Turning 65 Checklist Medicare Enrollment Periods

Confused about Medicare? Are you receiving crazy amounts of mail and calls about Medicare? You are not alone.

Turning 65 marks a major milestone in our lives. As we approach this pivotal age, it’s essential that we prepare for the changes and decisions that accompany this transition. With careful planning and understanding of the options before us, we can ensure our shift to retirement is smooth, empowering and financially secure.

Let’s examine each of these crucial areas in detail, laying the groundwork for a smooth shift into our mid-60s and beyond. The decisions we make now can have significant impacts on our health, finances and overall wellbeing as retirees. But with diligent preparation using this checklist, we can embrace 65 with confidence, clarity and readiness for an enriching next chapter.

Annual Open Enrollment Period

Every year from October 15 to December 7, you can make changes to your Medicare Advantage and Part D prescription drug plans during the Annual Open Enrollment Period. Use this time wisely to review your options.

Special Enrollment Period

You may qualify for a Special Enrollment Period outside the normal windows if you had a life event like losing other health coverage. Many use this if you will be keeping any employer coverage after turning 65. This gives you 8 months to sign up for Medicare without a penalty when your employer coverage ends.

The key is knowing these enrollment periods so you don’t miss your opportunity to get Medicare or make important changes. Mark your calendar and avoid those late fees!

Medicare Eligibility

To enroll in Medicare, there are a few key eligibility criteria we must meet. In most cases, we become eligible when we turn 65 years old. However, if we have certain disabilities or medical conditions, we may qualify for Medicare before age 65.

The Medicare eligibility age chart below outlines when we can sign up:

• Age 65 – The initial enrollment period starts 3 months before your 65th birthday, includes the month you turn 65, and ends 3 months after your birthday. This is the main time when you’ll become eligible.
• Under age 65 – You can get Medicare if you have received Social Security disability benefits for 24 consecutive months. You can also qualify with end-stage renal disease or ALS as well.

Before our initial enrollment period, it’s important to confirm our Medicare eligibility. Here are some tips:

• Check your eligibility status on the Social Security website with your personal account.
• Contact Social Security at 1-800-772-1213 to speak with a representative.
• Visit your local Social Security office and have a representative review your eligibility.

Taking these steps will verify that we meet the requirements to enroll in Medicare and avoid any coverage issues or penalties when signing up initially. Having clarity on the Medicare eligibility criteria and our status sets us up for a smooth transition when the time comes.

Enrolling in Medicare

Enrolling in Medicare Parts A and B is an important process as you approach age 65. Here are some key steps to take:

Enroll in Part A

• Most people can enroll in Medicare Part A premium-free at age 65. Even if you are still working, it’s wise to sign up for Part A when first eligible.
• You can enroll online at www.ssa.gov or visit your local Social Security office. Have your personal information ready including your Social Security number.
• Coverage will start the month you turn 65 or up to 3 months retroactively if you enroll late.

Enroll in Part B

• Part B covers outpatient and medical services. Premiums apply based on your income.
• If you have employer coverage, you may be able to delay Part B without penalty.
• To enroll, again you can apply online or in-person. Submit any required documents.
• Coverage begins the month after you enroll or after your employer coverage ends if still employed.

Enrolling While Still Working

• If you have health insurance through your employer, you can delay Part B without penalty.
• Enroll in Part A when first eligible as it is usually premium-free.
• When you retire, you have a Special Enrollment Period to sign up for Part B without penalty if you’ve had continuous coverage.
• Compare your employer plan with Medicare to decide if you should enroll in Part B or keep your existing coverage.

Enrolling online can be convenient and is the preferred method with Social Security. The key is knowing your options and enrolling at the right time to avoid penalties. With some preparation, you can smoothly transition onto Medicare.

Medicare Parts Explained

Understanding the different parts of Medicare is key to making informed choices about your coverage. Medicare has 4 main parts:

Medicare Part A

Medicare Part A covers inpatient hospital care. This includes expenses like a semi-private hospital room, meals, general nursing, and drugs given during your hospital stay. Part A also covers services in skilled nursing facilities, hospice care, and some home health care. 

