Medicare Explained: What You Need to Know Before Turning 65

Medicare can be confusing, but understanding your options before you turn 65 is crucial for making informed decisions about your healthcare coverage.

What is Medicare?

Medicare is the federal health insurance program for people 65 and older, as well as some younger people with disabilities.

The Four Parts of Medicare

Part A: Hospital Insurance

• Inpatient hospital care
• Skilled nursing facility care
• Hospice care
• Some home health care

Most people don't pay a premium for Part A if they or their spouse paid Medicare taxes while working.

Part B: Medical Insurance

• Doctor visits
• Outpatient care
• Preventive services
• Medical equipment

Part B has a monthly premium that most people pay.

Part C: Medicare Advantage

• Combines Parts A and B
• Often includes Part D (prescription drugs)
• May include extra benefits like dental and vision
• Offered by private insurance companies

Part D: Prescription Drug Coverage

• Helps cover the cost of prescription drugs
• Offered by private insurance companies
• Available as standalone plans or included in Medicare Advantage

When to Enroll

Initial Enrollment Period

• 7-month window around your 65th birthday
• Starts 3 months before your birthday month
• Ends 3 months after your birthday month

Late Enrollment Penalties

• Part B: 10% higher premium for each 12-month period you could have had Part B but didn't
• Part D: 1% higher premium for each month you went without creditable coverage

Medigap (Medicare Supplement) Plans

These plans help pay costs that Original Medicare doesn't cover:

• Deductibles
• Copayments
• Coinsurance

Making Your Decision

Consider:

• Your current health and medications
• Preferred doctors and hospitals
• Budget for premiums and out-of-pocket costs
• Travel plans (coverage outside your area)

Get Help

Medicare decisions are complex. Consider working with a licensed insurance agent who specializes in Medicare to help you navigate your options.