Whether you’re getting ready to turn 65 or you’re already on Medicare, we help you navigate through the confusion and select the best Medicare health plan.
Taking control of your healthcare as you age can be a scary proposition.
Chances are, you’ve been (or currently are) covered by an employer-sponsored health insurance plan, or you’ve been purchasing a plan through the Marketplace.
As you approach age 65, it’s time to start thinking about the next phase of your healthcare journey.
What is Medicare?
Medicare is the health insurance program that is run by the federal government. It’s available to those who are 65 or older, those under 65 who have certain disabilities and those with end-stage renal disease.
These are the four parts of Medicare, as well as an explanation of supplemental/Medigap coverage:
- Part A covers hospital stays, skilled nursing care, hospice, and home health care.
- Part B covers medically necessary doctor visits, outpatient surgery, clinical lab tests, physical therapy, home health care, and medical equipment.
- Part C is another way to refer to Medicare Advantage plans. The coverage does not come from the federal government but from private health insurance companies.
- Part D is a prescription drug plan that’s offered by private health insurance companies.
- Supplemental or Medigap plans are offered by insurance companies to fill in the gaps of your Medicare plan for the costs of deductibles and coinsurance.
Choosing the right Medicare plan for you
There’s no one-size-fits-all solution when it comes to deciding on coverage. It’s an important decision that requires you to take a close look at your needs and your budget.
Answering some specific questions can give you clarity about what your exact needs are in terms of Medicare coverage.
The answers to each of these questions will give you and your insurance agent the information they need to help you form a good healthcare gameplan.
- What is the status of your health?
- Are you currently in treatment for any chronic conditions?
- Do you take prescription drugs on a regular basis?
- What doctors do you normally see?
- What hospital do you prefer?
- Do you travel frequently?
- What were your medical costs last year?
- How much room do you have in your budget for health insurance?
- Are you more comfortable paying a higher monthly premium in exchange for low out-of-pocket costs or would you rather pay a lower monthly premium and pay higher out-of-pocket costs?
It may seem like a tedious chore to answer a list of questions such as these, but it really does go a long way in indicating the type of coverage that will be best for you.
Take the time to thoroughly go through the answers with a professional.
First-time Medicare Enrollment
Here’s a timeline of what you need to know if you’re enrolling in Medicare for the first time.
3 months before your 65th birthday:
- This is when your initial enrollment period begins.
- Already receiving Social Security? You’ll automatically be enrolled in Medicare Parts A and B and should receive your card in the mail at this time (three months before you turn 65).
- Not receiving Social Security? You’ll need to enroll now so that your benefits begin on the first day of your birthday month.
- This is also the best time to sign up for Medicare Part D, which is your prescription drug coverage. Keep in mind that it isn’t mandatory and it’s offered by private insurance companies.
- You should also consider a Medicare Advantage Plan (Part C)at this point in your enrollment journey. Medicare Advantage combines Parts A, B and C into one plan. Note that it’s not a federal plan and it’s offered by private insurers.
The month you turn 65:
- You have the option to wait until now to enroll in Medicare: however, you’ll have a one to three-month waiting period before your coverage kicks in if you do.
- The longer you wait to enroll, the longer you’ll have to wait for your coverage to begin.
Your 65th birthday through 3 months after:
- This is the end of your initial enrollment period.
3 months past your 65th birthday:
- Once you reach this point, you’ve missed the initial enrollment period.
- There are penalties for failing to enroll in Medicare. Work with a trusted advisor so you don’t miss the Annual Election Period.
Re-enrolling in Medicare: the Annual Election Period
The Annual Election Period is the one time during the year when you are able to change your coverage. The dates are the same each year: October 15 through December 7.
Let’s take a look at what options you have during this period of time:
- Switch from your Original Medicare plan to a Medicare Advantage plan.
- Switch from Medicare Advantage to Original Medicare.
- Change to a different Medicare Advantage plan from the one you currently have.
- Switch from a Medicare Advantage plan that doesn’t have prescription drug coverage to one that does have it.
- Change from a Medicare Advantage Plan that does have prescription coverage to one that doesn’t.
- Enroll in a Medicare prescription drug plan for the first time.
- Change prescription plans.
- Stop your Medicare prescription coverage.
Evaluate your Medicare coverage yearly.
Here are the reasons you may need to make a change in the future:
- You want a new primary care physician who isn’t part of your plan.
- You need better coverage.
- You need to save money.
- You aren’t happy with the arrangement you currently have.
- You move to a new area.
- Your health has changed.
