Medicare is a critical part of healthcare planning, and it's important to understand how this federal health insurance program applies to you before you turn 65. At RetireMed, we believe that educating individuals about Medicare is just as important as helping them find the right health coverage for their needs. Here’s why it's necessary to understand Medicare before age 65.
Enrolling in Medicare at the right time is critical to ensure you avoid penalties and gaps in coverage. Retirement is not a requirement for Medicare. If you don't enroll during your Initial Enrollment Period (when you’re initially eligible for Medicare) or you don’t have creditable coverage (coverage greater than or comparable to Medicare), you could face a lifetime penalty on your Medicare premium(s). Understanding when and how to enroll can help you prevent these issues.
As mentioned, your Initial Enrollment Period (IEP) is when you are first eligible for Medicare. More specifically, it’s a seven-month window that centers around your birth month, beginning three months before and ending three months after it. For example, if your 65th birthday is Nov. 20, your IEP would begin on Aug. 1 and end on Feb. 28. You can enroll in Medicare at any point during your IEP.
If you plan to delay your Medicare enrollment, you need to verify that your current coverage meets Medicare’s standards for creditable coverage. If you work for a company with fewer than 20 employees, you should enroll in Medicare Part A and B once you’re eligible because Medicare is primary to group insurance if your employer has fewer than 20 employees.
If you delay signing up for Medicare when you’re first eligible and you don’t have creditable health coverage, you will face fees and penalties that stick with you for life. Our advisors can walk you through signing up at the right time to make sure you avoid any late enrollment penalties or a lapse in coverage.
Medicare has various parts and plans, and each one has different benefits, costs, and restrictions. Understanding your options in advance can help you make an informed decision about which plan is right for you.
Most individuals qualify for Medicare Part A (hospital insurance) and Part B (medical insurance) when they turn 65, so long as they or their spouse worked at least 10 years (40 quarters) and paid into Social Security taxes. Together, Part A and Part B are considered “Original Medicare.”
Medicare Part C, also known as Medicare Advantage (MA), offers an alternative to Original Medicare for medical and drug coverage. MA plans are all-inclusive plans offered by private insurance companies that are contracted and approved by Medicare. They roll Part A, Part B, and often Part D (prescription drug coverage) coverage into one plan. Although MA plans are required to provide the same basic coverage as Medicare Part A and Part B, these plans also feature extra benefits, such as dental, vision, hearing, fitness memberships, and more.
You must have Medicare Part A or Part B to enroll in Medicare Part D (drug coverage). All standalone Part D plans have a monthly premium. You can save on this monthly premium, however, when you purchase a Medicare Part C (Medicare Advantage) plan, which includes Part D coverage (MAPD).
Medicare Supplement plans, also known as Medigap, are health insurance policies sold by private insurance companies. Medicare Supplement insurance is designed to be paired with Medicare Part A and Part B to “fill in the gaps” that Original Medicare does not cover (such as copays, coinsurance, and deductibles). Many individuals choose these plans because they have very few out-of-pocket costs. It’s important to know that you will likely pay a much higher monthly premium for a supplement compared to a Medicare Advantage plan.
Because supplements do not offer Part D benefits, if you choose a supplement plan, you will need to enroll in a standalone Medicare Part D plan or another form of creditable drug coverage.
Between Medicare Advantage and Medicare Supplement plans, hundreds of plan options are available if you want to purchase additional coverage. If you need help assessing your options, our local advisors can help you compare plans and find the right fit for you.
Despite what many individuals believe, Medicare doesn't cover every healthcare expense. You'll be responsible for paying certain costs out of pocket, such as deductibles, copays, and coinsurance. We created a free guide to help you.
Most people don’t pay a monthly premium for Medicare Part A. If you or your spouse have paid Social Security taxes for at least 10 years, your Medicare Part A premium is waived.
Below are Medicare Part B costs for 2024:
After the Part B deductible is met, Medicare pays 80 percent of the cost of services and you pay the remaining 20 percent. When budgeting for your Part B expenses, note that there is no cap on the 20 percent that you will be responsible for paying. The Part B costs above apply if your only coverage is Original Medicare (Part A and Part B). One way to lower your out-of-pocket costs is by exploring Medicare Advantage or Medicare Supplement plan options.
The amount you pay for a Medicare Advantage (MA) plan (Medicare Part C) varies based on the plan you select and the benefits it includes. Many plans are available with a low or $0 premium. Regardless of the MA plan you choose, you must continue to pay your Part B premium. When you use Medicare Advantage services, you pay copays, coinsurance, and possibly deductibles.
Actual costs for Medicare Part D plans, as well as the amount you pay for your medications, are set by the insurance companies and approved by the government. Your costs will vary based on the medications you take and the plan you choose. Standalone Part D plans typically have a monthly premium ranging from $7 to $80. Most Medicare Advantage Prescription Drug plans have a low or $0 monthly premium.
While many Medicare Supplement (Medigap) enrollees receive minimal bills for healthcare expenses, beneficiaries do pay a monthly premium in addition to their Part B premium. Supplement premium rates vary by the insurance carrier and are determined by your age, gender, where you live, and when you enroll.
Understanding Medicare before you turn 65 is crucial. Having the necessary knowledge can help you ensure that you're enrolled at the right time, consider the proper coverage options, and plan appropriately for healthcare costs.
At RetireMed, we're committed to helping individuals understand Medicare and find coverage that meets their unique needs. Reach out to us at 866.330.7448 or schedule a call to learn more about how we can help you prepare for a smooth transition to Medicare.
Share This Article