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How to be Medicare ready

Color portrait of Sachi Fujimori By Sachi Fujimori

You may not be 65 yet, but can still start thinking about your future health coverage options.

Original Medicare is the federal health care program for those age 65 and older. Some people who have certain health conditions may qualify earlier.

 

When to sign up for Medicare?

For most people, your first chance to sign up for Medicare will be your Initial Enrollment Period (IEP). It’s the period of seven months around your 65th birthday — the three months leading up to your birthday, your birthday month, and the three months after it. If you don’t sign up in this period, you may have to pay a late-enrollment penalty. This monthly penalty lasts for as long as you’re on Medicare. So it’s best to plan ahead to avoid it.

Choosing your Medicare plan is an important decision. You want to have the right information to select a plan that fits your lifestyle needs and budget. “It’s your future. It’s your pocketbook that’s impacted,” says Todd Meek, Chief Executive Officer, Medicare Diversified Distribution Business at Aetna® and CVS Health®. “Doing a little homework up front will help you be an educated consumer to make a good choice,” he adds.

 

Original Medicare vs. Medicare Advantage

We know that Medicare can be complex. Here are some basic terms to help it make sense.

Original Medicare is the traditional health care program from the federal government for people 65 and older. (Some younger people with certain health conditions can also sign up.) It includes Part A (hospital coverage) and Part B (medical coverage, such as doctor visits and lab tests).

Medicare Advantage, also known as Part C, is another way to get your Medicare benefits — through private insurance companies. These plans offer the same benefits as Parts A and B, but they may also have some extra benefits. For instance, coverage for hearing, dental and vision.

To learn more about the different parts of Medicare, check out our introduction here.

 

Are you working past 65?

As more people work past the age of 65, or have coverage through a spouse, delaying signing up may make sense. Some people who have coverage through an employer can delay signing up for Medicare without the penalty. The size of your employer will determine if you qualify for this exception.

If your employer has fewer than 20 employees, you should sign up when you’re first eligible. If you don’t enroll during this period, you may have to pay a late-enrollment penalty.

If your employer has 20 or more employees, get in touch with your benefits adviser. Find out if your current drug coverage is equal to Medicare’s benefits (called “creditable coverage.”) You’ll want to know if the two coverages can work together.

In some cases, you may get better value by opting out of your employee plan and signing up for Medicare. But first, do some homework. Be sure to compare your options before deciding which route to go. If you have coverage through a spouse’s plan, you’ll want to speak with their benefits adviser to better understand your situation.

Do you have retiree health benefits from your company or union? Then you should speak to the people who run that plan. You’ll want to see how it works with Original Medicare. There’s a lot of variety among retiree plans, especially those from unions.

Some may provide comprehensive coverage. So you may not need to not sign up for Medicare. Other plans may limit how much they pay for your care.

Some may provide “stop loss” coverage. That means they only begin paying your out-of-pocket costs when you reach a certain amount. Do your research before deciding if you’ll skip Medicare and go with only a retiree plan.

Learn more here about when to sign up for Medicare.  

 

Plan on retiring at 65 or are already retired?

If your answer is yes, it’s time to start thinking about what type of Medicare plan fits your needs.

Read here to learn more about Medicare Parts A, B, C and D.  

As you review your options, think about factors like your health status, financial situation and lifestyle. Here are some key questions to ask yourself:

  • Do I currently have coverage from a commercial plan? What do I like about the plan?
  • Will my preferred hospitals, physicians and specialists be in the network of the plan I’m thinking about?
  • Do I take a lot of prescriptions? Am I on any specialty medicines? Do the plans cover these?
  • Am I going to travel a lot in retirement? Will the plan cover me when I’m on the road?

 

Get advice and support from others

The great thing about starting on a Medicare journey is that you have many sources of support. In these months leading up to 65, you may want to talk to a health insurance broker. Medicare.gov also has a tool to explore plan options in your area.

Friends and family already in Medicare may also be good sources for advice. “Call friends that have already taken this step. Ask them if they have any learnings or would do anything differently going forward,” says Meek.

And remember to be a savvy shopper. Look at more than plan price. For example, you could sign up for a low-premium plan but then find out it doesn’t cover one of the brand-name prescriptions you take. “You really need to know, like anything else in life, what you’re buying. What’s the value of the product you choose?” says Meek.

You’re in a great position today. You have some time to get to know your plan options and to assess your needs. Make lists of the key Medicare enrollment dates and some questions you want answers to. Post these lists on your refrigerator so you can start thinking about them.

“I think you’ll find better peace of mind and comfort in a decision that you make about your Medicare options by getting an early start,” says Meek.

Need help?

Call us at 1-833-329-0413 (TTY: 711) to chat about any Medicare questions you have.