Medicare Part B

Medicare Part B covers outpatient medical services. This includes doctor visits, preventive care, ambulance services, mental health care, lab tests, X-rays, durable medical equipment, and more. Unlike Part A, most people have to actively enroll in Part B and pay a monthly premium.

Medicare Part C (Medicare Advantage)

Medicare Advantage plans are offered by private insurers as an alternative to Original Medicare. These plans bundle Parts A, B, and usually D together. They often include extra benefits like vision, hearing, dental, and more. You must be enrolled in Parts A and B to join a Medicare Advantage plan.

Medicare Part D

Medicare Part D provides prescription drug coverage. It helps pay for medications doctors prescribe for treatment. Part D plans are offered by private insurers approved by Medicare. You must actively enroll in Part D and pay a monthly premium based on the plan you select if you do not choose to enroll into a Medicare Advantage plan that includes Part D.

Understanding what each part covers allows you to select the right combination for your health needs. While Parts A and B make up Original Medicare, Parts C and D are additional coverage options to consider. Reviewing the benefits of each part ensures you make informed Medicare decisions.

Original Medicare vs Medicare Advantage

Choosing between Original Medicare and Medicare Advantage is one of the most important decisions when first enrolling in Medicare. It pays to understand the key differences between these two options.

Original Medicare consists of Part A, which covers hospital services, and Part B, which covers doctor visits and outpatient care. With Original Medicare, you can go to any doctor or hospital that accepts Medicare nationwide. You may add a separate Medicare Supplement (Medigap) plan to help pay for things Original Medicare doesn’t cover, like copayments and deductibles.

Pros of Original Medicare:

• Freedom to choose any Medicare-approved doctor or hospital nationwide.
• Predictable low costs if you have a Medigap plan.
• You don’t need referrals to see specialists.

Cons of Original Medicare

• You may have to pay deductibles and coinsurance with no annual limit or cap on your costs.
• It doesn’t cover prescription drugs.
• You may need additional Medigap coverage to pay those deductibles and coinsurances.
• This option can have the highest monthly cost and can easily get to $300 a month or more per person.

Medicare Advantage (also known as Part C) plans are offered by private insurance companies approved by Medicare. They provide all the coverage of Parts A and B and usually Part D drug coverage. Plans may have extra benefits like vision, hearing, dental, and wellness programs.

Pros of Medicare Advantage:

• Many plans have low or $0 premiums.
• Coverage for prescription drugs is usually included.
• Extra benefits like dental and vision are often included.
• This is generally the lowest monthly cost option
• You will have an annual maximum out-of-pocket to help limit your costs for catastrophic circumstances

Cons of Medicare Advantage:

• Provider choice may be limited to the plan’s network.
• You may need referrals to see specialists.
• Copays and deductibles vary by plan.

When choosing between Original Medicare and Medicare Advantage, consider your budget, health needs, doctor preferences, and desire for flexibility. Medicare Advantage plans offer simplicity but less choice, while Original Medicare offers more flexibility. Understanding the differences allows you to find the most suitable option.

Medicare Supplements (Medigap)

Medigap plans are supplemental insurance policies that help cover costs in Original Medicare. These plans are offered by private insurance companies and help pay for things that aren’t covered by Parts A and B, like copayments, coinsurance, and deductibles. Having a Medigap policy is important because it provides more complete coverage and protects us from high out-of-pocket costs.

There are 10 standardized Medigap plans, labeled Plan A through Plan N. Each offers a different level of benefits, from just the basics to more comprehensive coverage. When exploring Medigap policies, Plan G and Plan N tend to be popular choices for their robust coverage. Plan G covers all gaps in Original Medicare after the Part B Deductible of $240, while Plan N is similar but requires you to pay $20 for a doctor’s visit and $50 for hospital.

