The 5 Most Important Health Decisions to Make Before You Turn 65 — Time Is Running Out

You are closer to 65 than you think, and the clock started before you noticed.

Miss Medicare’s sign up window and you can pay a higher premium for the rest of your life. Miss the next window and insurers in most states can ask about your health history before they sell you a supplement.

The health decisions to make before you turn 65 are not complicated. But several of them come with deadlines that never reopen.

Before acting on anything here, talk with your doctor and a licensed Medicare counselor, especially if you take medication or have a diagnosed condition. Dollar amounts and rules below reflect 2026 and can change.

Here are the five decisions that matter most, in the order that protects you best. Each one is easier to handle with time to spare than in a rush.

1. Lock In Your Medicare Window Before It Closes

Your Initial Enrollment Period lasts seven months. It opens three months before the month you turn 65, includes your birthday month, and closes three months after.

If you already collect Social Security, you are usually signed up for Part A and Part B automatically. If you do not, nobody will do it for you.

Missing the window costs real money, and it never goes away. The Part B late penalty is 10% of the standard premium for every full 12 months you could have had coverage and did not. You pay it for as long as you have Part B.

The standard Part B premium is $202.90 a month in 2026, with a $283 annual deductible. A 10% penalty adds roughly $20 a month. Wait two full years and it is about $40 a month, nearly $490 a year, and it rises whenever the premium rises.

Prescription coverage has its own penalty. If you go 63 days or more without creditable drug coverage after your window ends, Part D adds 1% of the national base premium for each full month you were uncovered, for as long as you keep the plan.

Most people who worked at least 10 years pay no premium for Part A, which covers hospital stays.

Still working at 65? You may be able to delay Part B without a penalty if you have coverage through your own or your spouse’s current job. When that coverage ends, you get an eight month window to enroll.

The rules depend on the employer and the plan. Confirm with your benefits office before you delay anything.

One trap catches careful savers. If you contribute to a Health Savings Account, stop at least six months before you apply for Medicare or Social Security, because Part A coverage can reach back up to six months (never earlier than the month you first became eligible).

Contributions made during a month that Medicare covers retroactively can count as excess contributions and trigger a tax penalty.

2. Choose Your Coverage Type With Your Eyes Open

Once you are in Medicare, you pick one of two roads. Original Medicare (Parts A and B) lets you see any doctor or hospital that accepts Medicare. Medicare Advantage (Part C) is a private plan that replaces Original Medicare and usually bundles in drug coverage.

Each road has a real trade off. Original Medicare pays 80% of approved Part B costs after your deductible, and you owe the other 20% with no yearly cap unless you add a Medigap policy.

Medicare Advantage caps your yearly in network spending. The legal maximum is $9,250 in 2026, the average plan sits around $6,300, and many plans charge little or nothing beyond your Part B premium.

The catch is the network and the paperwork. Advantage plans generally require you to use their providers and to get approval for many services. Insurers made nearly 53 million prior authorization decisions in 2024 and fully or partly denied about 7.7% of them, according to published analyses.

The deadline most people miss is the Medigap window. You get a six month open enrollment period that begins the first month you have Part B and are 65 or older. During it, insurers must sell you any Medigap policy offered in your state, whatever your health.

It happens once. After it closes, insurers in most states can ask health questions, charge more, or turn you down.

That is why the order matters. If you start with Medicare Advantage and later want Original Medicare with a Medigap plan, you may no longer have guaranteed access. And you cannot use Medigap together with an Advantage plan.

Drug costs are capped either way. Part D plans, including Advantage plans with drug coverage, limit your yearly out of pocket spending on covered drugs to $2,100 in 2026. The cap only counts drugs on your plan’s formulary, so check yours.

Before you choose, do these three things:

• List your doctors and hospitals, then confirm each one is in the plan’s network.
• List your medications, then check every plan’s formulary for each one.
• Picture your worst health year and add up what each option would cost you.

Your state’s State Health Insurance Assistance Program (SHIP) offers free, unbiased Medicare counseling. Use it before you sign anything.

3. Book Your Baseline: Checkups, Screenings, and Shots

Medicare Part B covers one Welcome to Medicare preventive visit during your first 12 months with Part B. You pay nothing if your provider accepts assignment.

The visit reviews your medical and social history, height, weight, and blood pressure. It includes a simple vision test, a check on depression risk and safety, and an offer to talk about advance directives. You leave with a written plan of the screenings and shots you need.

It is not a full physical exam, so ask whether any extra tests will cost you. After the first year, you can get a free yearly wellness visit.

