Becoming Medicare age is a significant milestone for many people. However, figuring out exactly when, what to do, and how to enroll might be overwhelming. If you’re turning 65 soon (or are already there), you may wonder: Is Medicare the appropriate choice for me?
The short answer? Probably—but it depends on your situation. Whether you're already retired, still working, or covered under a spouse’s insurance, there are a few key things you’ll want to consider.
Here’s what you need to know to make an informed choice about Medicare.
What Is Medicare, and What Does It Cover?
Medicare is a federal health insurance program. It mainly covers people aged 65 and older, though it also covers younger people with specific disabilities and end-stage renal disease.
Here are the four parts to Medicare.
Part A – Hospital Insurance
Most people don’t pay a premium for Part A. It helps cover hospital stays, care in a skilled nursing facility, hospice care, and some home health care.
Part B – Medical Insurance
Part B comes with a monthly premium. It helps cover doctor visits, preventive services like screenings and vaccines, outpatient health care, and durable medical equipment like wheelchairs or CPAP machines.
Together, Parts A and B are known as “Original Medicare.”
Part C – Medicare Advantage Plans
Advantage plans are private insurance plans approved by Medicare. They bundle Part A and B, and often include extras like dental, vision, or hearing coverage, prescription drug coverage, and wellness programs.
Medicare Advantage plans may vary significantly in cost and coverage. What you'll pay depends on the provider and your location.
Part D – Prescription Drug Coverage
Part D helps pay for prescription medications. You’ll need to enroll in Part D separately if you choose Original Medicare (Parts A & B) and also want drug coverage.
When Do You Need to Sign Up for Medicare?
Timing matters when it comes to Medicare, and missing a deadline could cost you. There are two main enrollment timeframes: 1) your initial enrollment period, which applies to everyone, and 2) any special enrollment period,1 which applies only in some instances.
Your Initial Enrollment Period
You may enroll during a seven-month window that starts three months before the month you turn 65. This period includes your birth month and ends three months after. For example, if you turn 65 on June 15, your initial enrollment period is from March 15 to September 15.
If you miss this window, you could face late enrollment penalties unless you qualify for a special enrollment period.
Still Working? Covered Under an Employer Plan?
If you're still working and covered by a group health plan through your employer (or your spouse’s employer), you may be able to delay Medicare Part B without paying a penalty by qualifying for a Special Enrollment Period.
If your employer (or your spouse's employer) has twenty or more employees, you’ll be eligible for a Special Enrollment Period later. This lets you enroll in Medicare up to eight months after your employment (or employer coverage) ends. But even if you delay Part B, many people still enroll in Part A when they turn 65 since, for most people, it's premium-free, and may help cover any hospital stays.
What If You Have Retiree Coverage or COBRA?
COBRA and retiree health coverage are not considered "active employer coverage." That means they don’t help you avoid Medicare penalties if you fail to enroll during your Initial Enrollment Period. You still need to sign up for Medicare on time.
Failing to enroll when required may leave you with gaps in coverage and higher premiums down the road.
What’s Not Covered by Original Medicare?
Original Medicare (Parts A and B) covers a lot, but not everything. A few of the things that are not typically covered include: 1) prescription drugs (unless you add Part D); 2) routine dental, vision, and hearing exams; 3) glasses or hearing aids; and 4) long-term care.
That’s where Medicare Advantage or a Medigap (Supplement) Plan may help fill the gaps.
Should You Consider a Medicare Supplement (Medigap) Plan?
If you stick with Original Medicare (Parts A & B), a Medigap policy may help with deductibles, copayments, and coinsurance. These plans are sold by private insurers, but they’re standardized and labeled with letters (like Plan G, Plan N, etc.), so it’s easier to compare plans from different providers.
You must have Parts A & B to buy a Medigap plan, and you cannot be enrolled in a Medicare Advantage Plan at the same time.
Generally, an appropriate time to buy a Medigap plan is during your six-month Medigap Open Enrollment Period, which starts the first month you're 65 and enrolled in Part B. During this time, you cannot be denied coverage based on pre-existing conditions.
What If You Want an All-in-One Plan?
Many people choose Medicare Advantage (Part C) instead of Original Medicare + Medigap + Part D. These plans may come with lower monthly premiums (sometimes as low as $0) and may include prescription drug coverage and extra perks like dental, hearing, and vision insurance.
But there are disadvantages too. You'll probably need to use a specific network of providers, and your current physician(s) might not be covered. You could have more copays and higher out-of-pocket limits. You might need referrals to see specialists.
Whether you choose Original Medicare or Medicare Advantage depends on your needs, provider preferences, and budget.
Some questions to ask yourself before deciding on Medicare options include:
- Do I want to be able to continue to see my current doctor(s)?
- How often do I travel? Do I travel outside the U.S. frequently?
- Do I need dental, vision, or hearing coverage?
- How much could I afford to spend on healthcare each month?
- Do I want to manage my own health plan options or pick an all-in-one product?
The Bottom Line is Medicare May Be a Smart Choice—If You Plan Ahead
Medicare is a valuable benefit, but it’s not one-size-fits-all. The appropriate choice depends on your circumstances regarding your health, your financial situation, and whether you're still working. Learning more about the components of Medicare may help you make the appropriate choices for your situation.
Important Disclosures:
Content in this material is for educational and general information only and not intended to provide specific advice or recommendations for any individual.
This article was prepared by WriterAccess.
LPL Tracking #733175
Footnotes
1 Special Enrollment Periods https://www.medicare.gov/basics/get-started-with-medicare/get-more-coverage/joining-a-plan/special-enrollment-periods