No matter which Medigap plan we consider, it’s essential to enroll during our open enrollment period when turning 65. This 6-month window allows us to get any Medigap plan without being denied due to pre-existing conditions. After this window there are very few special enrollment periods (SEP) available to enroll with no questions asked. If you don’t qualify for a SEP then you will be required to go through underwriting where your health history will be considered. If the company does not like what they see then they can deny you coverage. Shopping around to compare plans can help us find the right supplement based on our healthcare needs and budget.

Overall, Medigap policies provide vital protection by filling in the gaps of Original Medicare. Understanding these plans and enrolling at the right time is key to making sure we have sufficient healthcare coverage as we transition into retirement. The right supplement goes a long way in covering medical costs not addressed by Medicare Parts A and B.

Avoiding Late Enrollment Penalties

Enrolling in Medicare on time is crucial to avoid paying lifelong late enrollment penalties that can significantly increase your healthcare costs. These penalties apply if you don’t sign up for Medicare Part B and/or Part D when first eligible.

The Part B late enrollment penalty is 10% of your Part B premium for every year your go without Part B since you were eligible. The Part D penalty can also add up, with a $0.34 penalty for every month you went without drug coverage since you were first eligible for Medicare. These penalties get added to your monthly premiums and continue for as long as you have Medicare coverage.

Here are some tips to avoid Medicare late enrollment penalties:

• Mark your calendar for your Initial Enrollment Period – the 3 months before, the month of, and 3 months after your 65th birthday. This is when you must sign up for Medicare Parts A and B to avoid penalties.
• Understand the Special Enrollment Period if you have group health insurance from an employer. This allows you to enroll later when that coverage ends, without facing penalties.
• If you missed your Initial Enrollment Period, use the General Enrollment Period (Jan 1 – Mar 31) to sign up, although you may incur penalties.
• Sign up for Part D when first eligible or you may face a penalty if you enroll later. Use the Initial Enrollment Period or Annual Enrollment Period.
• Seek guidance if you’re not sure when you need to enroll in Medicare. A knowledgeable advisor can ensure you don’t miss key deadlines.

Avoiding penalties requires awareness of the various Medicare enrollment periods and taking timely action. With proper planning, you can prevent added costs that could otherwise eat into your retirement income for years to come.

NOTE: If you have continuous employer coverage then these penalties will not apply or begin adding up until that employer coverage ends. 

Update Essential Estate Planning Documents

As you approach your 65th birthday, it’s a good time to review and possibly update your essential estate planning documents. This includes your will, any trusts you’ve established, and your powers of attorney. These documents play a crucial role in ensuring your wishes are honored in terms of asset distribution and decision-making should you become unable to manage your affairs.

• Will: Review your will to ensure it reflects your current wishes and family structure. Changes like the birth of a grandchild, marriage, or loss of a family member might necessitate updates.
• Trusts: If you have trusts in place, consider whether the appointed trustees still align with your current choices and if the terms meet your present needs and goals.
• Powers of Attorney: Check both your financial and healthcare powers of attorney to confirm the designees are still appropriate choices and aware of their responsibilities.

Updating these documents can give you peace of mind knowing that your personal affairs are well organized and your loved ones are protected.

Consider Healthcare and Housing Needs

Turning 65 is also an important time to consider your future healthcare and housing needs. Medicare will cover many of your basic health needs, but it’s wise to think about scenarios that Medicare may not fully cover, such as long-term care. Medicare does not cover Long-Term care or any assisted living.

• Long-Term Care Insurance: This insurance can help cover the cost of long-term care and assisted living situations, such as assistance with daily living activities or extended nursing care. Evaluating your options now can save you and your family significant financial and emotional strain in the future.
• Housing Options: Depending on your current and anticipated physical health, you might want to consider different housing arrangements. Whether it’s downsizing to a smaller home, moving to a retirement community, or exploring assisted living facilities, early planning can lead to better choices and a more comfortable transition.

By addressing these considerations now, you can ensure a more secure and enjoyable future as you enter this new chapter of your life.