Learning Center > Aging Into Medicare & Medicare Planning for Retirement

Aging Into Medicare & Medicare Planning for Retirement

Are you turning 65? Turns out, you’ll be joined by thousands of birthday buddies.

In fact, 10,000 Americans turn 65 every day - a real cause for celebration, whether it’s the milestone of retirement or your journey to the right Medicare coverage.

Still, many Americans are confused by Medicare: how to enroll, when their enrollment period is and what plan to even enroll in. But the process doesn’t need to be so complex. Here’s your Medicare checklist for turning 65.

1. Make Sure You Qualify For Premium-Free Medicare Part A

Most people qualify for Medicare Part A because of their work history. If you’re a U.S. citizen or permanent legal resident, you qualify for premium-free Part A as long as you have paid payroll taxes for at least 10 years.

Call your local Social Security Office to see if you’re eligible for Medicare Part A. You may receive a paper statement from SSA [sample here] as a reference, or you can create an account online at ssa.gov.

What If You Didn’t Work Enough?

You may still qualify for Medicare Part A through your spouse if you don’t (or won’t) have 40 quarters of work history. You’re eligible if your spouse qualifies for premium-free Part A, and:

  • You have been married for at least one year and your spouse is eligible for Social Security benefits.
  • You're divorced and your former spouse is eligible for Social Security benefits. You must have been married at least 10 years, and you must be single now.
  • You’re widowed, but were married for at least nine months, and you are currently single.

If you don’t meet any of these criteria, you can either continue working until you’ve logged 40 quarters, or pay for Part A. For 2020, the Part A premium is $458 per month, but this amount may be reduced if you have some work history.

2. Figure Out When You’re Going To Need Part B

If you are currently employed and you are covered by an employer health plan, and your employer has more than 20 employees, you don’t have to sign up for Part B until you retire and give up your employer-based health coverage.

Many people can’t take full Social Security benefits until age 66, so it’s common to delay retirement by a year. You can delay Part B as long as your employer coverage meets Medicare’s minimum requirements.

But if you work for a small company with less than 20 employees, you’ll probably need to enroll in Part B when you’re first eligible. Be sure to talk about this with your employer before your 65th birthday. There’s no reason to pay the Part B premium until you’ll actually need Medicare.

3. Decide When You’re Taking Social Security

There are a few nuances to receiving Social Security and how it impacts when you can enroll in Medicare Parts A and B:

  • If you take Social Security at age 65, your enrollment in Medicare will be automatic.
  • If you pass on Social Security at age 65, but want to sign up for Medicare, you’ll have to apply for it separately.
  • You can use ssa.gov to enroll if you choose to enroll before your 65th birthday.
  • If you wait until after you’re 65, you’ll have to visit a Social Security office to sign up for Medicare.

4. Know Which Doctors You Want To See When You Have Medicare

Make sure the doctors you see, or want to see, accept Medicare. Finding out ahead of time can help you avoid surprises.

If you plan to move during your retirement, it’s wise to get recommendations for doctors in your new hometown and see if they accept Medicare patients.

5. Get A Firm Understanding Of Your Medications

When it comes to medications and aging into Medicare, there are 3 steps to take:

  • You should always know your medications and their doses.
  • Talk to your doctor about generic versions of your prescriptions to reduce costs.
  • Find out if your doctor thinks you might need a new or different medication in the future.

6. Understand The Gaps In Original Medicare

Medicare doesn’t cover 100% of your health care costs. Instead, you’ll pay a portion out of your own pocket. The costs you pay for Part A differ from what you’ll pay for Part B.

Gaps In Medicare Part A

Part A will cover you for inpatient type of events, like:

  • Hospital stays
  • Home health care
  • Hospice
  • Skilled nursing facilities

When you have a hospital stay, you’ll have to pay the Part A deductible. For 2020, the deductible is $1,408. You’ll pay this inpatient hospital deductible each time you are admitted to the hospital, provided you haven’t received hospital or skilled nursing facility services within the previous 60-day benefit period.

Gaps In Medicare Part B

Part B of Original Medicare covers the services you’d receive in an outpatient setting, including:

  • Doctors and therapy appointments
  • Lab work and diagnostic imaging
  • Outpatient surgeries
  • Medical equipment like oxygen machines
  • Some cancer treatments like chemotherapy

When you use Part B coverage, you can expect to pay out of pocket for each service. Your share of cost can include:

  • Part B deductible: $198 for 2020 (you only pay the Part B deductible once each year).
  • Part B coinsurance: 20% of the cost for each service or procedure.
  • Part B excess charges: Up to 15% of the Medicare-approved charge if your doctor does not accept the Medicare-approved amount for a service (known as Medicare assignment).

