Medicare Open Enrollment 2026 for Atlanta Owners Nearing 65

Medicare eligibility usually begins around age 65, and your first enrollment window generally starts three months before the month you turn 65 and continues for three months after it. The Medicare Annual Enrollment Period (AEP), from October 15 through December 7 each year, is the time to review and change Medicare Advantage and Part D drug coverage for the following year. Acting early matters because the choices can affect your doctors, prescriptions, budget, and ability to avoid late-enrollment penalties.

For self-employed professionals and business owners in Atlanta, Medicare is often a bigger transition than expected. You may be used to comparing ACA marketplace plans, managing your own coverage, and making annual business decisions—but Medicare follows its own timelines, parts, and rules.

Medicare Has Two Important Enrollment Timelines

First is your Initial Enrollment Period. For most people, this seven-month period begins three months before the month they turn 65, includes their birthday month, and ends three months afterward. This is the key time to decide whether to enroll in Medicare Parts A and B, particularly if you do not have qualifying coverage based on current employment.

Second is the Annual Enrollment Period, which runs every year from October 15 through December 7. AEP is not the same as your first chance to enroll in Medicare. It is primarily the annual window to join, switch, or leave a Medicare Advantage plan or Part D prescription drug plan, with changes generally effective January 1.

That distinction matters for an Atlanta business owner approaching 65. Waiting until AEP may not be the right strategy if your initial enrollment timeline arrives earlier. A Medicare review with Jay Thurlow, Some1 Family Office, and The Insurance Shop can help you identify which dates apply to your situation before a deadline becomes a problem.

Medicare Parts A, B, C, and D in Plain English

Part A is hospital insurance. It helps cover inpatient hospital care, skilled nursing facility care under qualifying conditions, hospice, and limited home health services. Most people pay no monthly Part A premium because they or a spouse paid Medicare taxes long enough while working. In 2026, the inpatient hospital deductible is $1,736 per benefit period. People who do not qualify for premium-free Part A may pay $311 or $565 per month, depending on their Medicare work history.

Part B is medical insurance. It helps cover physician services, outpatient care, preventive services, durable medical equipment, and many other medically necessary services. The standard Part B premium in 2026 is $202.90 per month, although higher-income beneficiaries may pay more. The 2026 Part B deductible is $283, and Original Medicare typically leaves the beneficiary responsible for coinsurance after the deductible.

Part C is Medicare Advantage. These are Medicare-approved plans offered by private insurance companies as an alternative way to receive Part A and Part B benefits. Most Medicare Advantage plans include Part D drug coverage and may include extras such as dental, vision, hearing, or fitness benefits. Costs, provider networks, copays, prior-authorization rules, and annual out-of-pocket limits vary by plan.

Part D is prescription drug coverage. You can buy a stand-alone Part D plan alongside Original Medicare, or receive drug coverage through many Medicare Advantage plans. Part D premiums, formularies, pharmacy networks, and copays differ by plan. In 2026, Part D plans can have a deductible up to $615, and covered Part D out-of-pocket spending is capped at $2,100, although your actual costs depend on the plan and medications you take.

Original Medicare does not cover every expense. Routine dental care, most routine vision care, hearing aids, long-term custodial care, and care outside the United States are among the common gaps to understand before choosing coverage.

Medigap vs. Medicare Advantage: The Big Decision

This is the comparison many new Medicare beneficiaries search first, and for good reason. The decision affects how you access care and how you manage costs.

Medicare Supplement insurance, often called Medigap, works alongside Original Medicare. You keep Parts A and B, can add a stand-alone Part D plan, and may buy a Medigap policy to help pay certain deductibles, copays, and coinsurance left by Original Medicare. In general, Original Medicare lets you use any doctor or hospital in the United States that accepts Medicare. Medigap policies do not include prescription drug coverage, so a separate Part D plan is typically needed.

Medicare Advantage combines your Medicare coverage through a private plan. You continue paying your Part B premium and may pay an additional plan premium, although some plans have a $0 additional premium. These plans must cover Medicare-covered services and have an annual out-of-pocket maximum for covered Part A and Part B services, but they often use provider networks and may require referrals or prior authorization for certain care.

