How to prep for Medicare eligibility

September 9, 2020
how to prep for medicare eligiblity

Many of us have seen the quote “I am still learning,” attributed to the famed Michelangelo at age 87. And while the origin of this quote has been debated, the message still resonates. Most of us strive to become more involved in our healthcare, including learning the ins and outs of health insurance coverage. As you approach your milestone 65th birthday, it is time to think about enrolling in Medicare. How do you prep for Medicare eligibility? Here are a few things you need to know.

First, know when to enroll

If you are already receiving Social Security benefits, then you will be automatically enrolled in Medicare. (We always recommend you double check on this.) But if you are not, it is up to you to remember to enroll. The timetable to enroll in Medicare is very specific. Your Initial Enrollment Period (IEP) lasts seven months – three months before, the month of and three months after your 65th birthday. Knowing this timetable is important. If you do not enroll during this seven-month period, you can still sign up between January 1 and March 31 of each year, but this late enrollment is subject to permanently higher premiums. You will also be subject to a gap in coverage… both things that no one wants!

Second, check on your employer-sponsored health insurance coverage

If you are turning 65, but you are still working and have health insurance through your employer, or if your spouse is still working and you are covered under his or her health insurance, you may still be required to enroll in Medicare Parts A and B.

  • If your employer has fewer than 20 employees, you should sign up for Part A and Part B when you are first eligible. Medicare will become your primary health insurance coverage and will pay before other coverage.
  • If your employer has 20 or more employees, talk to your HR department to confirm if you have group health plan coverage (defined by the IRS). If this is the case, then you may be able to delay Part A and B without penalty.

Once your employer or union coverage ends, you may be able to get COBRA coverage, which continues your health insurance coverage through the employer’s plan for up to 18 months at a much higher cost to you. You have eight months to sign up for Part B, whether or not you choose COBRA. We recommend enrolling in Part B before your COBRA ends to avoid penalties or coverage gaps.

Third, educate yourself on the basics of Medicare

Medicare has multiple parts. Part A covers hospital and hospice care and some skilled nursing services after you’ve been in the hospital. Part B includes doctor visits and other outpatient services. Part C is Medicare Advantage, which is a combination of Parts A and B — and (most of the time) Part D, which helps pay for prescription drugs. Medicare Advantage plans are offered by private health insurance companies (like Aspire Health Plan) who have contracts with the government. (Visit our Medicare overview page for more details.)

Fourth, assess your health and lifestyle

Make a list of your doctors that you currently see and decide if you want to consider seeing them once you are on Medicare. Also check to make sure your providers accept Medicare. In addition, make a list of all of the medications that you take so that you are able to choose a prescription drug plan that best meets your needs. Also, think about your lifestyle – certain factors can influence your Medicare choices.

  • Are you a frequent traveler?
  • Do you travel in the U.S. or abroad?
  • Do you spend your time moving between different residences?
  • Do you need medical care in different states?

Fifth, assess your financial situation and plan for out-of-pocket costs

Medicare is a great federal program that provides care for people with disabilities and older Americans. However, it is not free. When budgeting for Medicare costs, consider your financial situation so that you are able to choose something within your budget. In addition, consider out-of-pocket medical expenses. Medicare Parts A and B (Original Medicare) does not cover expenses such as dental care, eye exams, dentures and hearing aids. You will need to decide if you need to enroll in a Medicare Advantage plan or purchase Medicare supplemental coverage (Medigap) to help pay for these expenses.

The biggest thing to remember as you prep for Medicare eligibility is to take time. If you have any questions about enrollment in Medicare (or Medicare Advantage), give Aspire Health Plan a call at (831) 657-0700.

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