Every day, more than 10,000 individuals embrace a pivotal moment – the day they turn 65 and become eligible for Medicare. It’s a milestone that brings both excitement and questions. If you’re approaching this age, you’re likely wondering, ‘How do I unlock the full potential of my Medicare benefits?’ This comprehensive guide is your key to understanding the benefits, navigating complex choices, and securing your healthcare future as you journey into your senior years.
Table of contents
Guide to Medicare benefits you get when turning 65
When turning 65, Medicare provides comprehensive health insurance benefits for seniors in the United States. Medicare Part A is your hospital insurance. It covers hospital stays, inpatient care at a skilled nursing facility, and hospice care.
Part B is your outpatient medical insurance, covering outpatient services, preventative care, durable medical equipment, and other medical services.
Medicare Part D is a voluntary prescription drug program, while Medicare Part C is an alternative to Original Medicare. Private insurance companies offer Medicare Advantage plans and typically provide additional benefits beyond those in Original Medicare.
In addition, there are Medicare Supplement insurance plans, also called Medigap insurance, to help cover costs left by Original Medicare. Medicare also provides preventive care services, such as wellness visits and screenings, for those aged 65 and over.
Ultimately, Medicare can provide seniors with various health insurance benefits, allowing them to prepare for their healthcare needs as they age.
Continuing to work while turning 65
Several options are available if you become eligible for Medicare while still working. If your employer provides health insurance, you may stay on that plan and delay enrolling in Medicare Part A and B coverage. If you have a retiree health plan, you may also choose to remain in that plan.
It’s important to note that if you are still employed and not eligible for premium-free Part A, you may be subject to a late enrollment penalty if you enroll in Medicare Part A or Part B after you become eligible.
Keep in mind that the employer or retirement coverage isn’t considered creditable. You may need to enroll in Medicare to continue the group or retirement plan.
If you enroll in Medicare Part A and B, you may switch to a Medicare Advantage plan or a stand-alone Medicare Prescription Drug plan. Be sure to weigh your options carefully, as there may be differences in coverage and costs.
If you delay your Medicare benefits, you’ll have a Special Enrollment Period lasting eight months from when you leave or lose your group coverage.
Group coverage vs. Medicare Advantage plans
Medicare Advantage plans and group plans are very similar. Both have HMO and PPO options and have networks, authorizations, and restrictions. Costs are usually what it comes down to when making this decision.
Group and retirement plans typically have high premiums, copays, coinsurance, deductibles, and maximum out-of-pocket limits. Since the Medicare system funds Medicare Advantage plans, they typically will have lower costs than a group health plan.
There are some exceptions; you should review the options with a licensed insurance agent. Private insurance companies contracted with the Centers for Medicare & Medicaid Services administer and provide access to Medicare Part C programs.
Group coverage vs. Medicare Supplement plans
Comparing a group plan with a Medicare Supplement is like comparing apples to oranges. Medicare Supplement plans have higher monthly premiums than Medicare Advantage plans but lower than many group plans. These Medigap plans also have little to no costs when using your Medicare benefits.
Medicare Supplement plans pick up the remaining expenses from Medicare, except for drug coverage. You must enroll in a stand-alone Part D prescription drug plan for your Medications.
Turning 65 Medicare checklist
Turning 65 can be quite an exciting milestone, and it’s essential to make sure you’re prepared for it. A Turning 65 Checklist is a great way to ensure you are ready to take on this age’s new challenges and opportunities.
Research your Medicare options to learn about the different plans and cost-saving measures. Additionally, plan your retirement budget and map out your finances to ensure you are on track. It’s also important to update your will and estate plan, review long-term care insurance, and look into any veteran’s benefits.
What to consider 9 Months prior to turning 65
Determine whether you’re eligible for Medicare benefits
You can determine your Medicare eligibility by calling the Social Security Administration, visiting your local Social Security office, or using Medicare’s Eligibility and Premium Calculator.
This information can help determine if you are automatically enrolled in Part A and B, when to expect your Medicare card in the mail, or if you need to sign up. It also provides estimated premium amounts to decide whether you wish to enroll in Part B.
Examine your present medical coverage
Enrolling in Medicare can affect your current coverage. For instance, if you are on an employer-sponsored plan, the company may alter your premiums and benefits or even discontinue coverage once you have enrolled in Medicare.