Do not wait until 65 to catch up. Several screenings start years earlier, and the numbers show why. Colorectal cancer caught while still localized has a five year survival rate above 90%. Once it spreads to distant organs, that figure falls below 20%.

Shingles deserves attention too. About one in three Americans will get it in their lifetime, and the two dose vaccine is more than 90% effective.

Family history can move these dates earlier. Tell your doctor which relatives had cancer, heart disease, or diabetes, and at what age.

Ask for your actual numbers. Under American Heart Association and American College of Cardiology guidelines, a blood pressure of 130/80 or higher counts as high. Cholesterol and blood sugar results are worth having in writing, not just hearing that everything looks fine.

If a number is borderline, you now have years to move it.

4. Build Strength and Balance While You Still Have a Cushion

Adults lose roughly 3% to 8% of their muscle per decade after 30, and the pace picks up in later life. Most people never feel it happening.

They feel it the first time a stumble does not get caught. Falls are the leading cause of injury and injury related death among older Americans. One in four adults 65 and older falls each year, and fewer than half tell their doctor.

Strong legs and good balance are what turn a stumble into a near miss. That is the mechanism, and it is trainable at any age.

A large Cochrane review of exercise trials found that exercise programs cut the rate of falls by about 23%. Programs that combine strength and balance work tend to do best.

Yet only about 13% of Americans 50 and older strength train at least twice a week. The CDC recommends muscle strengthening for all major muscle groups on at least two days a week, and three is an even better goal.

Two sessions of 20 to 30 minutes is enough to start. Try these:

• Sit to stand: Rise from a sturdy chair without using your hands, 8 to 10 times.
• Counter push ups: Lean into the kitchen counter and press, 8 to 10 times.
• Step ups: Use a low, stable step and hold a rail if you need it.
• One leg stand: Hold the counter and balance for 10 seconds on each side.

Everyone’s body responds differently, so check with your doctor before starting a strength or balance routine if you have joint problems, heart disease, osteoporosis, or a history of falls.

Balance practice works best most days of the week. Group programs such as tai chi are commonly recommended, and they add company to the routine.

Two quick protections round this out. Get your eyes checked every year, because vision changes raise fall risk. And mention any fall to your doctor, even a minor one, because that single detail changes what they look for.

5. Put Your Wishes in Writing and Name Your Voice

A stroke or an accident does not check your birth date. If you could not speak for yourself tomorrow, would anyone know what you want?

For most people, the answer is no. A 2017 review of 150 studies covering nearly 800,000 U.S. adults found that only 36.7% had completed an advance directive, and only 29.3% had a living will.

Adults over 65 were more likely to have one than younger adults (45.6% versus 31.6%), so the paperwork tends to wait until later in life.

A health care proxy, also called a health care power of attorney, names the person who makes medical decisions if you cannot. A living will describes the treatments you would and would not want.

Experts who study this strongly recommend that everyone at least name a proxy. A proxy can handle situations a living will never anticipated.

Advance directives are recognized in all 50 states, and in most cases you can complete one without a lawyer. Rules on witnesses and notarization vary, so use your state’s own form.

Here is a simple way to do it:

• Choose a proxy and a backup. Pick people who can stay calm under pressure and will honor your wishes even if they disagree.
• Have the conversation out loud. Tell them what matters most to you, not just which treatments you refuse.
• Sign the form the way your state requires.
• Give copies to your proxy, your doctor, and your hospital’s patient portal.
• Review it after any major life change, such as a move, a diagnosis, or a divorce.

Your Welcome to Medicare visit includes an offer to talk about advance directives, so you can start the conversation there.

Try This Today: Your 65 Countdown

• Mark your 65th birthday on a calendar, then mark the day your Medicare window opens three months earlier.
• Ask your benefits office or Social Security whether your current coverage lets you delay Part B.
• If you have a Health Savings Account, ask your payroll team when to stop contributions.
• Do 10 sit to stand reps and a 10 second one leg stand on each side, holding the counter.
• Text one person you trust and ask, “Would you be my health care proxy?”

Call Your Doctor Instead of Waiting If You Notice:

• A fall that causes a head injury, dizziness, or pain, or new unsteadiness when you walk
• Blood in your stool or a lasting change in bowel habits
• A cough that will not go away, coughing up blood, or unexplained weight loss
• Chest pain, sudden weakness on one side, or trouble speaking (call emergency services right away)

The Health Decisions to Make Before You Turn 65, Recapped

Sign up for Medicare on time. Choose your coverage type knowing the Medigap window only opens once. Book the Welcome to Medicare visit and catch up on screenings and shots.

Build strength and balance twice a week. Put your wishes on paper and name a proxy. Five decisions, and every one gets harder to fix the longer you wait.