5 Key Medicare Decisions You Must Make When Turning 65

5 Key Medicare Decisions You Must Make When Turning 65

Turning 65 is a milestone birthday – it’s the age when most Americans become eligible for Medicare. Deciding when and how to enroll in Medicare can be confusing. Make the most out of your Medicare benefits by understanding these 5 key enrollment decisions.

1. When to Sign Up for Part A and Part B

You have a 7-month general enrollment period to sign up for Medicare Part A (hospital insurance) and Part B (medical insurance) that begins 3 months before the month you turn 65. It ends 3 months after you turn and work past 65.

If you are already receiving Social Security benefits when you turn 65, you will automatically be enrolled in Parts A and B on the first day of your birthday month. You will receive your Medicare card in the mail 3 months before your 65th birthday.

If you aren’t getting Social Security, you will need to sign up for Medicare through Social Security during your 7-month initial enrollment period. Contact Social Security to apply.

If you miss your special enrollment period, you may have to pay a late enrollment penalty and delay getting coverage.

2. Should You Sign up for Medicare Part B when you turn 65?

Some people can delay Part B enrollment without penalty if they are still working and have employer health insurance. But for most people, not signing up for Part B when first eligible can lead to lifelong penalties added to your monthly Part B premium.

Here are some tips on whether to enroll in Part B at 65:

• If you have retiree insurance plan coverage through an employer, check if it requires Medicare enrollment at 65. If so, you must sign up for Part B.
• If your employer has less than 20 employees, definitely take Part B at 65 or you’ll face penalties.
• If you have COBRA and are paying yourself, enroll in Medicare Part B right away.
• If you have marketplace health plan, drop it to start Medicare at age 65 with no penalties.

Talk to your employer benefits administrator if unsure what to do about Part B.

3. Should You Enroll in Medicare Advantage Plan?

Original Medicare (Part A and B) is managed by the government. Medicare Advantage plans are offered by private insurers approved by Medicare. With Medicare Advantage, the plan manages your healthcare, not Medicare.

Some key considerations about Medicare Advantage health coverage:

• Advantage plans cover what Original Medicare does plus they may offer extra benefits like dental or vision.
• Most Advantage plans include Part D prescription drug coverage. With Original Medicare, you’d need to enroll in a separate Part D plan.
• Advantage plans have networks – you’ll generally need to see in-network providers. Original Medicare has a larger provider network.
• You still pay your monthly Part B premium in addition to any Advantage plan premium.
• Shop and compare plans annually during open enrollment as costs and coverage can change yearly.

Talk to a Medicare advisor to understand the pros and cons for your healthcare needs.

4. Should You Enroll in a Part D Prescription Drug Plan?

Original Medicare does not cover prescription medications. To get drug coverage, you need to enroll in a separate Part D prescription drug plan or a Medicare Advantage plan that includes drug coverage.

Here are some tips on Part D:

• If you don’t enroll when first eligible and go 63+ days without medicare drug coverage, you’ll pay a lifelong penalty added to your premium if you enroll later.
• Each plan has a list of covered drugs called a formulary. Make sure yours covers what you need before enrolling.
• Use the Medicare Plan Finder tool to find and compare Part D plans in your state. Compare premiums, deductibles, covered drugs and pharmacies in network.
• Re-evaluate your drug needs and shop for a new plan during open enrollment each year.

Get Part D right away at 65 if you regularly take prescription medications to avoid penalties.

5. Should You Purchase a Medigap Policy?

Medigap supplements your Original Medicare coverage by helping pay costs like deductibles and coinsurance. It only works with Original Medicare. Some tips on getting Medigap:

• Purchase during your open enrollment period which lasts 6 months from the start of the month you’re 65 or older and enrolled in Part B.
• After open enrollment you can be denied or charged more based on health status. Get it when first eligible.
• You pay a monthly premium in addition to your Medicare Part B premium.
• Compare standardized plans labeled A-D, F, G and K-N offered in most states. Each letter covers a unique set of benefits.
• Costs vary widely based on location, plan type and age you enroll. Shop carefully.

Understand how Medicare works with your existing coverage as you turn 65. Speak with a Medicare counselor if you need help navigating enrollment decisions. Making smart choices at 65 ensures you access Medicare benefits without penalties.