Medicare and You. What to do Before Your 65th Birthday.

What You Need to Know about Medicare Before 65

Medicare is the U.S. government’s health insurance for people 65 and older, and it pays up to 80% of most healthcare expenses.

When Should I Start Looking at Medicare Options?

Start checking out Medicare options well before your 65th birthday. Figuring out the coverage you need can be a lengthy process and will depend on whether you’re still working or retired, or you have insurance through a different program. 

Medicare.gov, the official U.S. government site for Medicare, provides detailed information about your options as well as what you want to consider when choosing your coverage, but you have two primary choices of Medicare coverage.

(1) Original Medicare, which includes Part A and/or Part B. Basically, Part A is hospital insurance, and Part B is medical insurance. Medicare provides the coverage; you can choose any doctor, hospital, or provider that accepts Medicare; and you usually have a deductible and coinsurance. For most people, Part A does not require a premium. Part B’s standard premium for 2020 is $144.60 or higher depending on income.

Medicare Supplement insurance works hand-in-hand with Original Medicare to pay for out-of-pocket expenses not covered by Medicare.

(2) Medicare Advantage (MA), also known as Part C, is provided through private insurance companies approved by Medicare and includes both Part A and Part B insurance. Your premium for an MA plan is in addition to your Part B premium, but it may have lower out-of-pocket costs than Original Medicare. 

What About Prescription Drug Coverage?

If you have Original Medicare, and you also want prescription drug coverage, you have to join a Medicare Prescription Drug Plan (Part D). 

Most MA plans also offer prescription drug coverage, and if you have an MA plan and want prescription drug coverage, you must get it through your MA insurance provider.

When Do I Enroll in Medicare?

Applying for Medicare when you turn 65 is not the best plan. Your Initial Enrollment Period for Medicare is the 3 months before your 65th birthday, the month of your birthday, and 3 months after your birthday (7 months total). 

If you miss your initial enrollment, you can apply during general enrollment (January 1 – March 31). However, your coverage does not go into effect until July of that year. 

In specific situations (for example, you have coverage with an employer), you may delay enrolling in Medicare and enroll during a special enrollment period.

Medicare also has an open enrollment period from October 15 to December 7. This is when you can switch plans or join or drop prescription drug coverage.

Keep in mind, if you don’t sign up for Medicare when you’re eligible and you didn’t have other insurance, you can still apply, but you may face a penalty for late enrollment and see a 10% increase in your Medicare Part B premiums for every year-long period you’re eligible but don’t enroll. 

When it comes to your Medicare enrollment options, be thorough. Even If you think you’ll be enrolled automatically, still doublecheck to make sure well before your 65th birthday. 

I Have Private Insurance…Do I Have to Sign Up for Medicare?

If your employer doesn’t require you to sign up at 65, you don’t need to enroll in Medicare, nor will you be penalized for not signing up during your initial enrollment period. 

Once you apply for Medicare, it becomes your primary health insurance. 

Does Social Security Impact Medicare?

It may. In some cases, you may be automatically enrolled in Medicare Part A and/or Part B when you turn 65. Once you sign up for Social Security (which can begin at age 62), it’s mandatory to enroll in Medicare Part A. Medicare Parts B, C, and D remain optional, and you can delay enrollment if you have other creditable coverage.

What if I Want Supplemental Coverage?

If you choose Original Medicare, and you want help paying for out-of-pocket costs not covered by Medicare, you can get a Medicare Supplement (also known as Medigap) policy from a private insurer, like SGIC. Medicare Supplement plans can help pay for:

  • Coinsurance (what you are responsible to pay after your insurance has paid your benefit)
  • Co-payments (the amount you pay when you have a doctor’s visit or otherwise seek care)
  • Deductibles (the money you pay before your health insurance benefits apply)

Medicare Supplement Open Enrollment begins the first day of the month you are both 65 or older and enrolled in Medicare Part B; it lasts 6 months.

If you apply for Medicare Supplement after your Open Enrollment ends, you risk rejection or higher premiums based on your health history.

For more information on SGIC’s Medicare Supplement policies, please contact a licensed representative today at (833) 552-0828 for a benefits review. 

Want to learn more about Medicare and your options? Check out these articles on our blog:

How Medicare Works with Other Insurance

How a Medicare Supplemental Insurance Policy Can Save You Money

Click here for more information on Medicare and Medigap. SGIC is not connected with or endorsed by the U.S. Government or Federal Medicare Program.)


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