Part 1: Here’s What You Need to Know About Medicare

May 29, 2024
Turning 65? Here’s What You Need to Know About Medicare

Turning 65 is a big life milestone, one marked by significant changes to your finances, healthcare coverage, and lifestyle. It’s a transitional period in your life filled with multiple choices and important decisions but also exciting possibilities.

This comprehensive, three-part series from Wandacare’s team of experts will walk you through those big choices and decisions, ensuring you have the knowledge and resources you need to be prepared and not scared!

Part 1: Navigating Your Healthcare Options

Once you turn 65, you can take advantage of Medicare benefits for your healthcare. However, Medicare coverage does not automatically take effect when you turn 65. You’ll have some decisions to make to ensure your healthcare needs are met at the best coverage price. That starts with knowing when to enroll in Medicare, what “parts” of Medicare you need, and how Medicare coverage works with any existing healthcare coverage you have.

Let’s walk through these Medicare steps:

When and How to Enroll in Medicare

Once you turn 65, you can claim your Medicare benefits by enrolling during your Initial Enrollment Period (IEP), which begins three months before your 65th birthday month, includes your birthday month, and continues for three months after your birthday month. You’ll complete your initial enrollment for Medicare through the Social Security Administration (SSA) to verify your eligibility.

If you miss your IEP, you can enroll during the Medicare General Enrollment Period (GEP), which runs from January 1 to March 31 every year. Once you enroll in Parts A&B coverage should be effective the 1st day of the following month.

If you continue to have other healthcare coverage when you turn 65 (e.g. you’re still covered by your employer’s plan or on your spouse’s plan) you can defer your Medicare coverage and be eligible for a Special Enrollment Period (SEP). Once you decide to retire and drop employer coverage, you have 60 days to enroll from the date the employer plan ends.

Many employers offer retiree health insurance, which extends or continues your employer-provided coverage, especially if you retire before reaching age 65 and Medicare eligibility. Once you become eligible, your retiree health insurance plan may require you to enroll in Original Medicare (Part A and Part B) as a condition of maintaining coverage.

Knowing your Medicare eligibility and enrollment periods and how these are impacted by any other health insurance you may have are crucial. Missing your Medicare enrollment periods and deadlines can result in costly premium penalties, some of which you’ll pay for the life of your Medicare coverage.

What Medicare Parts to Enroll In

During your Medicare enrollment period, you’ll choose which Medicare “parts” (or benefits) you want and the type of plan to administer those benefits—a privately administered Medicare Advantage Plan (also known as Part C) or federally administered Original Medicare, which includes Part A (hospital insurance) and Part B (medical insurance).

Let’s look at these different “parts,” plans, and benefit options, so you can choose the best coverage for you:

Medicare Part A: Hospital Insurance is your inpatient hospitalization coverage, including hospital admittance, skilled nursing facility care, hospice care, and some home health care services. If you worked and paid Medicare payroll taxes for ten or more years, your Part A coverage is premium free. However, Part A coverage does come with an inpatient hospital deductible.

Medicare Part B: Medical Insurance covers typical healthcare services at any hospital, doctor, or provider within the U.S. who accepts Medicare. Part B coverage includes preventive care and screenings, doctor visits, lab work, outpatient and ambulatory services, and durable medical equipment. It also covers some in-patient services that Part A doesn’t cover. Medicare Part B pays 80% of healthcare costs and you pay 20%, with the Part B premium, deductible, and coinsurance rates set annually, based on income according to the Social Security Act.

Medicare Part C: Medicare Advantage Plans are managed by private insurance companies approved by Medicare to administer your benefits and coordinate your healthcare services. Medicare Advantage Plans provide Part A and B coverage, but usually also include prescription drug coverage (Medicare Part D), as well as additional benefits like dental and vision plans, and wellness and fitness programs. As Medicare Advantage plans are private insurance plans, they often have a set network of providers you choose from, with higher rates for out-of-network providers, and can also have different cost-sharing requirements and premiums (beyond the Medicare Part B premium) based on the coverage and features of the plan.

Medicare Part D: Prescription Drug Coverage meets your prescription medication needs. All Medicare Part D plans are offered by private insurance companies. It is separate, optional coverage and not included in Original Medicare. You can choose to add a private Medicare drug plan when you enroll in Original Medicare. If you enroll in a Medicare Advantage Plan (Medicare Part C), your Part D coverage will be bundled with your Part A and Part B coverage, along with the additional benefits of the Advantage Plan.

Medicare Supplement Plans are offered by private insurance companies and designed to work with Original Medicare, filling in the “gaps” or costs that Medicare Parts A and B do not cover, such as deductibles, copayments, and coinsurance.

Turning 65 can mean greater choice and greater control over your healthcare coverage with your Medicare benefits. All these choices and decisions can also be overwhelming. That’s why the Wandacare Team is here to help you navigate your healthcare options, ensuring you have the right plan with the best benefits at the best price.

Stay tuned for Part 2 of this segment, where we’ll delve deeper into strategies to secure your financial future alongside quality healthcare coverage. Contact Wandacare today to schedule a consultation and get a head start on your golden years.

Contact Wandacare today!


Part 3: Embracing Life Transitions

Part 3: Embracing Life Transitions

This marks the final chapter in our 3-part series on navigating Medicare after 65. We’ve covered securing healthcare...