The biggest Part B expense is the 20% coinsurance, which you’ll pay throughout the year. There are other costs you can expect to pay out of pocket with Original Medicare, including things like dental care, eye exams, hearing aids, and more.

Keep in mind that there is no cap on how much you can spend out of pocket with Original Medicare.

How To Find The Right Medicare Plan For You

Make sure any Medicare plan you consider:

  • Covers the doctors you want to see
  • Covers the medications you need
  • Has a premium you can afford

You can also narrow your choices down further by asking yourself:

  • Do I intend to split my time between two or more States?
  • Am I comfortable with an HMO-type arrangement, or using a set group of doctors and facilities?

If you spend a lot of time travelling or living in a second home, you’ll want to consider Medicare Supplement Insurance. But if you’re comfortable with a particular HMO-type medical group and plan to live in one place, then Medicare Advantage could be right for you.

Your Options Beyond Original Medicare

There are Medicare plans available that help close the coverage gap of what Original Medicare doesn’t cover. They include:

  • Medicare Advantage
  • Medicare Part D (Prescription Drug Plans)
  • Medicare Supplement (Medigap)

Medicare Advantage Plans

Medicare Advantage plans, also known as Medicare Part C, is a contract between a private insurer and Medicare. These plans must cover everything that Original Medicare covers.

Medicare Advantage plans work like traditional private health insurance, so you may see certain out-of-pocket costs with Medicare Advantage, including:

  • Monthly premium: Many Part C plans don’t have a monthly premium.
  • Annual deductible: Most plans don’t have a deductible.
  • Copayments or coinsurance for services and procedures.

Medicare Advantage plans also offer a number of added benefits, which vary by state and health plan. Some benefits include:

  • Fitness programs like Silver Sneakers or free memberships to local gyms.
  • Vision coverage for exams, lenses, and sometimes frames.
  • Hearing coverage for exams and discounted hearing aids.
  • Dental coverage for basic dental services.
  • Transportation to and from medical appointments
  • Prescription drug coverage (some plans)

Medicare Advantage plans can also provide emergency coverage outside the United States. With the international coverage, out of pocket maximum protection, and a wide range of extra benefits, you can see why many people choose Medicare Advantage plans.

Prescription Drug Plans

Prescription Drug plans (PDPs or Medicare Part D) help with the cost of prescription drugs. Each company creates their PDPs differently, but you can expect to pay these costs for coverage:

  • Monthly premium, which varies based on income
  • Annual deductible (although many plans don’t have a deductible)
  • Copayment or coinsurance per filled prescription

The copayments and coinsurance costs increase as the total amount your plan pays rises above certain thresholds, also known as coverage stages:

Coverage Stage 1 – Deductible Stage: You pay full price until you’ve spent $435 (for 2020).

Coverage Stage 2 – Initial Coverage Stage: You pay small copayments or coinsurance for each prescription.

Coverage Stage 3 – Coverage Gap Stage: Also known as the Medicare “Donut Hole.” Once your total drug costs (what you’ve paid plus what your plan has paid) exceed $4,020, you hit the coverage gap. You’d then pay 25% of the cost of prescriptions.

Coverage Stage 4 – Catastrophic Stage: Once your total drug costs (excluding what your plan has paid) exceed $6,350, you pay no more than 5% for medications

These coverage stages reset on January 1 each year. But it’s important to know that there is no out-of-pocket cap on drug costs under Part D.

Medicare Supplement Insurance

Medicare Supplement Insurance, also known as Medigap, is designed to fill the gaps in Original Medicare. Medigap supplements Original Medicare by paying some or all of the expenses that you’d normally have to pay out of pocket.

Medigap policies are issued in 10 standardized plans: A, B, C, D, F, G, K, L, M, and N. Each of these plans cover a slightly different portion of the Original Medicare gaps.

Plan G is a popular Medigap option that covers every gap except for the Part B deductible. If you have Plan G, you can expect to pay for the first $198 in Part B expenses (like doctor’s visits). Plan G will then cover every penny of any Medicare-approved service or procedure.

Several Medicare supplements provide some international coverage, including plans C, D, F, G, M, and N.

Medigap plans also give you maximum flexibility, so you can see any doctor or use any facility that accepts Medicare patients, anywhere in the United States. You’re not bound to a network, or reliant upon referrals.

