Medicare at 65: What Do You Actually Need to Do?
Turning 65 brings a new set of decisions that can feel surprisingly complicated.
You may have heard that Medicare starts automatically. You may have heard that you have to sign up. You may still be working. You may have insurance through your employer, your spouse's employer, a retiree plan, or another source.
All of those situations can change what you need to do.
The biggest mistake is assuming that everyone reaches 65 and follows the same Medicare checklist. Your enrollment steps depend on whether you are already receiving Social Security, whether you have employer coverage, whether you have an HSA, and what kind of Medicare coverage you want.
The good news is that the process becomes much easier when you break it into decisions.
Start Planning Before You Turn 65
Your Medicare Initial Enrollment Period generally lasts seven months. It begins three months before the month you turn 65, includes your birthday month, and ends three months after the month you turn 65.
That means you should start looking at Medicare before your 65th birthday rather than waiting for your birthday month.
For example, if you turn 65 in October, your Initial Enrollment Period generally runs from July through January.
This is the time to figure out:
Whether you will be automatically enrolled
Whether you need to enroll yourself
Whether you are keeping employer coverage
Whether you need Part A, Part B, or both
Whether you want Original Medicare or Medicare Advantage
Whether you need prescription drug coverage
Whether you want Medicare Supplement Insurance, also called Medigap
Whether you have an HSA that requires special attention
Medicare provides an official enrollment tool that asks questions about your situation and helps identify when you should sign up.
Starting early gives you time to compare your options instead of trying to make several decisions at once.
Find Out Whether You Are Automatically Enrolled
Whether you need to sign up yourself depends partly on whether you are already receiving Social Security benefits.
If you are already receiving Social Security benefits at least four months before you turn 65, Medicare generally automatically enrolls you in Part A and Part B. Medicare says it will send your Medicare card and welcome information before coverage begins.
If you are not receiving Social Security benefits yet, you need to actively sign up for Medicare if you want coverage.
You can apply for Part A and Part B through Social Security. Medicare directs people who need to enroll to Social Security because Social Security handles enrollment for Medicare Part A and Part B.
You can use the official Social Security website to create or access your my Social Security account and apply online.
Waiting to claim Social Security doesn't mean you have to wait to enroll in Medicare either. Social Security retirement benefits and Medicare enrollment are related, but they are separate decisions.
If you receive an automatic Medicare enrollment notice, read it carefully. Your Medicare card will show whether you have Part A, Part B, or both. If you are automatically enrolled in Part B and have other coverage that makes you want to delay Part B, deal with that as soon as possible. Part B plan payments are automatically withdrawn from Social Security benefits.
If You Are Still Working, Check Your Employer Coverage
This is one of the most important decisions to make before turning 65.
If you or your spouse are still working and you have health insurance through current employment, you may be able to delay Part B without a late enrollment penalty.
A late nerollment penalty is not a one-time event; it will continue for the duration of you having Part B coverage. Every year you do not opt into Part B can accumulate a larger penalty, unless you meet an exception such as working.
The rules depend on the type of coverage and the employer. Medicare generally provides a Special Enrollment Period for people covered by an employer or union group health plan based on current employment.
Ask your employer's benefits department:
"When I become eligible for Medicare at 65, do I need to enroll in Part A, Part B, or both to keep my employer health coverage working correctly?"
Ask for the answer in writing if possible.
The size of the employer can also matter in determining whether the employer plan or Medicare pays first. Medicare specifically advises people who are still working at 65 to check with the employer providing their insurance about whether they need Part A and Part B.
There is another important detail if you have a Health Savings Account.
Once you have Medicare, you often cannot continue making HSA contributions.
Premium-free Part A can also have retroactive coverage in certain situations, which can create tax problems if you continued making HSA contributions during a period when you were already considered covered by Medicare. Medicare recommends coordinating the timing of your final HSA contribution carefully.
If you have an HSA, talk with your employer's benefits department and, if necessary, a tax professional before you reach 65. This is one area where timing matters.
How to Start
If you need to enroll yourself, Social Security is where you start.
