To be eligible for Medicare, you must be a U.S. citizen or legal resident who has lived in the country for at least five consecutive years. Additionally, you must be at least 65 years old or have a qualifying disability.

Because you are turning 65, you are entering the first enrollment period of Medicare called the Initial Enrollment Period. This is your first opportunity you have to enroll in Medicare. It begins three months before the month you turn 65 and ends three months after the month you turn 65. The Initial Enrollment Period is one of the most important times because you have the most options at this time and can get the best premiums when you enroll.

If you delay enrollment in Medicare because you are covered by an employer-sponsored health insurance plan, you can enroll during a Special Enrollment Period which lasts for 8 months after employer-sponsored coverage ends.

If you miss thess enrollment windows, there are two enrollment periods during the year: Open Enrollment &  General Enrollment.

Open Enrollment runs from October 15th to December 7th every year. During that time you can join, switch, or drop a plan. Coverage will then begin January 1st of the following year.

General Enrollment runs from January 1st to March 31st every year. If you are enrolled in a Medicare Advantage Plan, you can switch to a different Medicare Advantage Plan or switch to Original Medicaare once during this period.

There are four parts of Medicare Coverage: Part A, Part B, Part C, and Part D. Each part covers something different.

Part A: Hospital Insurance

Part A provides coverage for inpatient hospital stays, skilled nursing facility care, hospice care, and home health care. If you paid Medicare taxes while you were working, you don’t have to pay a monthly premium for Part A. If neither you nor your spouse paid Medicare taxes then a premium may apply.

Part B: Medical Insurance

Part B covers medically necessary services, such as doctor visits, lab tests, preventive services, and durable medical equipment that Part A does not cover. Part B is optional and does require you to pay a premium each month. Most people pay a standard premium amount and Social Security will notify you if you have to pay more due to income. It is important to sign up for Part B when you are first eligible. If you don’t, you may have to pay a late enrollment penalty.

Part C: Medicare Advantage

Part C is also known as Medicare Advantage, which is offered by private insurance companies approved by Medicare. It provides all the benefits of Parts A and B, as well as additional benefits such as dental, vision, and hearing. If you choose to get a Medicare Advantage Plan you will also want to make sure that it includes Medicare Prescription Drug coverage (also known as Part D). The cost for a Medicare Advantage plan can vary significantly since the level of benefits, out of pocket costs, and rules around how you get services vary by both carrier and plan type. It pays to shop multiple plans to find the best coverage for your needs. The rules and plans can change each year as well so it is important to check out your options every year once you start on one of these plans.

Part D: Prescription Drug Coverage

Part D provides coverage for prescription drugs. It is offered by private insurance companies approved by Medicare.

Medicare Supplement Plans

Though technically not an official part of Medicare, it can be an important part of your Medicare decision. A Medicare Supplement Plan works just like the name implies, it is a supplement to your Medicare plans. It helps to cover your healthcare costs like copayment, deductibles, and coinsurance.

When choosing a Medicare plan, you have several options. You can choose Original Medicare, which includes Parts A and B, and add a standalone Part D plan. Or, you can choose a Medicare Advantage plan, which includes Parts A, B, and often D, as well as additional benefits.

The most popular choices for those new to Medicare are a Medicare Supplement Plan or a Medicare Advatange Plan

Medicare Supplement Plans, also called Medigap Plans, are sold by private insurnace companies and are designed to work with Original Medicare Parts A & B to help share some of the health care costs that already covered. The help close the “gap” by reducing your expenses on copayments, coinsurance, and deductibles.

Medicare Advantage Plans are sold by private insurance companies and include the coverage in Medicare Parts A & B, along with additional benefits like prescription drug coverage and other wellness benefits like vision and dental insurance.

Medicare costs vary depending on the type of plan you choose. For Original Medicare, there is no premium for Part A coverage if you or your spouse paid Medicare taxes while working. However, there is a monthly premium for Part B coverage, which is based on your income. Medicare Advantage and Part D plans have their own premiums, deductibles, and copays.

Getting Medicare insurance at the age of 65 can be overwhelming, but understanding the eligibility requirements, enrollment periods, coverage options, and costs can help make the process easier. Whether you choose Original Medicare, Medicare Advantage, or Medicare Supplement Plans be sure to choose a plan that meets your individual healthcare needs and fits within your budget. Remember to take advantage of additional Medicare benefits and resources to ensure you have the coverage and support you need.

One of the best ways to be sure you are getting the right plan is to talk with a Licensed Insurance Agent, especially when making your initial entry into Medicare. They are trained professionals who specialize in understanding the plan options available and can guide you on what might work best for you. The best part is talking to them is easy and there is no obligation to buy anything from them. They can provide you with free quotes for all the plans that are out there and give you the confidence to pick from plans that suit your needs and budget.

Still Unsure or Want More Guidance?

To help with the process of understanding your Medicare Options we have also developed a comprehensive guide that you can review.