Medicare Supplement Insurance plans don’t cover prescription drugs, so you’ll need to enroll in a stand alone Prescription Drug plan to get drug coverage.

Considerations Before Choosing A Plan

Make sure any Medicare plan you consider:

  • Covers the doctors you want to see
  • Covers the medications you need
  • Has a premium you can afford

You can also narrow your choices down further by asking yourself:

  • Do I intend to split my time between two or more States?
  • Am I comfortable with an HMO-type arrangement, or using a set group of doctors and facilities?

If you spend a lot of time travelling or living in a second home, you’ll want to consider Medicare Supplement Insurance. But if you’re fine with HMO-type medical groups and plan to live in one place, then Medicare Advantage could be right for you.

As you approach age 65, it’s important to start your research sooner rather than later. Make sure you know what plans your doctors will accept, and which plans cover your medications.

Comparing Medicare plan features and costs doesn’t have to be complicated though. You can get Medicare quotes through our site. Or you can call 800-620-4519 to reach one of our licensed Medicare agents who can guide you through your Medicare plan options.

Get a Free Quote

Get a Free Quote

What you should read next

If you’re approaching your 65th birthday or caring for an older relative, you may be wondering how to apply for Medicare. Do you have to apply specifically, or is coverage provided automatically? What form(s) do you need? The answer depends on your unique situation and medical needs. In this article, we’ll help you understand how to apply for Medicare in a variety of situations. How To Apply For Medicare Part A and B? Medicare Part A is hospital insurance, while Medicare Part B is medical insurance. For most Americans with sufficient work history, there’s no monthly premium associated with Part A coverage. There is a monthly cost for Medicare Part B. Curious how to apply for Medicare Part A? You may not need to! You’ll receive Medicare Part A and B automatically without applying if you’re receiving Social Security or Railroad Retirement Benefits (RRB) for at least four months before you turn 65. If you’re not receiving Social Security benefits before you turn 65, you’ll have to enroll with Social Security to get the coverage you need. If you’re still working and have a group health insurance plan when you become Medicare-eligible, you can choose to delay enrollment in Medicare Part B without later paying a penalty when you enroll. When your group health insurance plan ends, you can apply online or by using the Part B enrollment form. If you have qualifying disabilities and you’re under 65, you’ll receive Part A and Part B automatically after you’ve received Social Security disability benefits for 24 months. If you have ALS (Lou Gehrig’s Disease), you’ll automatically get Medicare Parts A and B the month your disability benefits begin. Finally, if you have End-Stage Renal Disease, Medicare benefits are optional. If you want them, you will need to sign up by contacting Social Security. How To Apply For Medicare Part C & D Medicare Part C, also known as Medicare Advantage, is an all-in-one replacement for Original Medicare and includes additional benefits. For instance, most Medicare Advantage plans include prescription drug coverage, and some include vision, dental, and other benefits. You can purchase Medicare Advantage plans directly from private insurance companies. The plans vary in terms of price, benefits, and medical network. That’s why it’s important to get multiple quotes and compare your options before you make a decision. Medicare Part Dis an optional add-on that you can have in addition to Parts A and B. Part D, also known as a Medicare drug plan, provides prescription drug coverage and costs an additional monthly premium. How to Apply for Medicare Part D You can apply for Medicare drug plans using the Medicare Plan Finder tool or by calling the provider directly. Applying For Medicare FAQs As you review your Medicare options, you may find that you have a few questions. Here are some of the most common concerns we hear. What Documents Do I Need To Apply For Medicare? If you’re automatically enrolled in Medicare Part A and B, you won’t need any additional documentation. However, if you enroll yourself, you will need to provide your date and place of birth and information on any current health insurance, whether that’s Medicaid, private coverage, or group coverage from your employer. How Do I Sign Up For Medicare Online? Signing up for Medicare online is the easiest option if you aren’t automatically enrolled. Find and compare Medicare plans online. Learn More About How to Apply for Medicare With its various parts and enrollment dates, navigating Medicare can be a challenge. We’re here to make it easier for you. Contact us to speak to a licensed insurance agent who can answer all of your Medicare application questions.
Read More »