Review supplemental health insurance
Original Medicare may not cover all medical expenses. To better secure your healthcare needs, you may want to consider enrolling in a Medicare Advantage plan or supplementing with a Medicare Supplement plan. Additionally, you may need to look into obtaining Medicare Part D Prescription Drug coverage.
What to consider 6 months out prior to turning 65
Check with your physicians if they accept Medicare
Whether your doctors accept Medicare assignments and participate in Medicare Advantage networks can help you
Evaluate the benefits of Medicare Supplement and Medicare Advantage plans
You can enroll in a Medicare Supplement plan up to six months before your 65th birthday to lock in the premium. Please note that Original Medicare or Medicare Advantage enrollment is not available until three months before reaching this milestone.
What to consider 3 months out prior to turning 65
Sign up for Medicare
You can apply online, by phone, or in person if you are eligible. When applying, you must provide information such as your Social Security number, address, and the name of your current doctor. You will also need to provide proof of your identity.
After you have submitted your application, you should receive a letter or call from Medicare or Social Security confirming your enrollment. It’s essential to keep this information on hand and stay updated with any changes to Medicare.
Taking the necessary steps to apply for Medicare can ensure you have access to the benefits you need. Three months before your 65th birthday is when your Medicare Initial Enrollment Period begins.
You can’t start enrollment into Medicare until three months before your 65th birthday in most cases. Your coverage starts on the 1st day of the month you turn 65. If your birthday falls on the 1st, your Medicare will begin on the 1st day of the month before turning 65.
Choosing Medicare coverage options
Choosing the right Medicare coverage options ensures you have the best coverage to meet your needs. Medicare coverage options include Original Medicare (Part A and Part B), Medicare Advantage plans (Part C), Medicare Part D prescription drug plans, and Medicare Supplements.
Original Medicare offers basic hospital and medical coverage, while Medicare Advantage and Medicare Supplement plans may include more comprehensive coverage.
When deciding which Medicare coverage option is right for you, it’s important to consider your individual needs, budget, and doctor network. It’s also important to research the plan’s coverage and cost, as Medicare Advantage plans typically have different premiums and out-of-pocket expenses than Original Medicare. At the same time, Medicare Supplement plans cover the costs left over from Original Medicare.
FAQs
When to sign up for Medicare when turning 65?
You should plan to sign up for Medicare 3 months before your 65th birth month.
What’s the Medicare eligibility age?
Most Americans become eligible for Medicare at age 65. However, those with qualifying health conditions or who have been on disability for over two years can start Medicare early.
Can a person take Medicare at age 65 without drawing Social Security benefits?
A person can take Medicare at age 65 without drawing Social Security benefits. They can sign up for Medicare Part A and Part B during their Initial Enrollment Period, which is the seven-month period that begins three months before their 65th birthday and ends three months after their 65th birthday.
What happens if I don’t enroll in Medicare when I turn 65?
If you don’t enroll in Medicare when you turn 65, you may be subject to late enrollment penalties, which can be costly. You may also face an extended period without health coverage, which could leave you financially vulnerable in case of an unexpected health issue. You’ll need to enroll in the General Enrollment Period that runs from January 1 to March 31 to enroll.
Can I start Medicare before I turn 65?
Individuals with specific medical conditions and disabilities can enroll in Medicare before 65. Some examples are individuals with end-stage renal disease, Amyotrophic Lateral Sclerosis (Lou Gehrig’s disease), and those receiving Disability benefits for at least 24 months.
Is there a cost for Medicare Part A or Part B?
Most Medicare beneficiaries will receive Medicare Part A premium-free. This premium is calculated by the years they paid into Medicare taxes. Those who paid into Medicare for less than 40 quarters will have a Part A monthly premium.
Most beneficiaries will pay a standard Part B premium. Higher-income beneficiaries may have to pay an IRMAA and the Part B standard premium.
Does owning a home affect Medicare costs?
The only factors determining Medicare eligibility are age, paying into the program, or disability. The costs of Medicare are standard for most beneficiaries, but higher-income beneficiaries could pay more. Owning a home doesn’t affect your Medicare costs.
Getting help with Medicare upon turning 65
Let us know if you need help understanding the Medicare information, the parts of Medicare, or your options. We’ll be happy to help. Our licensed insurance agents are experts and can guide you through Medicare enrollment.
We’re only one call away! Call today or fill out our online request form!
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