Project Kos | Stage 1. Getting Started
Stage 1 of 7

Getting started means understanding which coverage path applies before deadlines close.

Turning 65, retiring, working past 65, qualifying for Medicaid, using VA benefits, or carrying federal or military coverage can all change how healthcare is paid for. This page explains the major paths in plain language so you can understand what usually happens, what questions to ask, and where to find free official help.

Educational only No plan sales No sponsored placement Use official help before enrolling
Project Kos explains public healthcare systems. It does not enroll you in coverage.
Use this page to understand the path, the terms, and the questions to ask. For enrollment decisions, plan comparisons, legal questions, tax questions, medical advice, or eligibility determinations, use the official agencies or free counselors linked below.
Which path is yours?

Choose the closest match. More than one may apply. This selector is meant to orient you, not determine eligibility or recommend a plan.

Start here I'm preparing Not sure which path applies yet. Start with plain-English situations.
Under 65 Pre-Medicare You need coverage now and Medicare has not started yet.
Still working Working past 65 You have employer coverage and are approaching or past 65.
Turning 65 Medicare You are entering Medicare for the first time.
Lower income Medicaid You may qualify for help paying for care or coverage costs.
Disability Disability to Medicare You receive disability benefits and Medicare may be coming.
Veteran VA Healthcare You served and want to understand VA healthcare access.
Military retiree TRICARE for Life You have TRICARE and are approaching Medicare age. Overview available
Federal retiree Federal Benefits You retired from federal service and kept health coverage. Overview available
Tribal member Indian Health Service You use IHS, tribal, or Urban Indian Health programs. Overview available
Coverage mistakes that can create problems later
Delaying Part B without qualifying active employer coverage
COBRA, retiree coverage, VA, and IHS are not treated the same as active employer coverage for Medicare late enrollment rules.
Missing the Medigap open enrollment window
In many states, the first six months after Part B begins are the main protected window to buy Medigap without health underwriting.
Skipping drug coverage because no prescriptions are needed today
Going without creditable drug coverage can create a late enrollment penalty if Part D is added later.
Assuming only one coverage type can apply
Many people have layered coverage: Medicare plus Medicaid, Medicare plus VA, Medicare plus FEHB, or Medicare plus TRICARE.
Start here

I'm preparing

Everyone's path into senior healthcare is a little different. The options below use plain-language situations instead of government labels. Choose the one that sounds closest to your life right now.

How to use this
Choose the situation that sounds most familiar.
This does not decide eligibility or recommend coverage. It simply explains which system may be involved and what usually happens next.
Choose the sentence that sounds most like you
Under 65
I need health coverage right now
You may need a bridge plan until Medicare begins, such as employer coverage, COBRA, Medicaid, or the Marketplace.
Understand this path
Still working
I’m turning 65 but still have employer coverage
Employer size and plan type matter. They affect whether Medicare can be delayed without penalty or coverage problems.
Understand this path
Turning 65
I’m entering Medicare for the first time
This path explains the initial enrollment window, Part A, Part B, Medigap, Part D, and Medicare Advantage.
Understand this path
Lower income
I need help affording care or coverage
Medicaid may help pay healthcare costs, Medicare costs, prescription costs, or long-term care depending on your state.
Understand this path
Disability
I receive Social Security disability benefits
Medicare may begin automatically after disability benefits. The card can arrive before someone understands what it means.
Understand this path
Veteran
I served and want to understand VA Healthcare
VA Healthcare is not automatic. This path explains applying, priority groups, and how VA can work with Medicare.
Understand this path
Military retiree
I have TRICARE and am approaching Medicare
TRICARE for Life can coordinate with Medicare, but Medicare Part A and Part B timing matters.
Understand this path
Federal retiree
I kept my federal employee health plan
Federal retirees may keep FEHB and decide whether Medicare Part B should be added alongside it.
Understand this path
Tribal member
I use Indian Health Service
IHS can work alongside Medicare and Medicaid, but it does not replace Medicare enrollment deadlines.
Understand this path
Not sure which applies?
More than one path may describe the same person.
Veterans can also have Medicare. Some people have both Medicare and Medicaid. Federal retirees may keep their workplace plan and add Medicare. Start with the most urgent question first.
If under 65

Pre-Medicare planning

You are not yet 65, so Medicare has not started. This path explains common ways people bridge coverage until Medicare begins.

