Checklist for Medicare and Turning 65

Whether you’re retired or still working, for most people transiting from Marketplace plan to Medicare and turning 65 can be a daunting experience. Most people become eligible for Medicare coverage on their 65th birthday, though this can vary depending on when they begin receiving Social Security benefits.

Start the process by reviewing when exactly you are eligible for enrolling in Medicare coverage. Our eligibility calculator can assist you. As you plan your transition to Medicare, use this step-by-step checklist to lead you through the process. 

Guideline for Enrolling in Medicare when Turning 65

You must take some steps when you first become eligible for Medicare coverage. These actions will depend on why you get approved for Medicare.

For example, if you are disabled and receive SSDI, you will be automatically enrolled in Original Medicare (Part A & Part B) after 24 months of SSDI payments.

If you want to register in other Medicare parts, such as Part C (Medicare Advantage) or Part D, you must take additional steps.

However, if you are eligible for Medicare because you are turning 65, you must act proactively. You should apply for Medicare coverage during your Initial Enrollment Period. 

Mark Your Calendar for Medicare Enrollment before

Your Initial Enrollment Period runs from three months before to three months after your 65th birthday. So, you’ll have to enroll in Medicare coverage from January 2022 to July 2022 after turning 65 in April 2022.

It is critical to register during your initial enrollment window. If you miss your deadline, you may be penalized later.

You will also be required to provide Social Security and Medicare with information proving your eligibility. In some cases, such as if you receive Social Security retirement benefits, Social Security would already have this information; in others, you will need to provide it.

• Birth certificate
• Proof of your citizenship status or residency permit if you were not born in the United States
• Income statements W-2 or other tax forms
• Discharge papers or other documents relating to military service before 1968

You can apply for Medicare online through our website or in person at your nearest Social Security office.

If you want to apply through your state office, you can go in person or send them a letter with your name, Social Security number, and the date you want to enroll.

Medicare Enrollment General Steps

To help you prepare for Medicare enrollment, take the following steps a few months ahead of time when turning 65:

• Check to see if your doctor and other providers accept Medicare.
• Use Medicare’s plan finder tool to compare the costs of Medicare Part D, Medicare Advantage, and Medigap plans in your state.
• Determine whether you will be automatically registered in Part A and Part B coverage or if you will need to take additional steps.
• Investigate how your current health plan interacts with Medicare.
• Examine the income requirements for any assistance programs, such as Medicare savings or Medicare Extra Help, and apply if you believe you might be eligible.
• Understand what Medicare covers and what it does not.
• Determine whether or not you will require additional coverage from a Medicare Advantage plan.

Medicare Part A & Part B

If you already get the Social Security benefits, you will be automatically enlisted in Medicare Part A (hospital insurance) and Part B (medical insurance), also known as Original Medicare. You can proceed to the next section of the checklist.

If you are not receiving Social Security health services, you should take the following steps:

• Check to confirm you are qualified for Medicare. You can do this by answering some quick questions at medicareleads.com.
• Make sure you understand when your enrollment period begins and ends.
• Gather any documents and information you might need.
• Choose whether you want to submit your application in person, by phone, mail, or online.
• Determine whether you want Medicare Part A and Part B coverage or just Part A. 

If you need Medicare Part C (Medicare Advantage plan)

If you’re thinking about getting a Medicare Advantage plan, you should:

• You can compare the costs of health plans in your region using Medicare’s program finder tool. These premiums are added to any Medicare Part A and Part B expenses; however, some Advantage plans cover all or some of the Part B premium.
• Check to see if any doctors or other providers you use are in the plan’s network.
• If the program includes Part D coverage, make sure it offers medications you take. 
• Ensure that you can easily afford premiums or any additional expenses.
• Enroll in the plan of your choice and pay the first premium.

If you need Medigap coverage (Medicare supplement insurance)

Take the following steps for Medigap plans:

• Using Medicare’s plan finder tool, calculate the price of programs in your area. 
• Determine how much health coverage you need and which Medigap plan best meets your requirements. 
• Check that the premiums for the health plan you select are within your budget. 
• Understand that Medigap plans only apply to Medicare Parts A and B coverage. This means that they do not cover Medicare Part C (Medicare Advantage) or Part D costs. In reality, you cannot have both Medigap and Advantage simultaneously; you must choose one or the other.

Medicare Part D (or Prescription Drug Coverage)

To obtain prescription drug coverage, you must:

• You can compare the costs of health plans in your state using Medicare’s plan finder tool.
• Check to see if any current prescriptions are on the plan’s formulary. A formulary is a list of medications covered by the program.
• Check out whether or not your pharmacy is in the plan’s network.
• Review that the deductibles, premiums, and other expenses fit in your budget. 
• You should be aware that you will encounter a permanent late enrollment penalty if you choose to enroll in Part D later and go without Part D coverage.
• Enroll first, and then pay your first premium.

If you need an Advantage plan and Medicare Part D coverage

• Find out which Advantage program in your region provides Part D coverage. Sign up and pay your initial premium if one of these plans is right for you.
• If none of these alternatives suit you, you can choose an Advantage plan without Part D and buy a separate Part D plan. Enroll in both programs and pay the first month’s premiums.

