By Jennifer Mauldin, Licensed Medicare Specialist  |  Mauldin Insurance Group, Lexington, SC  |  Updated April 2026

Turning 65 is one of the most significant financial milestones of your life — and Medicare is the centerpiece of it. If you live in Lexington, Chapin, Irmo, Lake Murray, or anywhere in the SC Midlands, this guide walks you through everything you need to do, when to do it, and how to avoid the most common (and costly) mistakes.

I am Jennifer Mauldin, a licensed Medicare specialist right here in Lexington. I help seniors through this process every single month. Here is everything I tell every turning-65 client before they make any decisions.

 

Step 1: Know Your Enrollment Window — And Do Not Miss It

Your Medicare enrollment window is called the Initial Enrollment Period (IEP). It is a 7-month window that works as follows:

 

Timing	What Happens
3 months BEFORE your 65th birthday month	Your enrollment window opens. This is the ideal time to enroll — your coverage starts on the first day of your birthday month.
Your 65th birthday month	Still in your enrollment window. Coverage starts the first of the following month.
3 months AFTER your 65th birthday month	Window is still open, but coverage is delayed by up to 3 months depending on when you enroll.
After the 7-month window closes	You must wait for a Special Enrollment Period (if eligible) or the next General Enrollment Period (January–March). Late enrollment typically triggers a PERMANENT penalty.

 

⚠️  THE MOST EXPENSIVE MISTAKE: MISSING YOUR PART B ENROLLMENT WINDOW   If you do not enroll in Medicare Part B when first eligible — and you do not have qualifying employer coverage — your monthly Part B premium increases by 10% for every 12-month period you delay. This penalty is PERMANENT. It follows you for as long as you have Medicare.   Example: A 65-year-old who delays Part B enrollment for two full years pays 20% more than the standard premium — every single month — for the rest of their life.   The 2026 standard Part B premium is $202.90/month. A 20% penalty adds $40.58/month, or nearly $487/year. Forever.

 

Step 2: Understand What You Are Enrolling Into

Medicare has four parts, and understanding them before you make any choices will save you from confusion and regret.

 

• Part A (Hospital Insurance): Covers inpatient hospital stays, skilled nursing facility care, hospice care, and some home health care. Most people get Part A free — no premium — if they worked and paid Medicare taxes for at least 10 years.
• Part B (Medical Insurance): Covers doctor visits, outpatient services, preventive care, lab tests, and medical equipment. The standard 2026 premium is $202.90/month, deducted from your Social Security if you are receiving benefits.
• Part D (Prescription Drug Coverage): Standalone drug plans that work alongside Original Medicare. The cap is $2,100 out-of-pocket in 2026. Premiums vary by plan — lowest available in SC in 2026 is $4.80/month. Enroll at 65 even if you take no medications — to avoid the late enrollment penalty.
• Part C (Medicare Advantage): Private plans that bundle Parts A, B, and usually D into one policy. Typically have lower premiums than a Supplement but include provider networks and prior authorization requirements.

 

Step 3: Choose Your Coverage Path — The Single Biggest Decision

Once you are enrolled in Parts A and B, you face the most important Medicare decision of your life: how do you want to structure your ongoing coverage?

 

Path 1: Original Medicare + Medicare Supplement + Part D

This is the most comprehensive option. You keep the full freedom of Original Medicare (any Medicare-accepting provider, including Lexington Medical Center and all Prisma Health facilities), fill the coverage gaps with a Supplement plan (Plan G or Plan N are most popular for new enrollees in SC), and add a standalone Part D drug plan.

Best for: Seniors who want predictable costs, freedom to see any provider, and plan to travel or use out-of-state specialists.

 

Path 2: Medicare Advantage (Part C)

A Medicare Advantage plan replaces Original Medicare with a private plan that includes all the same benefits plus often drug coverage and extras like dental and vision. Premiums are often lower — sometimes $0 — but you are working within a provider network, and out-of-pocket costs can reach up to $9,250/year.

Best for: Healthy seniors who want lower premiums, are comfortable staying within a network, and want the convenience of bundled coverage.

 

Step 4: Special Situation — Still Working at 65?

If you are still employed at 65 and covered by an employer health plan, you may be able to delay Medicare enrollment without penalty — but the rules depend on your employer's size.

• Employer has 20 or more employees: Your employer plan is primary. You can delay Part B without penalty. You should still enroll in Part A (free for most people).
• Employer has fewer than 20 employees: Medicare becomes your primary insurance. Delaying Part B is risky and could result in gaps and a permanent penalty.
• COBRA or retiree coverage: This does NOT qualify as creditable coverage for Medicare purposes. Enroll during your IEP.

 

This is one of the most nuanced areas of Medicare, and getting it wrong is expensive. If you are working at 65, call before you make any decisions: 843-509-2462.

 

Step 5: Your Complete Pre-Enrollment Checklist

Here is what to gather and do before your consultation:

 

• Find your Social Security card and confirm your Medicare eligibility date (typically the first day of your birthday month at age 65)
• Watch for your red, white, and blue Medicare card in the mail — it typically arrives about 3 months before your 65th birthday
• Write down every medication you take, including dosage and how often
• List your current doctors and the health system they are affiliated with (LMC, Prisma Health, Providence, other)
• Gather your employer health insurance information if you are still working
• Know your approximate annual income — relevant if you may be subject to IRMAA surcharges (starts at $109,000 for single filers)
• Call 843-509-2462 and schedule your free Medicare consultation with Jennifer Mauldin

 

Your 6-Month Medicare Timeline

Use this timeline to stay on track as you approach 65:

 

6 Months Out	Start researching Medicare options. Call a local agent for an introductory consultation. No commitment — just education.
3 Months Out	Your enrollment window opens. This is the ideal time to enroll in Part B (and Part A if not automatic). Compare Supplement and Advantage plans. Choose and apply.
Birthday Month	Your Medicare coverage begins. If applying this month, coverage starts the first of the following month. Still in window.
3 Months After	Window closes. After this date, standard enrollment is no longer available without a qualifying life event. Do not wait.

 

Why Work With a Local Independent Agent in Lexington?

You can enroll in Medicare on your own through Medicare.gov. But here is what you will not get if you go it alone:

• A drug formulary review specific to your actual medications across all available SC plans
• Provider verification confirming your LMC, Prisma Health, and other doctors are in-network
• A side-by-side cost comparison of every plan available in your Lexington zip code
• A local person you can call year after year when your plan changes, a provider drops out, or you have a question

 

And the best part: working with an independent agent costs you nothing. We are paid by the insurance carriers — you pay the same premium whether you use us or enroll directly.

 

 

 

Have Questions? We're Right Here in Lexington. Call or text Jennifer Mauldin for a free, no-pressure Medicare consultation.   📞  843-509-2462 jennifer@mauldininsurancegroup.com  |  MauldinInsuranceGroup.com | Serving the entire SC Midlands