Medicare at 65: Let’s Make This Simple

Turning 65 comes with enough changes without needing a dictionary to understand Medicare. If all the Parts, plans and insurance-company mail have you scratching your head, you are in good company. My goal here is not to make you a Medicare expert.

It is simply to help you understand what happens at 65, what Medicare pays for, what you pay for, and the two basic directions you can go.

The important stuff

• Medicare Open Enrollment is October 15 through December 7 every year. This is when people already on Medicare can review their coverage and make certain changes for the following year.

• Turning 65 is different from Open Enrollment. Around your 65th birthday, you have your own enrollment period for getting started with Medicare.

• You are not always automatically enrolled at 65. If you are already receiving Social Security benefits, you are generally automatically enrolled in Medicare Parts A and B. If you are not receiving Social Security yet, you may need to sign yourself up.

• Part A is mainly your hospital coverage. Most people do not pay a monthly premium for Part A because they paid Medicare taxes while they were working. That does not mean every hospital bill is free. There can still be deductibles and other costs.

• Part B is mainly doctors and outpatient medical care. You pay a monthly premium for Part B. With Original Medicare, after the deductible Medicare generally pays about 80% of Medicare-approved covered Part B services, and you are generally responsible for the other 20%.

• That remaining cost is where your next decision comes in. You can stay with Original Medicare and usually add a Medicare Supplement, often called Medigap, or you can choose a Medicare Advantage plan offered by a private insurance company.

• With Original Medicare + a Supplement: Medicare pays first. Your Supplement then helps pay eligible costs according to the policy you purchased. You usually purchase prescription drug coverage separately through Part D.

• With Medicare Advantage: Medicare pays a private insurance company to provide your Medicare benefits. You still have Medicare and generally continue paying your Part B premium. The plan may have its own copays, deductibles, provider network and other costs. Many Advantage plans include prescription coverage and may offer additional benefits.

• Medicare does not automatically choose your Supplement, Medicare Advantage plan or prescription plan for you. Those choices are yours.

So which one should you choose?

There isn’t one answer that fits everybody.

Your neighbor may love her plan, but that doesn’t mean it is right for you.

Your doctors matter. Your prescriptions matter. Your health matters. Your budget matters. Even how much you travel can matter.

That is why I would much rather start with you than start with an insurance plan.

In a Nutshell…

When that stack of Medicare mail starts showing up, don’t let it scare you.

You don’t need to understand everything at once.

I am here to give you information, explain the choices in plain English, and answer your questions. There is no need for pressure or a bunch of insurance jargon.

You make the decision.

Pull up a chair. We’ll figure it out together.

General Medicare information based on Medicare.gov and CMS guidance. Plan details, costs and eligibility can change.