If you want a Medigap policy and Part D coverage

• Examine the Medigap, and Part D plans available in your area.
• Make sure that both plans are within your financial constraints.
• Apply for your preferred Medigap plan and pay your initial expenses.
• Enroll in the Medicare Part D plan of your choice and pay your first premium.

During your first year on the Medicare plan: 

• Complete an authorization form that allows Medicare to contact your family member, spouse, or friend if you cannot communicate. 
• Make an appointment for your free “Welcome to Medicare” preventive treatment and health checkup.
• Create an online account for all components of Medicare you use, including Part A & B, Part C, Part D, and Medigap. 
• Monitor your coverage and claims, find providers and pay your bill using your online accounts.
• Consider visiting a local SHIP (State Health Insurance Assistance Program) center to get solutions to your Medicare issues and information on local coverage.

Consider Purchasing Long-term Care Coverage

A private long-term healthcare policy can help pay for long-term residential care or staying in an assisted-living facility or nursing home, which Medicare does not cover. If you haven’t purchased long-term care program but think you might be interested, now (when you’re in your mid-60s) is the last age when purchasing new coverage is affordable for most individuals. We can refer you to a long-term healthcare agent who can assist you in making this critical decision. 

Make a Plan for Your Social Security Benefits Claim

The “full retirement age” for Social Security is currently 66, which means you can claim your full Social Security retirement benefits without penalty if you continue to work. However, some people begin receiving reduced benefits as early as age 62, while others wait until after retirement age (near to age 70) to start receiving higher benefits. It takes some forethought to determine when to claim Social Security benefits for yourself, your dependents, and survivors.

Find out about Additional Assistance if You have a Low Income and few Assets

People turning 65 and up who have a low income and few assets other than their homes are eligible for full Medicare coverage and direct financial assistance. Medicaid can cover the entire cost of medical care and long-term home care, as well as nursing home care. Supplemental Security Income (SSI) can provide small monthly cash benefits in addition to Social Security benefits. 

Make a List of Doctors

One of the most common complaints beneficiaries have when changing their healthcare is that their new plan no longer covers their doctors. So, when it comes to Medicare, you’ll want to make sure that your doctor is covered in whatever Medicare plan you choose when turning 65. Not all physicians accept Medicare, and Medicare Advantage plans typically have physician networks. Having a list of your physician on hand makes it easier to determine if they take your new insurance.

Make a List of Prescription Drugs

Each Medicare plan provides different coverage for prescription drugs, often outlined in a list known as a formulary. Also, you may want to compare prescription costs when evaluating programs for best fit. Having a list ready will make this process easier.

Prepare Your Legal Documents

Although most 65-year old individuals have many years ahead of them, a sudden accident or illness could affect decision-making power, if not impossible. Getting your legal papers in order can help ensure that your wishes for healthcare, including end-of-life care, your ongoing finances, and your estate, are followed. These documents may include a will, a financial power of attorney, an advance medical directive (also known as a living will), and possibly a living trust.

Understanding Medicare Enrollment Periods before Turning 65

You can sign up for Medicare coverage during certain times of the year. These enrollment periods are tied to specific events in your life or the parts of the Medicare plan you’re interested in.

If you miss an enrollment period, you might be charged additional fees, and some of these penalties may apply for the rest of your life if you have Medicare.

Enrollment periods for Medicare include:

Initial Enrollment Period

This is the seven-month period just before, during, and after your 65th birthday, when you can enroll in Medicare for the first time. It begins three months before your birth month includes your birthday month, and lasts three months after your birth month. During this period, you can register for all parts of Medicare.

Open Enrollment Period (October 15 to December 17)

During this period, you can switch from the Original Medicare plan (Part A & Part B) to Part C (Medicare Advantage) or from Part C to Original Medicare. You can also change Part C plans or renew, add, remove, or modify a Part D plan.

General Enrollment Period (January 1 to March 31)

You must enroll in the General Enrollment window if you did not sign up for a Medicare plan during your Initial Enrollment Period.

Special Enrollment Period (SEP)

You could enlist in Medicare during the Special Enrollment Period if you delayed enrollment for an approved reason. If you discontinue other insurance coverage, you have eight months from the end of your health plan or your employment to sign up for new insurance coverage without penalty.

Enrollment (from January 1 to March 31)

You can move from one Advantage program to another or return to traditional Medicare during this time. Nevertheless, you can’t register in Medicare Advantage coverage if you have Original Medicare.

Part D Enrollment Period and Medicare Add-ons (from April 1 to June 30)

If you don’t purchase Medicare Part A but are enrolled in the Part B plan during the General Enrollment Period, you can enlist in a Part D prescription drug coverage at this time.

Medigap Enrollment

This six-month period begins after the first day of the month that you apply for original Medicare or on your 65th birthday. If you do not enlist during this period, you may be unable to obtain a Medigap plan. However, you might need to pay higher premiums, especially for health problems, if you get coverage later.

Sit Back and Enjoy Your New Services

While you wait for your insurance coverage to begin, you can rest assured that the details are handled. You have got a team of experts on your side! After you enroll, you will have access to that team for the rest of your life. You can contact us any time if you have questions about your plan or rush into problems that you cannot resolve.