I’m Turning 65 – How Do I Prepare for Medicare?

It’s a momentous time: your 65^th birthday is around the corner. In addition to the cake and candles (and hopefully gifts), it’s time to start getting ready to enroll in Medicare. Here’s what you need to know to make the process go as smoothly as possible.

What you’ll learn: 

What is Medicare?	Jump to
What’s the Difference Between Original Medicare and Medicare Advantage?	Jump to
How Do I Prepare to Enroll in Medicare?	Jump to
How Do I Sign up for Medicare?	Jump to

What is Medicare?

Medicare offers health insurance for those 65 and older. Those with a disability, amyotrophic lateral sclerosis
(ALS or Lou Gehrig’s disease), or end-stage renal disease may be eligible earlier.  

Medicare has several parts:

• Part A (hospital insurance): Addresses the cost of inpatient hospital care, skilled nursing facility care, and hospice care, and home health care. 
• Part B (medical insurance): Helps cover services from doctors and other healthcare providers, outpatient care, home health care, durable medical equipment such as wheelchairs and walkers, and a wide suite of preventative services such as screenings or vaccines.  
• Part C (Medicare Advantage): Medicare plans offered by private Medicare-approved companies, these provide Parts A and B, with most typically including Part D and other extra benefits. 
• Part D (drug coverage): Assists with coverage of prescription drug costs – you’ll either join a Medicare drug plan in addition to Original Medicare (Parts A and B) or by joining a Medicare Advantage Plan (Part C) with drug coverage.  

You can also buy Medicare Supplement Insurance, also known as Medigap, from a private provider who fills in any gaps in insurance. These plans supplement Original Medicare Parts A and B. Keep in mind that these standardized policies are typically named by letters such as Plan G or Plan N. Regardless of who you buy the plan from, the benefits are still the same per plan.

What’s the Difference Between Original Medicare and Medicare Advantage?

There are two main ways to get Medicare: Original Medicare and Medicare Advantage. One of the biggest decisions you’ll make when turning 65, is choosing between these two options. Let’s look at the basics of each.

Original Medicare:

• Includes Parts A and B 
• Allows enrollees to join a separate Medicare drug plan for their Medicare drug coverage (Part D). 
• Covers any U.S.-based provider or hospital accepting Medicare. 
• Comes with many out-of-pocket costs like copays, coinsurance and deductibles.  
• Enrollees can help pay out-of-pocket costs through Medicare Supplement Insurance. 
• Does not cover routine dental, vision or hearing care. 

Medicare Advantage:

• Is a private Medicare-approved plan providing an alternative to Original Medicare. Bundled plans include Parts A and B as well as (typically) Part D. 
• Enrollees may be limited to a specific provider network. 
• Plans may carry lower out-of-pocket costs than Original Medicare. 
• Enrolless cannot purchase Medicare Supplement Insurance with Medicare Advantage. 
• Extra benefits – including vision, hearing, and dental – may be available. 

How Do I Prepare to Enroll in Medicare?

Determine your IEP
First, determine your Initial Enrollment Period. This is a seven-month stretch that usually begins three months before you turn 65, includes your birthday month, and concludes three months after the month you turn 65.
It’s recommended that you know your preferences three months before turning 65.  

Determine if you need Part A, B or both
Choose whether to enroll in Parts A and B. Even if you have employer-provided health insurance, you should enroll in Part A since you likely paid Medicare taxes while working, which means you won’t pay a premium.  

Those with employer-provided insurance may be able to delay enrollment in Part B. In this case, it’s best to contact your employer to see how your insurance works in conjunction with Medicare – you may find that you must enroll to get full coverage.  

How Will I Estimate My Payment for Parts A and B?

• The Medicare Premium and Eligibility Calculator will help you do this provided you’re at least 64 years and 9 months old.  

Determine how you’ll cover out-of-pocket expenses
While you can’t necessarily avoid encountering these, you can minimize them. Some ways of doing this include enrolling on time to avoid late penalties and considering purchasing coverage outside your Original Medicare to help cover costs.  

This can include supplementary coverage like Medicare Supplement Insurance to help pay for Original Medicare’s deductibles, copays and coinsurance. Learn more about how these plans work with Medicare here.  

You can also supplement Original Medicare with a Part D prescription drug plan or even stand-alone vision, dental or hearing plans.  

Lastly, you have the option to replace your Original Medicare with a Medicare Advantage Plan that covers some or all of these things. Medicare Advantage is very different from Original Medicare. It’s important you take the time to understand how Medicare Advantage works vs Medicare Supplement Insurance when it comes to Medicare Parts A and B. Knowing the basics is the first step to knowing which path is right for you.  

Medicaid beneficiaries note: You may be eligible for Medicare Savings Programs that can also help if you have trouble affording your premiums. Still, Medicare Supplement Insurance premiums will likely be out of your budget. In this case, you’ll want to consider a special type of Medicare Advantage plan called a Dual Eligible Special Needs Plan.

How Do I Sign up for Medicare?

There are different paths to enrolling in Medicare depending on your specific situation. 

What if I Want Parts A and B to Start When I’m 65?
If you‘ll be getting Social Security or Railroad Retirement Board benefits at least four months before your birthday, you’ll automatically be enrolled. Look for your welcome package and your Medicare card in the mail three months before your birthday.  

If you won’t be getting benefits from Social Security or the RRB at least four months before turning 65, you’ll need to apply with Social Security. You can do this by visiting Social Security online or calling (800) 772-1213.  

Or if I Want to Delay Part B but Start Part A When I Turn 65?
If  you’ll be getting Social Security or RRB benefits at least four months before your birthday, you must refuse Part B. This can be done by following the instructions on your card and sending the card back or contacting Social Security. 

If you won’t be getting Social Security or RRB benefits at least four months before your 65^th birthday, you need to apply with Social Security to receive Part A.  

How About if I Choose Not to Enroll in Part B During my Initial Enrollment Period?
If you or your spouse are still working and you have employer-provided coverage, you should start Part B as soon as you stop working or lose employer coverage. While you have eight months to enroll in Medicare once this happens, you’ll need to plan ahead to avoid a coverage gap. 

If you or your spouse are not working and do not have employer coverage, you’ll need to wait to enroll during the Medicare General Enrollment Period, which runs from January 1 to March 31 every year.  

Remember that you’ll need to cancel any previous individual-market insurance once you’ve enrolled in Medicare. Make sure to discuss this with your agent so that you’re not paying double for coverage or cancelling too early.  

That said, if you’re getting a premium subsidy through the individual market, it will continue until the day before your Medicare coverage kicks off. Just make sure you enroll during your Initial Enrollment Period.

Conclusion

Enrolling into Medicare when you turn 65 is a big deal. It requires you make some important decisions about how you’ll manage out-of-pocket costs – setting the stage for your health care for the rest of your life. Choosing the right path can take some time, and lots of research, but you don’t have to do it alone.  

Need help understanding your Medicare options? Call the number on this page to talk to an Ensurem licensed agent. They’ll complete a free, no-obligation consultation to help you find Medicare solutions that match your lifestyle.  

Here’s what to expect when calling Ensurem for a consultation.  

You can also start the process online with Emma, your virtual Medicare assistant! Emma can help guide you through a needs analysis to determine what type of coverage is right for you. In many cases, she can even help you apply for coverage online.