- Your prescription drug needs have changed.
- Your plan changes.
- You move into or out of a nursing home.
- There’s a change in your marital status.
Medicare’s Special Enrollment Period
What happens to your coverage when you make a move or life just happens. Medicare does allow for these circumstances that are out of your control with a special enrollment period or SEP.
Here’s a breakdown of what circumstances qualify you for making changes during the SEP:
- Making a move. Because a move isn’t usually a snap decision, you’ll most likely have time to find out what you need to do to adjust your coverage. There are time parameters that you have to abide by. If you tell your carrier before the move, you have from one month before the move to two months after to make changes.
- Losing current coverage. You could lose coverage due to a job loss, losing prescription drug coverage or you simply choose to leave the plan. The general rule is that you have two full months after the month you make the change.
- A chance for alternate coverage. It’s possible that you could be eligible for coverage through the Veteran’s Association (VA), through your employer, or you may be enrolled in a Program of All-Inclusive Care for the Elderly (PACE) plan. The parameters are more flexible for this type of change. If the coverage is through an employer, you can make the switch whenever you’re eligible to begin the new plan. If it’s for another reason, you can make the transition at any time.
- Contract termination. Medicare may terminate their contract with your plan, necessitating you finding a new plan. Situations like these are usually handled on a case-by-case basis. If Medicare terminates the plan, you have two months before and one month after the contract ends.
A situation such as one of these can cause a considerable amount of uncertainty. Talking to an expert can help
Frequently Asked Questions
Am I automatically enrolled in Medicare when I turn 65?
If you’ve been receiving benefits from Social Security or the Railroad Retirement Board for at least four months, you’ll be automatically enrolled in Medicare Parts A and B. However, if you aren’t receiving these benefits, you will need to sign up for Medicare yourself. If you are working for an employer with 20+ employees and have creditable coverage, you can delay. We recommend exploring Medicare vs. group coverage prior to making this decision.
Am I entitled to Medicare if I already receive benefits based on disability?
If you’ve received monthly Social Security or Railroad Retirement Benefits based on a disability for 24 months, you’re entitled to receive Part A and Part B. Individuals with ALS are also entitled to Part A the first month they are entitled to Social Security or Railroad Retirement Benefits.
Do I need to sign up for Medicare if I’m turning 65 and on my employer’s sponsored health plan?
If you’re 65 or older, you can remain on your employer-sponsored health plan while also enrolling in Medicare.
Do I need to enroll in Medicare if I’m on my spouse’s health insurance?
That depends on your spouse’s employer. Some employers require covered dependents who meet the age requirements for Medicare to enroll in the program to remain covered by the employer plan. Reach out to your employer’s benefits administrator to learn about your options.
What happens when I or my spouse stop working?
After you or your spouse stop working, you’ll have an eight-month Special Enrollment Period to sign up for Medicare or add Part B to your existing coverage.
How does enrolling in Medicare affect my dependents?
Medicare coverage is individual, meaning you cannot add dependents to your plan. Contact your benefits representative if you decide to enroll in Medicare and drop your employer coverage to understand what options may be available for your dependents. NSI Health has solutions for under 65 individual health insurance options as well.
Should I choose a Medicare Advantage plan or Medicare Supplement Insurance?
The decision that’s right for you may depend on your health and budget needs. A Medicare Advantage Plan may provide you with additional coverage within a network of providers, whereas a Medicare Supplement plan may help you with your out-of-pocket expenses and allow you access to a broader network. A Medicare Supplement plan will not come with any extra benefits, which you may receive with Medicare Advantage.
When can I change my coverage after I’m already on Medicare?
You can change your Medicare plan during the Annual Enrollment Period, which runs from October 15 to December 7.
What happens if I don’t enroll in Medicare?
If you don’t sign up for Medicare coverage during your IEP, you could be subject to late enrollment penalties or gaps in your health coverage. You may be able to delay coverage if you are working for an employer with 20+ employees and have creditable coverage
Where do I go to enroll in Medicare?
- You can enroll in Medicare through the Social Security Administration.
- Online at ssa.gov
- By calling 1-800-772-1213
- Visiting a local Social Security office
Where can I get additional assistance?
NSI Health is your trusted Medicare resource, designed to help you make the best health insurance decisions based on your budget and needs.
As your one-stop shop for Medicare, NSI Health can help you:
- Understand your Medicare options
- Answer your health insurance questions
- Avoid penalties and other costly mistakes
- Provide an annual review of your coverage to ensure you have the best plans year in and year out
- Transition seamlessly to the right plan
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