15 Facts About Medicare Enrollment For Those about to Turn 65

Medicare eligibility begins at age 65, which means you need to understand how it works before your initial enrollment period begins. Here are 15 important facts about Medicare for those approaching age 65.

Medicare Part A and B Enrollment when Turn 65

Medicare coverage part A, which covers hospital care, is free for most people. However, Medicare part B, which covers doctors visits and outpatient care, requires a monthly premium or deductible that is currently $170.10. You will need to enroll in both parts A and B when you turn 65 to have the full benefits of Original Medicare. You can also enroll in a Medicare Advantage Plan instead.

When to sign up for Medicare

Most people become eligible for Medicare the month they turn 65. Your initial enrollment period starts 3 months before the month you turn 65, includes the month you turn 65, and ends 3 months after that month. This is the special enrollment period.

You Get Enrolled in Medicare Automatically

If you are receiving Social Security benefits when you’re first eligible for Medicare at age 65 or older, then you will be automatically enrolled in Medicare parts A and B. But if you are not receiving Social Security yet, you will need to proactively sign up in order to be part of Medicare during your initial enrollment period. So get medicare early if you’re still working and approaching age 65.

Premiums and Penalties

If you don’t enroll in Medicare part B during your initial enrollment period, your monthly part b premium may go up 10% for each year that you delay enrollment. This penalty stays for as long as you have Medicare part B. You’ll also have gaps in your health coverage until you do enroll.

Choosing a Plan

When you enroll in Medicare, you can choose between Original Medicare (parts A and B) or a Medicare Advantage Plan (part C). These plans include things like prescription drug coverage, lower out-of-pocket costs, dental and vision benefits. Make sure to research your options and compare plans during your enrollment period.

What Medicare Covers

While Medicare covers many health costs for seniors, it does not cover everything. For example, Medicare does not cover long-term custodial care, dental care, hearing aids, or vision care beyond an annual exam. You may need supplemental insurance (Medigap) or a Medicare Advantage Plan to cover these extra services.

Prescription Drug Coverage

Original Medicare does not include prescription drug coverage (part D). So if you want drug coverage, you must proactively enroll in a stand-alone Medicare prescription drug plan during your initial enrollment period or pay a penalty for late enrollment later on.

Enrolling in Medicare Advantage Plan

To enroll in a Medicare Advantage Plan or Medicare prescription drug plan, you’ll need to contact the specific insurance provider directly or use Medicare.gov during open enrollment. Coverage will then begin on the 1st day of the month after your plan gets your enrollment form.

State Assistance Programs

If you have limited income and assets when you enroll in Medicare, you may qualify for Medicaid and other state assistance programs to help cover costs that Medicare does not cover. Contact your state Health Insurance Assistance Program (SHIP) to learn more about eligibility and how to apply.

Apply for Medicare

You can apply for Medicare online at SSA.gov or by filling out a paper application (Form 40-B). Be sure to get a copy of your medical records together to include with your application. For the quickest processing, apply 3 months before you turn 65.

Understand Your Options

Take time to understand all of your Medicare options before making any decisions. This includes Original Medicare, Medicare Advantage, Medicare Supplement Plans, and prescription drug plans. Carefully comparing plans based on your needs and budget can help you choose the best coverage for your situation.

Get Help Enrolling

Don’t hesitate to get help enrolling in Medicare if you need it. Free assistance is available from your local State Health Insurance Assistance Program (SHIP), Area Agencies on Aging, and some non-profits. Using an insurance agent or broker may also make the process easier but they typically charge fees.

Consider Your Situation

Your specific situation will affect which Medicare option is best for you. Consider factors like the medications you take, your health needs, your budget,the providers that you prefer, and whether you want dental, vision, and hearing coverage in addition to standard home health and medical benefits.

Develop A Plan to receive Medicare Benefits

Use the months leading up to your 65th birthday to develop a Medicare Plan. Gather information, compare options, and get answers to any questions you have. Ask family members for advice if they are already on Medicare. The more prepared you are, the easier the enrollment process will be.

Don’t Procrastinate

Many people wait too long to look into Medicare and end up rushing their enrollment at the last minute. To avoid this, put Medicare on your to-do list now and start researching your coverage choices. The sooner you understand the basics, the more control you’ll have over choosing the right plan when the time comes.

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