Retirement income
Medicare and Social Security: how they connect, and the decisions that cost people money
Claiming age, automatic enrollment, premium deductions and IRMAA surcharges. A practical guide for coastal Georgia retirees.
Medicare and Social Security are run by different agencies, but for most people they arrive in the same season of life and they are tied together in ways that are easy to miss. Social Security handles Medicare enrollment, deducts your Part B premium from your benefit, and uses your tax return to decide whether you pay more. Get the sequence right and the process is quiet. Get it wrong and you can pay penalties for the rest of your life.
This guide covers the questions we hear most often at our Abercorn Street office and at our seminars in Pooler and Sun City.
If you already receive Social Security, enrollment is automatic
If you start Social Security retirement benefits before 65, you are enrolled in Part A and Part B automatically. Your red, white and blue Medicare card arrives in the mail about three months before your 65th birthday.
Automatic enrollment is convenient, but it is not always right. If you are still covered by a large employer's group plan, you may want to decline Part B for now to avoid paying its premium. The card comes with instructions for sending it back. Call us before you do, because declining Part B incorrectly is one of the costliest mistakes in Medicare.
If you have not claimed Social Security, you must act yourself
Full retirement age for Social Security is now 67 for anyone born in 1960 or later. That means many people reach Medicare age two years before they plan to claim benefits. In that case nothing happens automatically. You need to apply for Medicare during your Initial Enrollment Period, which runs three months before, the month of, and three months after your 65th birthday.
You can apply online at ssa.gov in about twenty minutes. We often sit with clients, at their kitchen table or on a video call, while they complete it.
- Have your Social Security number and date of birth ready.
- Know your current health coverage details, including employer size.
- Decide whether you want Part B to start right away or later.
- Save the confirmation number and check your my Social Security account for status.
How premiums are paid
Once you receive Social Security, your Part B premium is deducted from your monthly benefit before it reaches your bank. If you are not yet collecting, Medicare bills you quarterly, and you can pay online or set up Medicare Easy Pay.
Medicare Advantage plan premiums and Part D premiums can also be deducted from Social Security, though many clients prefer to pay the carrier directly by bank draft so it is easier to see the charge. Medigap premiums are always paid to the insurance company.
IRMAA: the surcharge that surprises higher earners
Social Security uses your federal tax return from two years earlier to decide whether you owe an Income Related Monthly Adjustment Amount on Part B and Part D. For coverage in 2026, that means your 2024 return.
The surprise usually comes from a one-time spike: selling a rental property on Wilmington Island, a large Roth conversion, or the final year of salary plus a severance payment. If your income has dropped because of a life-changing event such as retirement, you can ask Social Security to use a more recent year by filing form SSA-44.
- Qualifying events include work stoppage, work reduction, marriage, divorce, death of a spouse and loss of pension income.
- Attach proof such as a letter from your employer or an estimated tax return.
- IRMAA is recalculated every year, so a surcharge one year does not mean a surcharge forever.
Spouses and the working-past-65 question
If your spouse is still working and you are covered by their employer's plan, you may also be able to delay Part B. The rules depend on whether the employer has 20 or more employees and whether the coverage is based on current employment. Retiree coverage and COBRA do not count, and relying on them is a common path to a late enrollment penalty.
When the working spouse retires, you each get an eight-month Special Enrollment Period to sign up for Part B. We recommend starting paperwork at least two months before the group coverage ends so there is no gap.
A simple timeline
Six months before 65, decide whether you will claim Social Security now or later. Three months before, apply for Medicare if you are not automatically enrolled. In your birthday month, choose a Medigap plan or Medicare Advantage plan and a Part D plan. Every October, review your plan against the Annual Notice of Change.
If you would like a printed version of your personal timeline, book a review. We will prepare it with your exact dates.
This guide is general education, not legal or tax advice. Figures change annually. We do not offer every plan available in your area. Any information we provide is limited to those plans we do offer in your area. Please contact Medicare.gov or 1-800-MEDICARE to get information on all of your options.