Medicare was originally designed for individuals who had retired from the workforce. As a result, the standard was set that you qualify for Medicare when you’re 65 years old. However, there are now additional ways to qualify for Medicare. Younger people with qualifying disabilities can also be eligible, along with individuals with end-stage renal disease. If you meet certain qualifications, you can get Medicare Part A for free, but Medicare Part B comes with a monthly premium. It’s important to understand who is eligible for Medicare Part A and Part B and who is not eligible for Medicare so you get the benefits you understand your medical benefits and costs. Medicare Eligibility Requirements There are a variety of requirements to be eligible for Medicare, especially if you want Part A with no monthly premium. Below are some of the more specific details on Medicare eligibility requirements. To qualify for Medicare you need to: Be a U.S. citizen or permanent legal resident who has been in the U.S. for at least five years Be 65 or older You can qualify for Medicare if you’re under 65 but have a qualifying disability or end-stage renal disease Who Qualifies for Premium-Free Medicare Part A? You can get Medicare Part A without a premium if: You are 65 or older and you or a spouse worked and paid Medicare taxes for at least 10 years You receive benefits from Social Security or the Railroad Retirement Board You or your spouse had government employment that was Medicare-covered Who Can Apply For Medicare Part A and Part B? Anyone who meets the eligibility requirements can apply for Medicare coverage. Your initial enrollment period begins three months before your 65th birthday and lasts seven months. If you sign up during the first three months of your enrollment period, your Medicare coverage will go into effect the first day of the month you turn 65. If you qualify for premium-free Medicare Part A and you are receiving Social Security benefits when you become eligible for Medicare, your Part A coverage will begin automatically when you turn 65. . If you’re not receiving benefits, you can still get Medicare Part A on time by enrolling online or contacting Medicare directly. While Part A may be automatic for some, all individuals must apply to enroll in Part B. You can sign up for Part B during your initial enrollment period that occurs around your entitlement to Part A, and then generally only between January 1 and March 31 of each year (unless you have delayed because you continue to work). . If you don’t apply for Medicare Part B when you’re eligible, you’ll most likely have to pay a late enrollment penalty. If you have to pay for Medicare Part A, it follows the same rules as Medicare Part B. You can only enroll at specific times, and you have to sign up. Who can Apply for Medicare Online? Any qualifying individual can apply for Medicare online, however, you can only sign up during the initial enrollment period and then between January 1 and March 31 of each year. Medicare Eligibility FAQs Here are a few common questions we hear about Medicare eligibility: Can I Get Medicare at 62? Some people begin to claim retirement benefits from social security at age 62 and might wonder if they can also get Medicare benefits at that time. Generally, the answer is no. You can only get Medicare before age 65 if you have been on Social Security disability for at least two years, have ALS (Lou Gherig’s disease), or suffer from end-stage renal disease. Can You Get Medicare If You’ve Never Worked? If you haven’t worked, you can still qualify for Medicare, but you may have to pay a monthly premium for both Medicare Part A and Part B. You may still be able to get Medicare Part A premium-free if your spouse worked, or if you have specific disabilities or medical conditions. Who Can Get Premium-Free Medicare Part A? You can qualify for premium-free Medicare Part A if you qualify for Original Medicare and have the appropriate work history as described above (i.e. paid Medicare taxes for 10 years). Generally, you have to pay a premium for Medicare Part B, but there are options for those with limited income and limited assets. The Medicare Savings Program (MSP) can help pay your Medicare Part A and B premiums if you qualify. Learn More About Medicare Eligibility Requirements If you’re curious about your Medicare eligibility and want to talk to a licensed insurance agent, we’re here to help. Simply give us a call at 1-866-955-0898 (TTY 711) or visit our website to review your options today!
Read More »

