| Wed, Dec 11, 2013 @ 09:00 AM

Are You Ready for 65?

Posted by Medicare Made Clear

medicare eligibilityWere you born in 1949? Get ready to make some choices about your Medicare coverage!

In most cases, Medicare eligibility starts at the age of 65. Medicare plans can vary widely in coverage and costs. Choosing a Medicare plan that has the coverage you need and fits with your budget may sound easy. But it can become complicated under certain circumstances.

Below you’ll find answers to some of the Medicare questions commonly asked by other people. It may be helpful to write down additional questions you think of while reading through this. As a next step, use the resources listed below to get more information.

Who is eligible for Medicare?

U.S. citizens who are over the age of 65 qualify for Medicare. In some cases, people who are under age 65 and have certain disabilities or health conditions may qualify for Medicare.

When am I eligible for Medicare?

There is a certain amount of time when you can sign up for Medicare. It is called your Initial Enrollment Period (IEP). This time to sign up is different for everyone. Your Initial Enrollment Period is the three months before your 65th birth month, the month of your birthday, and three months after. If you sign up later, you might have to pay more for a plan.

How do I sign up, or am I automatically signed up for Medicare?

In most cases, people who get benefits from Social Security or the Railroad Retirement Board will be automatically enrolled in Medicare Part A & Part B. If you are not receiving any of those benefits, you will need to sign up during your Initial Enrollment Period.

Can I delay signing up for Medicare, or do I have to sign up once I’m eligible?

Most people do not delay signing up for Medicare Part A because they get it at no cost. In most cases, if you or your spouse has worked full time for at least 10 years you will not pay a premium for Part A. Some people may elect not to sign up for Parts B and D because they have other coverage when they turn 65.  When they do decide to enroll in B or D, they will have a limited window to apply without incurring a penalty for a later enrollment. Also, you could have to wait several months for your coverage to start. If needed medical services were needed during that waiting period, it would probably be paid for out-of-pocket.

What is the difference between Medicare Open Enrollment (OEP) and the Initial Enrollment Period (IEP)?

IEP is the time period when you can first sign up for Medicare. IEP differs from person to person because it depends on the date they were born. Your Initial Enrollment Period is the three months before your 65th birth month, the month of your birthday, and three months after.

For Medicare beneficiaries, OEP is at the same time for everyone. It happens once a year, October 15-December 7. OEP is the time when you can change, add, or drop your Medicare coverage.

Unless you qualify for a Special Election period (SEP), you can only enroll during IEP or OEP.

If I’m still working and I’m insured by my employer, do I still need to sign up for Medicare?

If you get insurance from your union or your employer, or you’re covered by your spouse’s health insurance you can choose to delay signing up for Medicare. If you don’t have coverage and sign up late, you may have fewer plan choices. You may also have to pay a penalty. Check with your benefit administrator so you understand how the rules may apply to your situation.

Can I get benefits when my spouse joins Medicare?

Medicare is only individual coverage. It does not provide multiple family member coverage.  Your coverage starts when you reach age 65. Until then, you may have other options such as COBRA coverage or an individual health insurance policy.

I’m in the military and have insurance through Tricare. Is that the same as Medicare?

Tricare is a worldwide health care program for uniformed service members, retired military and families of military members. Medicare is a federal health care program for U.S. citizens age 65 and older. There are some exceptions for people who are not 65 but have certain disabilities or health conditions.

Some people are eligible for both Tricare and Medicare. You must have Medicare Part A and Part B to qualify for Tricare’s Medicare wrap-around coverage called Tricare for Life (TFL). For some TFL beneficiaries, there is no advantage to signing up for a Part D plan. TFL includes comprehensive prescription drug coverage. The exception is people who need help paying for their drugs. They may qualify for Extra Help paying Medicare drug costs.

What are my choices for a Medicare plan?

There are two ways you can get Medicare. One choice is Original Medicare (Part A & Part B). It is offered by the federal government. The other choice is Medicare Advantage (Part C). Private insurance companies offer Medicare Advantage/Part C.

Original Medicare has two parts, Part A and Part B.  Part A covers health care you get at hospitals and skilled nursing facilities. Most people do not pay a premium for Medicare Part A. However, most people do pay a premium for Part B, which covers doctor visits and outpatient care.

Medicare Advantage, or Part C plans provide all the benefits included under Original Medicare. Many Part C plans also include dental, vision, hearing or prescription drug coverage, also called (Medicare Part D).

Below are some examples of Medicare coverage choices.

  • Choose Original Medicare Part A and Part B
  • Choose a Medicare Advantage Part C plan. Some plans include prescription drug coverage (Part D) and benefits not covered by Original Medicare. If you choose a Part C plan, you will still need to pay your Part B premium. Some plans may have a $0 premium.
  • Join a Medicare Part D plan to add drug coverage to Original Medicare, or to a Part C plan that doesn’t include it.
  • Sign up for a Medigap plan to help cover some costs and benefits not covered by Original Medicare.
  • Delay enrollment in Medicare if you are still receiving health care coverage through an employer, or union.

If I don’t take prescriptions, do I need to sign up for a Part D prescription drug plan?

You don’t have to sign up for Medicare Part D but if you sign up later, you may have to pay more for your plan.

What is a Medicare Supplement Insurance Plan?

Medicare supplement insurance plans, or Medigap is available in most states. These plans help people cover some of the costs that Medicare Part A & Part B won’t cover. You must have Medicare Part B to qualify for Medigap. Private insurance companies offer 10 types of Medigap plans.

For more information, contact the Medicare helpline 24 hours a day, seven days a week at 1-800-MEDICARE (1-800-633-4227), TTY 1-877-486-2048.


Medicare.gov: Search for Medicare plans in your area.

Show Me Guide: Read easy to understand information about your Medicare choices.

SHIP: Get assistance from your state’s health insurance program


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