Learning Center > Turning 65? Age into Medicare with these tips

Turning 65? Age into Medicare with these tips

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 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 find and compare Medicare quotes or enroll in a plan through our site. We also have licensed Medicare agents available to help answer any questions you may have.

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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.