Turning 65 or New to Medicare?

Cure Medicare Confusion by Understanding the Basics.

Turning 65 is a major life milestone. At 65, many older adults find themselves ready to slow down and enjoy life. However, there’s another big event that happens at 65, Medicare eligibility! At 65, you become eligible for Medicare, and for many that means lots of confusion. Trying to understand the different parts of Medicare, enrollment periods, coverage options, and more can be overwhelming. We understand and you’re not alone.

At Griset Medicare Solutions our goal is to guide you through the Medicare maze to ensure you are confident in choosing the best Medicare coverage that is right for you. Whether you are turning 65 soon or are already 65, know a little or a lot about Medicare, we here to help you when help is needed. Let’s start with understanding the basics of Medicare coverage.

What Is Medicare?

New to Medicare

Medicare is a federal health insurance program for individuals 65 years of age or older or for those under the age of 65 who qualify under specific special circumstances. Medicare insurance replaces your traditional health insurance coverage and can also replace or work alongside your employer’s health coverage.

How Do I Know if I’m Eligible for Medicare?

Most older adults are eligible for Medicare when they turn 65 as long as they are a U.S. citizen and have resided in the United States for at least 5 years.  If you are already retired and collecting social security you will be automatically enrolled in Original Medicare when you turn 65.  If you are still working at the time of your 65th birthday you can choose to either enroll in or delay Medicare coverage until after you retire and your employer health benefits expire. If you haven’t been automatically enrolled in Medicare and wish to enroll you will need to do so by working with your local social security office or enrolling online at ssa.gov.

Confused about Eligibility and Automatic Enrollment?  We can help you navigate the process.

What Does Original Medicare Cover?

Original Medicare consists of two parts:

✅ Part A 

Medicare Part A, also known as hospital insurance, covers inpatient hospital services, hospice care, home health care, and more.

Most individuals do not have to pay a Part A premium as long as they or their spouse has paid Medicare taxes for at least 10 years while working.  However, the Part A deductible still applies.

✅ Part B

Medicare Part B, also known as medical insurance, covers out-patient services like doctor visits, mental health services, and some preventive care.

Part B benefits require a monthly premium (in 2021 it begins at $148.50). This premium, however, can increase in relation to a participant’s higher income level.

What’s Not Covered Under Medicare Part A & Part B

  • Prescription drugs
  • Most dental care/dentures
  • Eye exams/prescription glasses
  • Hearing aids
  • Long-term care
  • Homeopathic care
  • Acupuncture
  • Foot care and orthopedic shoes
  • Certain routine or physical exams
  • Deductibles, coinsurance, or copayments for health services

Fill in the Gaps of Original Medicare with Additional Coverage Options

Unfortunately, Original Medicare doesn’t cover everything leaving many beneficiaries with gaps in coverage.  The good news is there are options to fill in those gaps through additional Medicare coverage provided by private insurance carriers, these plans include:

✅  Medicare Advantage
✅  Medicare Supplement

Turning 65 Medicare Chart

 Medicare Part D (Prescription Drug Coverage)

Those who have enrolled in Medicare Part A and/or Part B can add a stand-alone prescription drug plan to their coverage. Unlike Medicare Advantage and Medicare Supplement plans that cover medical services, Medicare Part D only provides prescription drug coverage.

When do I sign up for Medicare?

Initial Enrollment Period (IEP)

The initial enrollment period is your first opportunity.  This enrollment opportunity is available for a seven-month period of time.  The seven-month window begins three months before your 65th birthday, your birthday month, and three months after your birthday.  If you fail to sign up for Medicare during this time you may be subject to a late enrollment penalty.

Special Enrollment Period (SEP)

The special enrollment period is available for those who continue working past 65 and have health coverage through their employer or spouse.  The time frame for SEP is eight months, which begins one month after your employment or health coverage ends.

Annual Enrollment Period (AEP)

The annual enrollment period runs from October 15th through December 7th.  During this time frame, you can add Medicare plans, drop Medicare plans, and make changes to existing Medicare plans.  Any changes made during this enrollment period will take effect in January the following year.

What happens if I don’t enroll in Medicare?

If you don’t sign up for Medicare when you’re first eligible you may be required to pay a late enrollment penalty once you do sign up for Medicare.  The late enrollment penalty for Part B is 10% of the national average of Part D premiums for every 12 month period you went without Part B coverage. The penalty is added to your Part B premium and remains the entire time you are enrolled in Medicare.  In addition to a Part B late enrollment penalty, there is also a penalty for not having prescription drug coverage which is again added to your monthly premium once you enroll in prescription coverage.  Late enrollment penalties can be avoided if you had creditable coverage (employer or group coverage) or if you qualify for Extra Help.

Get Help Find your Best Medicare Coverage Options with Griset Medicare Solutions

More than half of seniors find Medicare confusing, but getting the right coverage at the right price is so important. As an independent Medicare Insurance Agent, we work for YOU, not for an insurance company. Unlike a “captive agent” or call center with only one plan to sell, we are independent, unbiased, and provide you with the benefit of over 40 years of experience caring for clients. And here’s the best part… .our services are Free!  Sign up below for a FREE and unbiased Medicare Consultation!

Turning 65 or New to Medicare? Don’t get lost in the confusion!
Let us guide you through the process every step of the way!