Turning 65 & Medicare

To enroll, you need to contact Social Security. You can enroll over the phone by calling 1-800-772-1213 Monday through Friday between 7am and 7pm, online at SocialSecurity.gov, or in person at your local Social Security office. You can search by ZIP code for the closest office at Social Security Office Locator.

Usually, if you don’t sign up when you should, you have to pay a higher monthly premium. As these late penalties continue to increase the longer you delay enrollment, it’s important to sign up on time or as soon as you realize you’ve missed your Initial Enrollment Period.

Whether you need to sign up while you’re still working depends on the size of your employer. If you have coverage through your job or your spouse’s job and your employer has fewer than 20 employees, Medicare will be your primary insurance when you turn 65.

If you have coverage through an employer with 20 or more employees, you can usually delay enrolling in Medicare with no late penalties until you (or your spouse) retire or leave your job. Since most people who have worked for 10 years or more qualify for premium-free Part A, it makes sense to sign up as soon as you can.

If you are covered under COBRA, the delayed enrollment rules do not apply. You need to enroll during your Initial Enrollment Period to avoid late penalties.

Medicare Parts A and B (collectively known as Original Medicare) don’t cover everything. Part A covers 80% of inpatient hospital stays, care in a skilled nursing facility, hospice care, and some home health care. Part B covers 80% of your doctor visits, outpatient care, medical supplies, and preventive services. You are responsible for the other 20%.

With Original Medicare, there are other out-of-pocket expenses, such as deductibles, copays, and coinsurance. There is no dollar cap as to how much you might have to pay out of pocket in a year. Original Medicare also provides no Part D prescription drug coverage.

You can pick up prescription coverage and reduce these non-covered expenses by enrolling in a Medicare Advantage plan that includes Part D coverage or by enrolling in a Medicare Supplement plan along with separate Part D plan.

Medicare Advantage plans (also known as Part C) are an all-in-one alternative to Original Medicare. These plans cover everything covered by Parts A and B. Most Advantage plans also include Part D coverage.

• When you enroll in an Advantage plan, you must use the doctors and hospitals in the plan’s network. Out-of-network coverage will have a higher out-of-pocket cost.
• Most services require a copay or coinsurance. There is an annual out-of-pocket maximum for how much you can spend each year.
• Many Advantage plans include supplemental benefits, such as dental, hearing and vision, and gym memberships.
• Monthly premiums vary. Many insurers now offer $0 premium plans. In general, the lower your monthly premium, the higher your copays and coinsurance.
• Each insurer has its own unique drug formulary for covered drugs. Drugs are grouped into tiers that determine out-of-pocket costs such as copays or coinsurance.

Medicare Supplement plans (also known as Medigap plans) help fill coverage gaps from Original Medicare Parts A and B.

• There are 10 different standardized Medigap plans to choose from, each identified by a letter. Each plan provides a different level of coverage to supplement Original Medicare.
• There is no single best plan. You should compare plans and choose one you can afford that covers most of what you need. Some plans are not available in every state.
• Monthly premiums vary based on the plan you choose, your ZIP code, and the insurance carrier. Other factors such as your gender, marital status, and whether you are a smoker will also influence cost.
• The best time to apply for a Supplement plan is during your six-month open enrollment period, which begins during the first month you turn 65. This is the only time you have guaranteed issue rights – meaning you can’t be denied coverage.

Several factors can help determine which option is best for you, including your lifestyle, overall health, and finances. A Medicare Advantage plan can be less expensive, but you’ll need to use the plan’s network of doctors and hospitals. If you travel extensively or want to be able to see any Medicare-approved doctor or use a hospital anywhere in the country, Original Medicare with a Medigap plan might be right for you. If you have a chronic health condition or take specialty medications, you’ll need to do your due diligence to find out what coverage you’d receive under both options.

If you opt for Original Medicare, you will need to enroll in a separate Part D prescription plan during your seven-month Initial Enrollment Period.

Every fall, Medicare mails out its annual Medicare and You Official Handbook. This helpful guide includes a summary of Medicare’s benefits and has answers to frequently-asked questions. You can request the 2023 Handbook by calling 1-800-633-4227 (1-800-MEDICARE).

Medicare can be complex and confusing. The independent, licensed agents at O’Neal Insurance Group are here to help. We can help you evaluate your options and find the right Medicare coverage to suit your needs.