Navigating Medicare Eligibility

The day you turn 65 is one of the most important milestones in terms of your health. Sure, it’s not as exciting as the day you became eligible for a driver’s license, but 65 does mean a new kind of eligibility: Medicare!

Baby boomers are reaching this milestone at a rate of more than 10,000 per day. And just like studying for your road test, preparing for Medicare eligibility means doing your homework and understanding what’s coming around the bend.

First and foremost, you’ll want to determine your eligibility and calculate your premium at www.medicare.gov. Those who have a special condition, disability, or receive benefits from Social Security or the Railroad Retirement Board may qualify prior to turning 65. Everyone else should apply at a Social Security office or online at www.ssa.gov/medicare starting three months before turning 65 and no later than three months after to avoid late penalties that can be permanent.

If you or your spouse are still working, and you’re covered by the employer’s plan, check with the benefits administrator to see if they require you to sign up for Medicare. If not, you can sign up later during a Special Enrollment Period without a penalty. Also, be sure any prescription drug coverage you receive through an employer after turning 65 is “creditable” – considered by Medicare to be at least as good as its drug coverage – or you’ll be liable for more late penalties.

Once you’ve determined your eligibility, it’s important to understand the fundamental parts of Medicare. Medicare Part A offers hospital insurance for inpatient stays, skilled nursing facilities, and hospice care, while Medicare Part B provides medical insurance for doctor services, outpatient care, medical supplies, and preventive care. Excluded from Parts A and B (Original Medicare) are a number of value-added benefits and services like routine vision and dental visits, health management programs, and more. These costs would be out-of-pocket. Prescription drugs also are not covered by Original Medicare and require a separate Medicare prescription drug plan (Medicare Part D). If you’ve worked and paid taxes for 10 years or more, you wouldn’t have a premium for Part A, but there are separate premiums for Parts B and D.

Alternatively, Medicare Advantage plans (Medicare Part C) are offered by health plans – like CDPHP – to replace Medicare Parts A and B while providing additional coverage. Medicare Advantage plans include everything covered by Parts A and B as well as important services such as dental, hearing, vision, annual physicals, case management, medication reviews, nutrition and wellness classes, and even no-cost gym memberships. Many Medicare Advantage plans also provide prescription drug coverage (Part D) and the convenience of having one plan administer all of your Medicare benefits.

It’s important to note that there is an open enrollment period, called AEP or Annual Election Period, for making changes to your Medicare plan that spans from October 15 to December 7. While you can sign up for Original Medicare up to three months before turning 65, and have the coverage begin on the first day of your birthday month, changes to your plan can only be made between those dates. You must be enrolled in Original Medicare Parts A and B to join a Medicare Advantage plan, so get that squared away first even if you know you’ll be replacing it.

If you’re about to overheat, take a minute to cool down. Medicare can be overwhelming because it requires learning a new system with its own timelines, rules, and terminology. That’s why I suggest starting the process early, asking questions, and reading the information you receive in the mail. Educating yourself now will allow you to make the right choices for yourself and your health, so you can cruise into this important stage of life without so much as a glimpse in the rearview.

Want to learn more about your Medicare options? CDPHP can help!