up, and almost none of it mentions the protections built into the system for you.

Several of these protections have narrow windows, and if you miss one of the windows, it can result in additional money being paid for years, possibly even for the remainder of your life. Others are so easy to overlook that you might never realize that you have them. Below are the most important ones to know, including the 2026 numbers and how to determine your own status.

Protection of enrollment deadlines

Most everyone knows that enrolling late in Part B results in penalties. However, there’s a large exemption. As long as you or your spouse continues to work at age 65, and you receive health insurance so of that employment, you can postpone Part B and avoid the late penalty. This is referred to as a Special Enrollment Period, and it’s designed to ensure that no one has to pay twice for coverage they already possess.

As long as the job and the related coverage remain active, you can enroll in Part B in any month you choose. Upon termination of either the job or the coverage, you receive an eight-month window to enroll in Part B without penalty. Failure to do so will add ten percent to your premium each twelve months you could have enrolled. Using the 2026 standard monthly premium of $202.90 per month, this can quickly add up and, usually remains attached to your premiums for the remainder of your lifetime.

Of course, there’s one common “trap” associated with this protection that can catch seniors who believe they have continued coverage. COBRA coverage doesn’t constitute current job-related coverage. Similarly, retirees receiving post-retirement benefits from their employer don’t meet the criteria for protection under this provision. So, if you’re relying upon either type of coverage, confirm whether your window has closed using Social Security before assuming you’re protected.

Your one-time opportunity to buy supplements

Medigap policies, commonly known as Medicare Supplement plans, provide financial assistance with the expenses remaining to the individual for services covered by Original Medicare. When you first become eligible to enroll in Part B at age 65 or older, a six-month Medigap Open Enrollment Period automatically begins. During this time frame, insurers can’t deny you coverage based on your previous or current health conditions; charge you higher premiums than would be charged someone else; or require you to wait longer for coverage. After this window closes, most states allow insurers to base your premium rates on your health; increase your premium; or deny you coverage altogether. Since this protection is limited to a six-month period beginning with your initial enrollment in Part B and doesn’t occur again, it’s recommended that you research available Medigap options regardless of whether or not you believe yourself to be in good health.

Care that costs you nothing

Beginning after twelve months of continuous enrollment in Part B, you’re entitled to one free annual wellness visit. To be eligible for this benefit, your healthcare provider must accept Medicare assignment, i.e. They agree to accept Medicare’s approved rate as payment-in-full for all services rendered. Your Part B deductible doesn’t apply to this benefit.

This wellness visit isn’t intended to be a head-to-toe physical. Rather, it’s a face-to-face meeting with your physician to discuss your medical history and list of prescription medications; measure basic health indicators (such as blood pressure); and develop a written checklist of screening examinations and vaccinations that you’re scheduled to undergo. Many of these screening examinations, as well as certain vaccinations (including flu shots), are also provided at no cost to you. Please note that while these services may be included in the definition of “preventive care,” additional charges may arise if your healthcare provider performs additional testing or treatment during the same appointment. Before scheduling an appointment, we recommend asking your healthcare provider which services will be considered “preventive” and so provided at no cost to you; and which services will incur a separate charge.

Disagree? Don’t give up

If Medicare or your plan denies a claim for coverage that you believe should be allowed, that’s not necessarily the end of the story. You have the right to appeal, and there are five levels of appeals available if you continue to disagree:

Under Original Medicare, the first step is called Redetermination. Review your Medicare Summary Notice (MSN), which includes what was denied and by what date you must submit a complaint (also called Redetermination Request Form). If your complaint is denied, an independent reviewer reviews your case for the next level of appeal; afterward, you can appeal directly to a judge. At each level of appeal, a detailed explanation is given about how to proceed further.

Please remember that deadlines exist at every level of appeal, so please don’t let denials languish. A simple letter from your treating physician stating why the particular service was medically necessary frequently changes the outcome; in addition, instructions for steps to follow and copies of forms required are located at medicare.gov.

Try Medicare Advantage without getting stuck

Medicare Advantage plans (also referred to as Part C) contract with private companies to offer bundled coverage; although Advantage plans frequently offer additional amenities or perks, they also restrict you to their network providers, which may be unexpected. There are two key rights that protect people considering trying an Advantage plan. Unfortunately, unless specifically pointed out by someone familiar with Medicare Advantage plans, both rights may easily be overlooked.

First, each year from January 1st through March 31st is a Medicare Advantage Open Enrollment Period. If you’re presently enrolled in an Advantage plan, during this time frame you can transition to another Advantage plan or drop back to Original Medicare. Only once during this time frame will you be able to make one change.

Second, there’s a trial right associated with Advantage plans. Although less prominent than the above-described open enrollment right, the trial right is more valuable. If you joined an Advantage plan either at age 65 (when initially eligible) or dropped a Medigap policy (to attempt an Advantage plan for the first time) you have a 12-month trial right. Within this 12-month trial period, if you decide that you prefer returning to Original Medicare, rather than continuing with the Advantage plan, you retain your guaranteed right to purchase a Medigap policy, without answering health-related questions. While this trial right allows for greater flexibility outside of the above-referenced open enrollment periods, dropping back to Medigap can potentially be costly, or denied outright, if action is taken outside of this trial right period, we highly recommend taking advantage of this opportunity if you experience any doubts about continuing with an Advantage plan.

The income surcharge you can appeal after a life change

Additional premiums (referred to as IRMAA) are assessed against higher-income people who participate in Part B and Part D. The assessment is calculated based on income reported on your tax returns. For 2026, IRMAA assessments begin when income reaches $109,000 annually for single filers or $218,000 annually for joint filers.

Here’s what many people fail to recognize. Social Security assesses IRMAA assessments using tax returns from two years prior. So, if a life event occurs (i.e. Retirement or other cessation of employment; death of a spouse; marriage or divorce; etc.) resulting in decreased income since that time period, you may petition Social Security to reassess your surcharge using updated income data instead. You file Form SSA-44, accompanied by supporting documentation (e.g. Letters confirming retirement; death certificates; etc.), requesting reconsideration based on changed circumstances.

If IRMAA has already begun, this same form will reduce or remove your ongoing surcharge. Income thresholds and surcharges vary annually so please consult ssa.gov before filing.

Before you act

Medicare regulations evolve over time. Some Medigap and Advantage protections vary from state to state. The figures referenced herein were derived from government sources and represent 2026 information. We encourage people seeking guidance relative to their unique situations contact Medicare at 1-800-MEDICARE; Social Security; or access free counseling from your local State Health Insurance Assistance Programs (SHIP) representative before making decisions affecting their future healthcare coverage and expenses.

Sources

• 2026 Medicare Parts A & B Premiums and Deductibles (CMS)
• Special Enrollment Periods (Medicare.gov)
• When can I buy a Medigap policy? (Medicare.gov)
• Yearly Wellness visits (Medicare.gov)
• Appeals in Original Medicare (Medicare.gov)
• Request to lower an Income-Related Monthly Adjustment Amount (IRMAA) (SSA.gov)

Photo by Markus Spiske on Unsplash