What to understand first
Coverage before 65 is usually a bridge.
Employer coverage, a spouse's plan, COBRA, Medicaid, or Marketplace coverage may fill the gap. Medicare timing still matters as 65 approaches.
What usually happens
1
You
Identify current coverage options
This may include active employer coverage, a spouse's employer plan, COBRA, Medicaid, or a Marketplace plan.
Start early
2
Marketplace, HR, or state agency
Enroll before the gap begins
Loss of job-based coverage may create a Special Enrollment Period. COBRA and Marketplace timing are different, so compare dates carefully.
Often 60 days
3
You
Prepare for Medicare before 65
Medicare's Initial Enrollment Period opens three months before the month you turn 65. It is worth preparing before the window opens.
6 months before 65
Common questions
Can COBRA bridge me to Medicare?
COBRA can continue employer coverage temporarily, but it is usually expensive and does not protect someone from Medicare late enrollment penalties after 65.
Can Marketplace coverage bridge me to Medicare?
Marketplace coverage may be available before Medicare begins. When Medicare eligibility begins, Marketplace subsidies and Medicare timing rules need to be reviewed carefully.
Could Medicaid be an option?
Depending on income and state rules, Medicaid may be available before Medicare and may cost less than Marketplace or COBRA coverage.
Watch out for
COBRA is not the same as active employer coverage for Medicare timing.
Do not assume COBRA lets someone delay Medicare Part B after 65 without penalty. Verify timing with Social Security, SHIP, or Medicare before deciding.
Free official help
Free personal help
Marketplace Navigator or Certified Application Counselor
Navigators and certified application counselors can help explain Marketplace eligibility and enrollment. They do not sell insurance or receive commissions.
Visit healthcare.gov
Still working

Working past 65

If someone is still working at 65 and has employer coverage, Medicare timing depends heavily on employer size, plan type, and whether coverage is active employment coverage.

What to understand first
Employer size matters before delaying Medicare Part B.
For many people, the key question is whether the employer has 20 or more employees. Confirm directly with HR and verify with SHIP or Medicare before delaying enrollment.
What usually happens
1
You and HR
Confirm employer size and plan type
Employer size affects whether the employer plan pays first or Medicare is expected to pay first.
Before 65
2
You
Review whether Part A affects an HSA
Enrolling in any part of Medicare generally ends the ability to make new Health Savings Account contributions.
Before enrollment
3
You and HR
Keep proof of active employer coverage
This documentation may be needed later if Part B is delayed and enrollment occurs after employer coverage ends.
Before retirement
4
You
Use the Special Enrollment Period when active coverage ends
Once active employment coverage ends, Medicare timing changes. COBRA and retiree coverage generally do not extend the same protection.
After work coverage ends
Common questions
Can someone delay Medicare while still working?
Sometimes. It depends on whether coverage is based on active employment and whether the employer meets Medicare coordination rules. HR and SHIP can help confirm.
What if the employer has fewer than 20 employees?
Medicare may be expected to pay first. If Part B is not active, claims can become complicated or unpaid.
Does COBRA count the same as active employer coverage?
No. COBRA is not treated the same as active employer coverage for Medicare late enrollment protection.
Watch out for
Small employer coverage can create a hidden coordination problem.
If Medicare is supposed to pay first and Part B is not active, the employer plan may not pay the way the person expects.
Free official help
Free personal help
State Health Insurance Assistance Program (SHIP)
SHIP counselors provide free, unbiased Medicare guidance and can help with employer coordination, delayed enrollment, and late penalty questions.
Find your local SHIP counselor
Turning 65

Medicare enrollment

Medicare is the federal health insurance program for people 65 and older, and for some people under 65 with qualifying disabilities. This path explains the first enrollment decision.

What to understand first
The first Medicare decision affects access, cost, and future flexibility.
Most people compare Original Medicare with Medigap and Part D against Medicare Advantage. Project Kos explains the tradeoffs but does not recommend or sell plans.
What usually happens
1
You
The Initial Enrollment Period opens
This seven-month window opens three months before the month someone turns 65, includes the birthday month, and continues for three months after.
7-month window
2
Social Security Administration
Part A and Part B enrollment is handled through Social Security
Part A covers hospital care. Part B covers outpatient care and doctor services. The standard Part B premium is $202.90 per month in 2026.
Before coverage starts
3
You, with official help if needed
Compare how Medicare will work
Original Medicare can be paired with Medigap and Part D. Medicare Advantage is a private plan alternative with different rules, networks, and authorizations.
During enrollment
4
You
Understand the Medigap window
The Medigap open enrollment window begins when someone is both 65 and enrolled in Part B. After the protected window, access may depend on state rules and health history.
6-month window
5
You
Review prescription drug coverage
Part D covers prescriptions. Going without creditable drug coverage can create a late enrollment penalty if coverage is added later.
During enrollment
Common questions
Is Medicare Advantage or Original Medicare better?
Neither is universally better. Medicare Advantage may have lower monthly premiums but uses plan networks and authorization rules. Original Medicare with Medigap usually costs more monthly but may provide broader provider access.
What is the Part B premium?
The standard Part B premium is $202.90 per month in 2026. Higher-income enrollees may pay more through an income-related surcharge.
What is the Part B deductible?
The Part B deductible is $283 in 2026. After the deductible, Original Medicare generally pays 80 percent of approved outpatient costs and the person pays 20 percent unless another coverage applies.
Can someone switch later?
Medicare election periods allow certain changes, but moving from Medicare Advantage back to Original Medicare does not always guarantee Medigap access after the initial Medigap window closes.
Watch out for
Medicare Advantage advertising is not the same as unbiased guidance.
Plan advertisements and broker calls may emphasize benefits and minimize tradeoffs. SHIP counselors offer free, unbiased support.
The Medigap window can be hard to recreate later.
Medigap protections vary by state after the initial window. Understand this before choosing a path.
Free official help
Free personal help
State Health Insurance Assistance Program (SHIP)
SHIP counselors provide free, unbiased Medicare guidance. They do not sell plans and do not receive commissions.
Find your local SHIP counselor
Lower income or need help with costs

Medicaid enrollment

Medicaid is a public health coverage program for people with limited income and resources. It is run by states within federal rules, so eligibility and benefits vary by location.

