You’re turning 65 and you may be looking forward to a number of different things: retirement, spending more time with your family, traveling, etc. Turning 65 may also be a significant year for you as it may be the first year that you’re eligible for Medicare. Medicare is the government health insurance program that provides hospital (Part A) and medical (Part B) insurance to people 65 and older and some under 65 who qualify because of a disability.
Medicare Part A and Part B are called Original Medicare.
What’s the difference between Medicare Part A and Medicare Part B coverages?
Part A is the hospital services part of Medicare. This benefit covers inpatient care, hospital stays, skilled nursing facility care, hospice care, and medically needed home health care services.
Part B is the medical services part of Medicare. It covers many of the medically necessary services not covered in Part A, such as outpatient and preventive services. This involves things like x-rays, bloodwork, doctor’s visits, and outpatient care. It will also cover other medical items such as diabetic test strips, nebulizers, and wheelchairs.
Medicare Part A and Part B do not cover:
- Long-term care (i.e. nursing homes)
- Most dental care (i.e. dentures)
- Eye exams for prescription glasses
- Cosmetic surgery
- Hearing exams and hearing aids
- Routine foot care
- Health care outside of the Us
When should I sign up for Medicare?
You may be automatically enrolled in Medicare when you become eligible. Learn the difference between signing up for Medicare automatically and manually. It is a good idea to sign up for medicare at least 90 days before you turn 65.
Signing up for Medicare automatically
You may be automatically enrolled in Medicare if you:
- Are already getting retirement benefits from the Social Security Administration
- Are already getting retirement benefits from the Railroad Retirement Board
If you are signed up for Medicare automatically, your Medicare card will be mailed to you three months before your 65th birthday. Your Medicare benefits will start on the first day of the month you turn 65. If your birthday is the first of the month, your benefits will start on the first day of the previous month. You can be sure that you address is updated for Medicare by going to your My Social Security account online.
Signing up for Medicare manually
If you don’t get Medicare automatically, you can manually sign up for Medicare. To sign up for Medicare manually, you can:
- Visit Social Security’s website and you can apply for Medicare when you are ready to start receiving retirement benefits.
- Call Social Security at 1-800-772-1213, Monday through Friday, from 7AM to 7PM.
- Apply in person at your local Social Security office. If you worked for a railroad, you can apply for Medicare through the Railroad Retirement Board at 1-877-772-5772, Monday through Friday, from 9AM to 3:30PM.
Late-Enrollment Penalties to Avoid
You might not be getting retirement benefits when you turn 65 because you are still working. In this case, you will have to sign up for Medicare when you retire and lose your employer’s health care coverage. When your employer coverage ends, you should have a special enrollment period to sign up for Medicare Part B without receiving a late-enrollment penalty.
What is the penalty? Your monthly premium for Part B will go up 10% for each full 12- month period that you could have had Part B but didn’t sign up for it. Similarly, your Part A monthly premium may go up by 10% if you didn’t enroll when you were first eligible. However, most people qualify for premium-free Part A and therefore are also exempt from the Medicare Part A late-enrollment penalty.
Medigap Plans and Alternatives to Original Medicare
Here Are Your Healthcare Options
When you are eligible to sign up for Medicare at 65 you are going to need additional coverage in addition to Original Medicare (Part A and Part B) to help cover some of the things Medicare does not cover.
This would include:
- Medicare Supplement Insurance (Medigap) plans: Medicare Supplement insurance plans help pay out-of-pocket costs such as copayments, coinsurance, and deductibles. You have a “Seven month Medicare Supplement Open Enrollment Period” that begins the 3 months before you turn 65, the month of your birthday and 3 months after you turn 65. You also have to be enrolled in Medicare Part B.
- Medicare Part D: Medicare Part D is prescription drug coverage. Original Medicare generally doesn’t cover most of the prescription drugs you take at home which is why some Medicare beneficiaries chose Part D coverage. You have a 7-month Initial Enrollment Period for Part D which starts three months before the month you turn 65, includes the month you turn 65, and lasts three months after the month you turn 65. (You will also pay an additional penalty on Part D prescription drug coverage if you do not sign up during your special enrollment period if you apply at a later
- Medicare Advantage / Part C: Is an alternative way to get your Part A, Part B & Part D benefits from a private insurance company. Medicare Advantage plans must cover everything that Medicare Part A and Part B cover, with the exception of hospice care, which is still covered by Medicare Part A. Most Medicare Advantage plans do include prescription drug coverage along with additional benefits. The Medicare Advantage Initial Enrollment Period is the same as the Medicare Part D Initial Enrollment Period, which is 7 months. It starts three months before you turn 65, includes the month of your 65th birthday, and ends three months after your 65th birthday
You Have “Two Options” for Your Health Insurance after Enrolling In Medicare
1. Keep Parts A & B and stay with original Medicare and, Medicare will be your primary insurance coverage and enroll in a Medicare Supplement plan and Part D prescription drug coverage.
2. Or Choose Part C and have a Medicare Advantage plan as your primary insurance coverage and let a Private Insurance Company manage Parts A & B instead of Medicare. Most advantage plans will include prescription drug coverage.
Our office offers both plan options because we work with both Medicare Supplement and Medicare Advantage insurance companies. We will help provide you with an unbiased review of each option to help you determine which plan either a Medicare Supplement or Medicare Advantage is best for you.
If you still have questions regarding Medicare or need help in finding the right health coverage Contact our office. We can help answer all your questions about Medicare.