Medicare provides an online enrollment process through Social Security, and you can also contact your local Social Security office.
If you enroll during the three months before your birthday month, your coverage can generally begin with your 65th birthday month, assuming you qualify for premium-free Part A. If you wait until your birthday month or the three months afterward, your coverage generally starts later.
Waiting can also create a late enrollment penalty if you do not qualify for a Special Enrollment Period.
Part B has a monthly premium for most people, so some people who have qualifying employer coverage choose to delay it. Other people need Part B when they first become eligible.
This is why "sign up at 65" is not enough advice by itself.
You need to know which enrollment situation applies to you.
After you enroll, you will receive a Medicare card with your Medicare Number and information about your Part A and Part B coverage.
You will use your Medicare Number when setting up your Medicare account and enrolling in additional Medicare coverage. Keep the card somewhere secure. Your Medicare Number is personal information, so treat it like other important insurance and identification information.
Decide How You Will Get Your Medicare Coverage
Getting Part A and Part B is only the beginning.
Once you have Medicare, you generally have two main ways to receive your Medicare health coverage:
Original Medicare: Part A and Part B administered by the federal Medicare program. You can generally see any doctor or hospital that accepts Medicare. You can also add a separate Part D prescription drug plan and may choose a Medigap policy.
Medicare Advantage: A private Medicare-approved plan that provides your Part A and Part B coverage. Most Medicare Advantage plans include prescription drug coverage, and plans generally have their own provider networks, costs, and rules.
These choices affect how you receive care, which doctors you can use, what you pay when you receive services, and whether you need additional coverage.
Medicare provides an official comparison tool where you can enter your ZIP code and compare available health and drug plans. You can also enter your medications and preferred pharmacies to get more useful cost information.
When comparing plans, have your actual healthcare information in front of you.
Write down your doctors.
List your regular prescriptions.
Identify the pharmacies you normally use.
Think about whether you travel or spend part of the year somewhere else.
Then check whether the plans you are considering work with those doctors, medications, pharmacies, and locations.
Medicare recommends checking provider networks, prescription coverage, premiums, deductibles, and estimated yearly costs before joining a plan.
Give Yourself Time to Set Everything Up
Your first Medicare year involves more than receiving a card.
Once you know when your coverage begins, start using the information to organize your healthcare.
Save your Medicare Number somewhere secure.
Give your new insurance information to your doctors and pharmacy once your coverage is active.
Check that your doctors participate in your chosen plan if you selected Medicare Advantage.
Review your prescription coverage.
If you selected Original Medicare, determine whether you need Part D and whether Medigap makes sense for your circumstances.
Medicare also recommends using its plan comparison tools and contacting your State Health Insurance Assistance Program, commonly called SHIP, for free personalized Medicare counseling. SHIP counselors are not connected to insurance companies or Medicare health plans.
SHIP can be particularly useful if you are comparing several plans or have questions about how Medicare interacts with your existing insurance.
You can also contact Medicare directly at 1-800-MEDICARE (1-800-633-4227).
If you are not receiving Social Security benefits, Medicare premiums are generally billed to you rather than automatically deducted from a Social Security check. The Social Security Administration says CMS will send a quarterly bill with payment instructions in that situation.
Final Thoughts
Turning 65 is a big decision-making time. Find out whether you will be automatically enrolled in Medicare long before your 65th birthday.
If you are still working, talk with your employer about how its health insurance coordinates with Medicare. Pay attention to HSA rules if you have one. Enroll in Part A and Part B when your circumstances require it.
Then compare the ways you can receive your Medicare coverage and choose the combination that fits your healthcare needs.
Keep your Medicare information organized after enrollment. Save your Medicare card, know when your coverage begins, keep track of your plan information, and make sure your doctors and prescriptions are covered.
Medicare also provides a free handbook, Medicare & You with information about coverage, costs, enrollment, and using your benefits.
Up Next: Knowing that you need Medicare is one thing. Knowing exactly when to enroll is another.
The next article breaks down the Initial Enrollment Period, Special Enrollment Periods, General Enrollment Period, and the timing that determines when your coverage actually starts.
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