5 Things You Need to Know About Medicare Before Turning 65

Turning 65 is a significant milestone, and for many, it marks the beginning of a new chapter in life. One of the most important aspects of this transition is enrolling in Medicare. While Medicare provides essential health coverage for millions of Americans, it can also be complex and confusing. To help you navigate this critical step, here are five key things you need to know about Medicare before turning 65.

Initial Enrollment Period

1. Medicare Doesn’t Automatically Cover Everyone at 65

While many people assume Medicare enrollment happens automatically when you turn 65, this isn’t always the case. If you’re already receiving Social Security benefits, you’ll typically be enrolled in Medicare Parts A and B automatically. However, if you’re not yet receiving Social Security, you’ll need to proactively sign up during your Initial Enrollment Period (IEP).

Your IEP begins three months before your 65th birthday, includes your birthday month, and extends three months after. Missing this window could result in late enrollment penalties or gaps in coverage, so mark your calendar and plan ahead.

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2. Original Medicare Has 2 Parts.

Medicare is divided into 2 parts each covering specific services:

• Part A (Hospital Insurance): Covers inpatient hospital stays, skilled nursing facility care, hospice care, and some home health care.
• Part B (Medical Insurance): Covers doctor visits, outpatient care, preventive services, and medical supplies.
• Medicare Advantage also known as (Part C): An alternative to Original Medicare (Parts A and B) offered by private insurers. These plans often include additional benefits and incorporates prescription drug coverage. So, that Part A, B, and D rolled into one which makes Medicare Advantage Part C
• Part D (Prescription Drug Coverage): Helps cover the cost of prescription medications.

Understanding what each part covers is crucial to choosing the right plan for your needs. For example, if you take regular medications, you’ll want to ensure you have Part D or a Medicare Advantage plan that includes drug coverage.

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The cost of Original Medicare

3. There Are Costs Associated with Medicare

While Medicare provides valuable coverage, it’s not free. Here’s a breakdown of the costs you can expect:

• Part A: Most people don’t pay a premium for Part A if they or their spouse paid Medicare taxes while working. However, there are deductibles and coinsurance costs for hospital stays.
• Part B: Comes with a standard monthly premium (which can be higher based on your income), a deductible, and typically 20% coinsurance for most services.
• Part C and Part D: These plans have varying premiums, deductibles, and copays depending on the provider and plan you choose.

It’s important to budget for these costs and explore supplemental insurance options, like Medigap policies, to help cover out-of-pocket expenses.

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4. You Can Customize

Your Coverage

Medicare isn’t a one-size-fits-all program. You have options to tailor your coverage to fit your health needs and budget. For example:

• Original Medicare (Parts A and B): This is the traditional fee-for-service option, but it doesn’t cover everything. Many people pair it with a Medigap policy and a Part D plan for more comprehensive coverage.
• Medicare Advantage (Part C): These plans often bundle Parts A, B, and D into one plan and may include extra benefits like gym memberships or telehealth services.
• Supplemental Plans: Medigap policies can help cover costs like deductibles, copays, and coinsurance.

Take the time to compare plans during your enrollment period to find the best fit for your needs.

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5. Timing Is Everything

Enrolling in Medicare at the right time is critical. As mentioned earlier, your Initial Enrollment Period is your first opportunity to sign up. If you miss this window, you may face penalties or have to wait for the General Enrollment Period (January 1–March 31), which could leave you without coverage.

If you’re still working at 65 and have employer-sponsored health insurance, you may be able to delay enrolling in Medicare without penalty. However, you’ll need to confirm that your employer’s plan is considered “creditable coverage” by Medicare standards. Be sure to coordinate with your employer’s benefits administrator to avoid any surprises.

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Final Thoughts

Medicare is a valuable resource for seniors, but it requires careful planning and understanding. Before turning 65, take the time to research your options, compare plans, and consider your current and future healthcare needs. If you’re feeling overwhelmed, don’t hesitate to seek guidance from a Medicare counselor or insurance professional.

By being proactive and informed, you can make the most of your Medicare benefits and enjoy peace of mind as you enter this exciting new phase of life.

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Don't miss out on the opportunity to ensure you're getting the most from your Medicare healthcare coverage. At Lons Insurance, we specialize in helping individuals like you maximize their benefits and explore additional options you may qualify for. Our team is dedicated to providing personalized, expert advice to meet your unique healthcare needs.

Take the first step towards better coverage and peace of mind. Call Lons Insurance at 954-598-5109 today to schedule a review of your current Medicare plan. Let us help you make informed decisions about your healthcare future. Your health and well-being are our top priorities—reach out now and see how we can make a difference for you!