Turning 65: Making Your Medicare Decions with Confidence-Part 2

Turning 65 comes with plenty of decisions, and choosing Medicare coverage is one of the most important. In Part 1, we discussed when to begin preparing and the basic parts of Medicare. Now, let’s look at the choices you will make as your Medicare eligibility date approaches. The goal is not simply to enroll in Medicare. It is to understand how your coverage will work, what costs you may have, and which option fits your healthcare needs and lifestyle.

Choosing How You Receive Your Medicare Benefits

Once you are enrolled in Medicare Part A and B, you generally have two main coverage paths.

Option 1: Original Medicare with Additional Coverage

Original Medicare includes Part A for hospital coverage and Part B for medical coverage. Many people also choose:

• A Medicare Supplement insurance policy to help pay certain out of pocket costs left by Original Medicare

• A separate Medicare Part D prescription durg plan

With Original Medicare, you can generally visit any doctor or hospital in the United States that accepts Medicare. Medicare Supplement plans are standardized, but premiums can vary among insurance companies.

Option 2: Medicare Advantage

A Medicare Advantage plan is another way to receive your Medicare Part A and Part B benefits through a private insurance company approved by Medicare.

Most Medicare Advantage plans include prescription drug coverage, and some may offer additional benefits not included with Original Medicare. Plans may use provider networks, service area, copayments, prior authorization requirements, and other plan rules.

A Medicare Supplement policy and a Medicare Advantage plans are not designed to be used together. Understanding the differences before enrolling is important.

Look Beyond the Monthly Premium

A low or even $0 monthly plan premium may sound attractive, but the premium is only one part of the overall cost.

Before selecting coverage, consider:

• Are your doctors and preferred hospitals included?

• How much will you pay for office visits, specialists, testing, and hospital stays?

• Are your prescriptions covered?

• Which pharmacies are preferred?

• Does the plan require referrals or prior authorization?

• Will your coverage work when you travel?

• What is the plan’s annual out of pocket limit?

Your current health is important, but your coverage should also provide protections if your healthcare needs change during the year.

Review Your Prescription Medications Carefully

Prescription drug coverage deserves more attention than simply choosing the plan with the lowest premium.

Each Medicare drug plan has its own list of covered medications, called a formulary. Plans may also place medications into different cost sharing levels and use different pharmacy networks.

When comparing coverage, have the following information available:

• The exact name of every medication

• Dosage and frequency

• Your preferred pharmacy

• Whether you use mail order presriptions.

Even if you do not currently take medication, delaying Part D coverage without other creditable drug coverage could result in a late enrollment penalty later.

What If You Are Still Working at 65?

Turning 65 does not automatically mean you must retire, but you should not assume that employer coverage allows you to delay every part of Medicare.

The rules can depend on factors such as:

• Whether the coverage is based on your current employment or your spouse’s current employment.

• The size of the employer

• Whether the employer plan is considered creditable coverage

• How the employer plan coordinates with Medicare

COBRA and retiree coverage do not follow the same Medicare enrollment rules as active employer coverage. Before delaying Medicare, speak with your employer’s benefits department and someone who understands Medicare enrollment requirements.

Medicare generally provides an eight-month Special Enrollment Period for Part B after current employment or qualifying job-based coverage ends, whichever happens first. However, waiting for COBRA to end does not extend that period. Medicare.gov explains the working past 65 rules here.

Do Not Miss Your Enrollment Window

Your initial Enrollment Period generally last seven months:

• The three months before the month you turn 65

• The month you turn 65

• The three months after your birthday month

The date your coverage begins can depend on when you enroll. Waiting too long could create a gap in coverage or lead to late enrollment penalties unless you qualify for a Special Enrollment Period. You can review Medicare’s enrollment timing here.

it is better to begin preparing several months before your 65th birthday than to rush through these decisions at the last minute.

Your Medicare Checklist

As you prepare to turn 65, gather:

• Your Medicare card, if you have received it

• A complete medication list

• The names of your doctors and preferred hospitals

• Information about current employer or retiree coverage

• Your preferred pharmacy

• Your expected travel needs

• Questions about premiums and out of pocket costs

Having this information available makes it easier to compare coverage based on your actual needs.

You Do Not Have to Navigate Medicare Alone

Medicare can feel overwhelming because there is no single option that is right for everyone. Your doctors, medications, budget, travel plans, and comfort with different types of coverage all matter.

At The Guffey Group, education comes first. I take the time to explain your options, answer your questions, and help you make an informed decision without feeling pressure.

If you are approaching your 65th birthday, now is the time to begin the conversation.

The Guffey Group

618-593-6558

theguffeygroup.net

Protecting what matters most!

The Guffey Group is not connected with or endorsed by the U.S government or the federal Medicare program. Plan availability, benefits, cost, provider networks, and drug coverage vary by plan and location.