Signing up for Medicare at 65: What you need to know

Make the best decisions for your health coverage with Medicare ABC's (and D's)

Medicare at 65: Multi Generation Family Celebrating Birthday In Garden

You become eligible for Medicare at age 65 or with a qualifying disability. It’s an important insurance milestone that can be overwhelming as you try to understand your options. Learning about how the program works will help you make the best decisions.

Signing up for Medicare at 65

Your Initial Enrollment Period begins three months before you turn 65. If you receive disability benefits, Medicare enrollment opens the 25th month of your benefits. The enrollment period continues for four months afterward.

It’s important to sign up for Medicare as soon as possible because delayed enrollment can result in penalties. There is a waiting period. You could be without insurance for up to a year if you miss the initial enrollment period.

Related: The top five Medicare mistakes

The General Enrollment Period usually runs between Jan. 1 and March 31 each year. Medicare coverage for people who enroll during this time begins July 1. People who enroll during this time may face penalties if they were eligible a year or more before enrollment. In very rare circumstances, people can qualify for a Special Enrollment Period.

If you’re currently receiving Social Security benefits, you are automatically enrolled in Medicare Part A and Part B, effective the month you turn 65.

Know the language

Medicare consists of four major programs:

  • Part A: Covers inpatient hospital services, inpatient skilled nursing facility care, inpatient blood services, home health care, and hospice care
  • Part B: Covers outpatient doctors’ services, preventive care, outpatient medical and surgical services/supplies. It also covers clinical lab tests, durable medical equipment, and diabetic testing supplies.
  • Part C: Permits Medicare beneficiaries to receive their medical care from among a number of delivery options, such as HMOs and PPOs
  • Part D: Private insurance plans covering the costs of outpatient prescription drugs

Original Medicare — Part A and Part B — pays only part of your medical costs. Part A and Part B cover many health care expenses, but beneficiaries are responsible for co-payments and deductibles. They are also responsible for prescription drugs, emergency health coverage abroad and routine dental and vision care. These gaps leave additional expenses, which is why many choose to enroll in Medicare Supplement or Medigap plans.

Medicare Supplement Plans

A Medicare Supplement is an optional policy. It helps pay for out-of-pocket-expenses like co-payments and deductibles for those who enroll in Original Medicare Parts A and B.

If you don’t purchase a Medicare Supplement when you enroll in Original Medicare at 65, you won’t be guaranteed the extra coverage.

Learn more: Medicare Supplement options from Sanford Health Plan

Signing up for Part B

If you are still working and have a health insurance plan, it’s possible you can wait to sign up for Medicare Part B. Your employer can tell you whether the plan is the primary insurer. If Medicare — rather than your employer’s plan — is the primary insurer, you will need to sign up for Part B. Even if you don’t sign up for Part B, you should enroll in Medicare Part A, which may help cover costs not covered by your group health plan.

If you don’t have an employer or union group health insurance plan, sign up for Medicare Part B during your initial enrollment period. And, if your employer has less than 20 employees, you will probably need to sign up for Part B.

What about Part C or Medicare Advantage plans?

As a Medicare recipient, you can choose a private insurance provider to manage your Medicare coverage. Most of these plans will combine your Part A, Part B and Part D coverage. Some will also provide other coverage, such as for vision, dental and hearing.

Visit Medicare.gov to learn more about Medicare Advantage plans.

Ready to switch coverage? Wait for open enrollment

Open enrollment is Oct. 15 through Dec. 7 each year. If you choose to change your coverage during that time, Medicare allows plans to evaluate your health. If you’ve developed an illness, you may be rejected or face a sharp rate increase.

Know the costs

Medicare is not free. You are required to pay annual deductibles and monthly premiums. Buy the best coverage you can afford, considering more than the cost of the premium. The cheapest premium might not provide you with the cheapest overall coverage — you’ll need to factor in co-payments and deductibles.

Avoid penalties

For every month you delay enrollment past the initial period, your premiums will increase by at least 1%. This raises your premiums for Medicare Part B and Part D for the rest of your life. Your monthly premium may go up by 10 to 12 percent for each year you aren’t enrolled.

Don’t make the mistake of assuming your health insurance will stay the same when you turn 65. Retiree plans can end, including coverage from some small workplace plans. COBRA, retiree or VA benefits plans do not count as a health insurance plan for Medicare purposes.

What about Part D?

Medicare Part D prescription coverage is more complex. You are exempt from delayed enrollment penalties if you have other drug coverage from a private insurer, as long as the coverage is as good as Medicare’s.

This marketing material is intended for informational purposes only as part of a solicitation of insurance campaign. Contact will be made by an insurance agent or insurance company. Neither Sanford Health Plan nor its agents are connected with or endorsed by any governmental entity or Medicare.

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Posted In Health Information, Health Plan, Senior Services

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