10 Things to Know About Medicare as You Turn 65
Turning 65 is a big deal—not just for the birthday cake and retirement plans, but because it marks your first eligibility for Medicare. Whether you’re already retired, planning to retire soon, or plan to keep working, understanding Medicare is essential to making the best decisions for your health and finances. Here are some important things to know as you begin your Medicare journey:
1. There’s a 7-Month Initial Enrollment Period
You can initially enroll during what is known as the Initial Enrollment Period (IEP). Your IEP will begin the three months prior to your birthday month. It includes your birthday month, and will conclude the three months after your birthday month. Missing this window can potentially lead to penalties and/or gaps in your Medicare coverage.
2. Enrolling Late Can Cost You
Missing deadlines for enrolling in Part B Medical coverage or Part D prescription coverage could result in penalties being added to your monthly premiums. It is important to enroll on time—even if you think you don’t need it—to avoid extra out of pocket costs.
3. You May Be Automatically Enrolled or You May Have To Enroll Yourself
If you’re not already receiving Social Security benefits prior to your enrollment into Medicare then you will not automatically be enrolled. You will need to process your enrollment into Medicare Parts A & B yourself through the Social Security Administration. You can do this by calling them or through the SSA website.
4. You’re Eligible at 65—Even If You’re Still Working
You are eligible for Medicare at age 65, regardless if you’re already retired. If you or your spouse are still working and have employer coverage, you may be able to delay some parts of Medicare without penalty—but it depends on the size of your employer and type of coverage. It is a good idea to check with Social Security or a licensed Medicare professional if you are not sure.
5. Medicare Has Four Parts
• Part A (Hospital Insurance): Covers inpatient hospital care, skilled nursing facility care, hospice, and some home health care.
• Part B (Medical Insurance): Covers outpatient medical care, doctor visits, preventive services, and medical supplies.
• Part C (Medicare Advantage): An alternative to Original Medicare offered by private insurers which often offers extra benefits.
• Part D (Prescription Drug Coverage): Covers prescription medications however, does not cover them fully
6. Part A Is Usually Free
If you or your spouse paid Medicare taxes for at least 10 years, Part A will typically be $0. However, Part B does have a premium, which most people pay monthly. This amount can change based on your income.
7. Medicare Doesn’t Cover Everything
Medicare doesn’t cover long-term care, most dental, vision, or hearing services. In addition there will be out of pocket costs in the form of deductibles, co-payments and co-insurance amounts. You may want to consider supplemental insurance (Medigap) or a Medicare Advantage plan to fill in the gaps.
8. You Can Choose Between Original Medicare and Medicare Advantage
Original Medicare (Parts A & B) is run by the government and allows you to see any doctor who accepts Medicare. Medicare Advantage plans are offered by private insurance companies. They include the same basic benefits as Original Medicare and additionally usually bundle in Part D, dental, vision, and other extra benefits. This is not a one time choice. You are able to make this decision at least annually during the annual Open Enrollment Period (October 15 - December 7).
9. If You Have A Part D Plan You Should Compare Plans Annually
Plan premiums and drug formularies could change each year, so it’s a good idea to review your prescription drug coverage annually during the Open Enrollment Period (October 15 – December 7).
10. There Is Help Available
Medicare can be a confusing journey—there are places that you can seek assistance. You can get help from licensed insurance agents specializing in Medicare, Medicare.gov, or your local State Health Insurance Assistance Program (SHIP).
Final Thoughts
Medicare is a major part of your health care in retirement. The more you understand it, the better prepared you'll be to choose the right coverage for your situation and avoid unnecessary out of pocket costs. As you approach your 65th birthday, use this time to explore your options and educate yourself to be able to make a confident transition into Medicare.