What to understand first
Medicaid can mean different things depending on the situation.
It may be primary coverage, help with Medicare costs, support for prescription costs, or a path to long-term care coverage.
What usually happens
1
You
Identify which Medicaid category may apply
The path may involve Medicaid, Medicare Savings Programs, Extra Help, or long-term care Medicaid.
Before applying
2
You
Gather documentation
Applications often require proof of income, assets, identity, residency, and insurance. Long-term care applications may require more financial history.
Varies
3
State Medicaid agency
The state reviews eligibility
Eligibility rules vary by state. The state Medicaid agency determines whether the person qualifies.
State process
Common questions
Can someone have both Medicare and Medicaid?
Yes. People who qualify for both are often called dual-eligible. Medicare generally pays first, and Medicaid may help with premiums, deductibles, copays, and some services Medicare does not cover.
What is Extra Help?
Extra Help is a federal program that helps people with limited income pay Medicare Part D prescription drug costs.
Do Medicaid rules vary by state?
Yes. Eligibility, covered services, asset rules, and long-term care rules vary significantly by state.
Watch out for
Long-term care Medicaid has asset-transfer rules.
Moving money or property without qualified legal guidance can create Medicaid ineligibility. Use an elder law attorney for legal planning questions.
Free official help
Official help
Your state Medicaid agency
State Medicaid agencies handle applications, eligibility questions, renewals, and coverage rules.
Find your state Medicaid agency
Under 65 with disability

Disability to Medicare

People who receive Social Security Disability Insurance may become eligible for Medicare before age 65. Timing depends on the disability benefit timeline and certain special conditions.

What to understand first
The Medicare card may arrive automatically.
When it arrives, review what Part A and Part B mean before declining anything. Ask SHIP or Social Security if another coverage source is involved.
What usually happens
1
Social Security
Disability benefits are approved
The official disability date affects the Medicare timeline. Retroactive approvals can change how soon Medicare begins.
Varies
2
Automatic process
Medicare eligibility approaches
For many SSDI recipients, Medicare begins after 24 months of disability benefits. Some conditions have different timing rules.
Often 24 months
3
You
Review Medicare options
Medigap availability for people under 65 varies by state. Medicare Advantage and Part D may also be relevant.
Before start date
Free official help
Free personal help
SHIP or Disability Rights organization
SHIP can help with Medicare questions. Disability Rights organizations may help with SSDI and work incentive issues.
Find your local SHIP counselor
Veteran

VA Healthcare enrollment

VA Healthcare is a benefit available to many veterans, but enrollment is not automatic. It can also work alongside Medicare.

What to understand first
VA Healthcare does not replace Medicare deadlines.
VA access can be valuable, but Medicare at 65 may still matter for care outside VA facilities, travel, specialists, and penalty avoidance.
What usually happens
1
You
Gather service documentation
A DD-214 or other service documentation is typically used to verify eligibility.
Before applying
2
VA or VSO
Submit the VA healthcare application
The application can be completed through VA channels, and a Veterans Service Organization can often help at no cost.
Application process
3
VA
VA assigns enrollment and priority information
Priority group, income, service connection, and other factors can affect cost and access.
VA decision
Watch out for
VA access does not extend Medicare enrollment windows.
If Medicare is delayed without qualifying employer coverage, late enrollment penalties may apply later.
Free official help
Free personal help
Veterans Service Organization
Accredited VSOs provide free benefits counseling and application assistance.
Find an accredited VSO
Military retiree

TRICARE for Life

TRICARE for Life is designed to work with Medicare for eligible military retirees and certain family members. Medicare Part A and Part B timing is central to this path.

What to understand first
TRICARE for Life depends on Medicare Part A and Part B.
Keep DEERS updated and verify Medicare timing through official TRICARE and Medicare resources.
What usually happens
1
You
Verify DEERS information
Accurate DEERS information helps prevent eligibility and claims issues.
Before 65
2
Social Security
Medicare Part A and Part B become active
TRICARE for Life generally requires both Medicare Part A and Part B.
At Medicare age
3
TRICARE
TRICARE for Life coordinates with Medicare
Medicare usually pays first for Medicare-covered services, and TRICARE for Life may cover remaining eligible costs.
After Medicare starts
Watch out for