Medicare eligibility begins three months before age 65 for most people. (If you were born in 1955 or earlier you can join the ranks of Medicare beneficiaries this year.) Here’s what you need to know about turning 65 and signing up for Medicare for the first time.
1. Find Out Your Medicare Initial Enrollment Period Dates.
You have a set time period when you can first sign up for Medicare (unless you qualify to delay). It’s called your Initial Enrollment Period and lasts 7 months. Your Medicare Initial Enrollment Period (IEP) is based on your 65th birthday and includes the below.
- The 3 months before your 65th birthday month
- The month you turn 65
- The 3 months after
Special Note About Automatic Medicare Enrollment
You are automatically enrolled in only Part A and Part B at age 65 if you are receiving Social Security or Railroad Retirement Board benefits. You still will want to use your IEP to make further coverage choices such as for a Medicare Advantage (Part C) or Part D prescription drug plan.
If you’re not receiving these benefits, you will need to sign up for Medicare yourself online, in-person, on the phone or at your local Social Security office.
2. Find Out If You Can Delay Enrolling in Medicare.
You may be able to delay enrolling in Medicare Part B, or both Parts A & B, and postpone paying Medicare costs if you either (1) are going to work past 65 and have creditable employer coverage, or (2) you have creditable coverage through a spouse’s employer.
In either of these situations, you may qualify to delay. You’ll need to check with the employer’s benefits administrator to find out all of your options.
Keep in mind that there is a penalty for late enrollment for Part B and Part D unless you qualify for a Special Enrollment Period when your employer coverage ends.
3. Learn About the Different Ways to Get Medicare Benefits
There are two ways to get Medicare Part A and Part B benefits, and a total of seven different ways to combine all the different parts of Medicare to create comprehensive coverage.
To get Medicare Parts A & B, you can either choose to get your benefits through Original Medicare or a Medicare Advantage plan.
Original Medicare (Parts A & B) is administered by the federal government. Medicare Advantage plans (Part C) are offered by private insurance companies and provide all the same benefits as Original Medicare as well as additional benefits, such as coverage for prescription drugs and for dental, vision and hearing care – all in one plan.
Once you decide how you want to get Parts A & B, check out the different ways to combine the different Medicare parts.
4. Decide If You Want Coverage for Prescription Drugs, Dental, Vision & Fitness
Original Medicare doesn’t provide coverage for prescription drugs, dental, eye health, hearing, fitness and a few other benefits.
In most cases, if you want Medicare coverage for all of these, you’ll need to look at getting a Medicare Advantage plan. If you just want to get prescription drug coverage, you can choose to get either a standalone Part D plan or a Medicare Advantage plan with included drug coverage.
Check out different plan and benefit options in your area here.
5. Estimate Your Total Medicare Costs: Premiums & Out-Of-Pocket Expenses
What you pay for Medicare will depend on the coverage you choose and the health care services you use during the year. You may pay premiums, deductibles, copays and coinsurance. Which type of costs you pay and how much will vary based on your coverage.
A good rule here is to create estimates of your costs based on the different Medicare plan options you’re exploring. This can help you see which choice may fit your budget best.
Financial Protection Tip: With a Medicare Advantage plan your annual out-of-pocket costs are capped with an annual out-of-pocket maximum. Each Medicare Advantage plan sets its own cost terms, and every plan must set an annual out-of-pocket maximum. After the maximum, the plan pays 100% for all Medicare-covered services. Original Medicare doesn’t provide this. Neither do Part D plans.
Turning 65 Soon?
Just like your 65th birthday, Medicare enrollment can sneak up on you. Use the tips above and the exclusive resources available here to get a head start on learning about Medicare basics, enrollment, coverage options and more so you can make an informed decision when the time comes.