Medicare is a health insurance program provided by the federal government. Medicare is provided for individuals who are 65 and older, as well as younger people with disabilities or end-stage renal disease. Medicare includes several parts, each of which provides coverage for specific medical needs. Original Medicare includes Part A (hospital coverage), Part B (medical coverage), and Part D (prescription medication coverage). Medicare Part C is known as Medicare Advantage. Who Qualifies for Medicare? As we mentioned above, an individual qualifies for Medicare if he or she is 65 or older. Younger individuals can qualify for Medicare if they are permanently disabled or diagnosed with end-stage renal disease. What Is The Purpose Of Medicare? Medicare is available to make health coverage accessible to older Americans age 65 and over, including those who are traditionally retired and no longer have access to employer-based health insurance. Medicare also provides coverage to those under 65 with certain disabilities to cover their health needs and associated expenses. These Americans often cannot work and don’t have access to employer coverage or other health insurance. Types of Medicare Medicare is divided into several parts, labeled from A to D: Medicare Part A is known as hospital insurance. It offers coverage for inpatient hospital care, lab tests, and surgery, as well as home health care and skilled nursing facilities. These services must be deemed medically necessary to be covered by Medicare. You may have to pay a deductible or coinsurance Medicare Part B is used for medical visits to a doctor. Medicare covers medically necessary services and preventive services. Each Medicare participant pays a monthly premium for Medicare Part B and there may also be deductibles and coinsurance that apply, depending on the care you receive Medicare Part C is known as Medicare Advantage. This isn’t part of Original Medicare but instead is an all-in-one replacement plan. Medicare Advantage plans include hospital coverage and doctor’s visits, along with prescription drug coverage. Many also offer additional benefits Original Medicare doesn’t cover, such as vision and dental care. However, you will often need to use medical professionals within the provider’s network. You’ll pay different copayments and deductibles with Medicare Advantage than with Original Medicare, which may allow you to save money. You may also have an additional monthly premium Medicare Part D is prescription drug coverage. It helps you pay for both brand-name and generic drugs, depending on your needs. The drug plans for Medicare are offered by insurance companies and other approved private companies. If you choose Medicare Part D, you will have a separate Part D premium each month Medicare FAQ In addition to the different types of Medicare, qualified individuals, caregivers, and loved ones often have questions about Medicare coverage. Here are some additional Medicare FAQ and answers. What Does Medicare Cover? Medicare covers a wide variety of healthcare services. The specific coverage depends on the Medicare policy you choose. Services covered by Medicare include: Ambulance services Anesthesia Artificial eyes & limbs Bariatric surgery Blood processing & handling Cardiac rehabilitation programs Cardiovascular disease screenings Cervical & vaginal cancer screenings Chemotherapy Depression screenings Diabetes prevention programs Diagnostic tests (laboratory and non-lab) Eye exams (routine) Eyeglasses & contact lenses Flu shots Foot care Hearing aids Hepatitis B and HIV screenings Inpatient hospital care Kidney transplants Lung cancer screenings Mammograms Mental health care (inpatient and outpatient) Occupational therapy Opioid use disorder treatment services Organ transplants Pain management Prescription drugs (outpatient) Preventive & screening services Radiation therapy Sexually transmitted infections screenings & counseling Sleep studies Surgery Urgently needed care X-rays Yearly "wellness" visits Do I Need Medicare if I Already Have Health Insurance? Whether or not you need Medicare if you already have health insurance depends on your individual medical needs. You may need Medicare even if you already have other health insurance if your current plan doesn’t meet the minimum coverage requirements. Most plans offered by employers meet these standards. So if you have insurance through your job, you probably don't need Medicare. However, by staying on an employer plan, you can delay enrolling in Part B without a penalty and avoid paying Part B premiums. An important note: When you have Medicare plus additional insurance policies, each provider becomes a "payer." The policy that pays for your specific medical services first depends on the coordination of benefits rules for your plans. In other words, the primary payer will pay what it owes on your medical bills first, then the provider will send the remaining amount to the secondary payer to pay the rest. What is the Difference Between Medicare and Medicaid? Medicare is a federal health insurance program for older Americans and those with disabilities regardless of income. Medicaid is a state-based health insurance program for lower-income Americans that need help paying for medical care. To learn more about costs, eligibility, and coverage, visit this guide to Medicare vs. Medicaid. Who Do You Call for Medicare Questions? If you have additional questions about Medicare and what it covers, you can call 1-866-955-0898 (TTY 711) to speak with one of our licensed insurance agents. Agents are available Monday - Friday from 8am - 9pm and Saturday - Sunday 10am - 5pm ET. Where Can I Get Free Medicare Advice? For information on Medicare coverage, open enrollment, the different types of Medicare, and more, visit our Medicare learning center. For specific Medicare questions, contact us to speak with a licensed insurance agent. Learn More About Medicare Medicare is a valuable way to cover your healthcare costs if you are older or disabled. To compare your options and find the right Medicare plan in your area, visit our Medicare plans page today!
Read More »

Healthinsurance.com LLC is a commercial site designed for the solicitation of insurance from selected health insurance carriers. It is not an insurer, an insurance agency, or a medical provider. You may obtain a complete list of available Medicare plans by contacting 1-800-MEDICARE (TTY users should call 1-877-486-2048), 24 hours a day/7 days a week or consult www.medicare.gov.

This site is not maintained by or affiliated with the federal government’s Health Insurance Marketplace website or any state government health insurance marketplace.