Neither path is automatically better. A Lawrenceville business owner who travels often and wants broad physician choice may weigh Original Medicare with Medigap differently than a Peachtree Corners resident whose preferred doctors and prescriptions work well within a local Medicare Advantage network. The right comparison should include your doctors, medications, travel habits, expected care, budget, and comfort with network rules—not just the monthly premium.

What Changes for Self-Employed Owners Leaving ACA Coverage

If you have been buying individual coverage through the ACA marketplace, Medicare can feel like a familiar shopping experience. But Medicare is not marketplace coverage, and the timing is different. Once you have Medicare, you generally do not keep a marketplace plan alongside it. In fact, it is against the law for someone who knows you have Medicare to sell you a marketplace plan.

For a sole practitioner, independent consultant, or owner of a small Georgia business, do not assume that simply renewing your current individual plan is enough once you become Medicare-eligible. Review when your marketplace coverage should end, when Medicare should begin, and whether you have any group coverage connected to current employment that could affect your enrollment choices.

Business owners with higher income should also ask about Medicare’s income-related monthly adjustment amounts. Medicare generally uses tax information from two years earlier to determine whether an additional Part B and Part D amount applies. A retirement, sale of a business, or major reduction in income may create a reason to ask Social Security to reconsider that amount based on a qualifying life-changing event.

Common Enrollment Mistakes—and Why They Can Be Expensive

• Confusing AEP with your initial enrollment period: October 15 through December 7 is important, but it does not replace the enrollment timeline tied to turning 65.
• Delaying Part B without confirming you qualify for a Special Enrollment Period: If you do not have qualifying coverage based on current employment, delaying can result in a gap or a late penalty. The Part B late-enrollment penalty is generally 10% for each full 12-month period you could have had Part B but did not.
• Skipping drug coverage because you do not take prescriptions today: Going 63 days or more without creditable prescription drug coverage after you are eligible can trigger a Part D late-enrollment penalty.
• Choosing only on premium: A low premium can be appealing, but the provider network, drug formulary, copays, prior authorization, and maximum out-of-pocket amount may matter more when you need care.
• Waiting too long to consider Medigap: Your one-time Medigap open enrollment period generally begins when you are 65 or older and enrolled in Part B. After that period, you may face medical underwriting or have fewer options, depending on the circumstances.

Why an Independent Medicare Conversation Helps

Medicare decisions are personal, especially for owners who have spent years building a business and managing their own benefits. An independent advisor can help organize the comparison around the questions that actually matter: Which doctors do you want to keep? Which medications need coverage? What will the premium and out-of-pocket exposure look like? Will you travel? Are you transitioning from an ACA plan, employer coverage, or a spouse’s plan?

Some1 Family Office, Jay Thurlow, and The Insurance Shop serve Atlanta, Lawrenceville, Peachtree Corners, and surrounding communities with an independent approach to Medicare planning. They can help you understand the available paths while keeping the conversation focused on your needs rather than a one-size-fits-all answer.

FAQ

When is Medicare open enrollment for 2026 coverage?

The Annual Enrollment Period for 2026 coverage ran from October 15, 2025 through December 7, 2025. For 2027 coverage, the next Annual Enrollment Period is October 15, 2026 through December 7, 2026. During that period, you can generally make changes to Medicare Advantage and Part D coverage effective January 1, 2027.

Do I need Medicare if I have an ACA marketplace plan?

If you are eligible for Medicare, do not assume marketplace coverage is a substitute. Review your initial Medicare enrollment timeline because marketplace coverage generally does not allow you to delay Medicare without potential consequences.

Can I have Medigap and Medicare Advantage at the same time?

No. Medigap works with Original Medicare, while Medicare Advantage is an alternative way to receive Medicare benefits through a private plan.

Does Medicare cover dental and vision?

Original Medicare generally does not cover most routine dental, vision, or hearing services. Some Medicare Advantage plans may include additional benefits, and separate coverage may also be available.

What should I bring to a Medicare review?

Bring a list of your prescriptions, preferred doctors and hospitals, current coverage information, and any questions about travel, budget, or upcoming changes in your work and income.

Before the October 15 through December 7 enrollment window arrives, take time to understand your choices. To schedule a Medicare review conversation with Some1 Family Office, Jay Thurlow, and The Insurance Shop, schedule a 24-minute conversation.