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Resources

Preparing Yourself to Transition to Medicare

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Written by:
Aaron Garcia
A man with short brown hair and a goatee, wearing a teal shirt, smiles slightly at the camera against a gray background.
Reviewed by:
Brett Braithwaite

Key Takeaways

  • The two main forms of Medicare are Original Medicare (Parts A and B)Original Medicare is a fee-for-service health insurance program available to Americans aged 65 and older and some individuals with disabilities. Original Medicare is provided by the federal government and is made up of two parts: Part A (hospital insurance) and Part B (medical insurance). and Medicare AdvantageMedicare Advantage (Medicare Part C) is health insurance for Americans aged 65 and older that blends Medicare benefits with private health insurance. This typically includes a bundle of Original Medicare (Parts A and B) and Medicare Prescription Drug Plan (Part D). . Original Medicare is government-funded insurance, and private insurance companies provide Medicare Advantage plans. For additional coverage, a Medicare Supplement plan (Medigap) is another option. Medicare Supplement plans help fill the gaps with Original Medicare.
  • Medicare has several different enrollment periods depending on whether you’re enrolling when you turn 65, or need to change, add, or drop your current plan. The period that most Medicare beneficiaries take advantage of is AEP (annual enrollment period).
  • Both Original Medicare and Medicare Advantage enrollees have to pay for their service. Medicare Supplement plans usually have a premium that may range from $100-$500 per month. Several programs can provide financial relief if you need help paying for Original Medicare or Medicare Advantage plan.
  • Medicare plans are individual plans. If you’re married, you and your spouse will have separate Medicare plans when you’re both 65.

Asking yourself, “How can I prepare myself for Medicare before I turn 65?” can make your enrollment much more manageable when your time comes. But Medicare is a huge topic with a lot to know. Here is an overview to get you started. In our experience, understanding these points will help guide your search as you go. That way, you’ll know how to get the coverage you need when you’re ready for it.

Your Ideal Medicare Plan is out there.

Let’s Find It Together
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Know Your Medicare Choices

Many people think of Medicare as a specific health insurance plan. In reality, it’s more of a blanket term that’s broken down into two main options: Original Medicare and Medicare Advantage. Choosing which of these options you want to start with comes down to knowing what they offer. Here’s a breakdown:

  • Original Medicare: Provides hospital (Part A) and medical (Part B) coverage. Enrollees can add Medicare Supplement Insurance (Medigap) to help with Original Medicare’s high out-of-pocket costs and gaps in coverage. Medicare Prescription Drug Plan (Part D) is added separately to provide drug coverage. These plans offer flexibility as you can see any doctor that accepts Medicare.
  • Medicare Advantage: Private Medicare plans that offer at least the same coverage as Original Medicare. These plans often offer benefits that Original Medicare doesn’t, including dental and vision. Medicare Advantage plans are also referred to as Part C, and these plans are network-based. That means you will need to see certain doctors or specialists.

Do I Automatically Get Medicare When I Turn 65?

Most beneficiaries are automatically enrolled into Medicare but if not there is a 7 month Initial Enrollment Period to sign up for parts A and B. Many people mistakenly think they’ll be automatically enrolled in Medicare when they turn 65. This is one of several myths about Medicare that can get people into trouble. Unless you’ve received Railroad Retirement Benefits (RRB) or Social Security benefits due to disability for 24 months, you may need to enroll yourself into Medicare when it’s time.

The good news? There are several ways to do so. You can apply for Medicare online through the Social Security Administration. You can also do so in person or over the phone. If you need guidance with your Medicare eligibility, you can contact a licensed insurance agent to help navigate the enrollment process.

Find the Medicare Plan that works for you.

Find My Ideal Plan
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When to Enroll? Different Periods for Different Needs.

Medicare has several enrollment periods, during which you can do different things with your coverage. The first is your Initial Enrollment Period. There are also different enrollment periods each year when you can re-enroll, add or change your coverage. Make sure you know the answer to questions like “What is the Medicare Open Enrollment Period?” and “When can I change plans?”

Belated Enrollment? Expect Penalties.


Don’t want to enroll when you turn 65? It’s not required. Not enrolling, however, can leave you with stiff enrollment penalties when you do. Medicare Parts A, B and D each will tack on an extra charge onto your monthly premium payments to account for this delay. The longer you put off enrollment, the more you’ll pay. Even worse, many of these penalties will remain active as long as you have your Original Medicare coverage.

65 with Other Coverage? Medicare Still May Be Your Primary Payer.

Once you turn 65 and don’t have other coverage, Medicare takes over as the primary payer for your healthcare claims. This also happens when you have coverage through an employer that has 20 or fewer employees. In other words, don’t assume you can put off preparing for Medicare until you need it.

You’ll Have to Pay for Your Medicare. But it Can be Cheaper.

The Federal Government partially funds Medicare through taxes. The other chunk comes out of your pocket when you pay your plan’s premiums, deductibles, copayments and coinsurance. If you’re worried about affording your coverage when you turn 65, several programs are designed to help pay your medical costs and prescription drugs. These include Medicare Savings Programs and the Part D Limited Income Subsidy (LIS), or Extra Help. Depending on where you live, Medicaid may be an option if your income is low enough.

Looking for a plan with prescription drug coverage?

Find My Ideal MA Plan
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You and Your Spouse Share Everything? Not Medicare.

With Medicare, “I do” means just you. Every person has a separate Medicare policy, whether they have Original Medicare or Medicare Advantage. Unlike your old private or group plan, there are no family plans you can choose when you’re enrolling in Medicare. If you and your spouse share a family plan, the other will need to continue their coverage alone or find a new policy when the other enrolls in Medicare. If you’re still working at 65 and have coverage through a group plan, you may be able to delay enrolling in Medicare until you finish working or lose coverage.

Retiring Before 65? Make Sure You’re Covered.

Retiring before 65 can be a major accomplishment. But it can also leave you without coverage while you’re waiting to turn 65 and enroll in Medicare. Even worse, going uncovered can leave you with higher costs when you enroll, especially when it comes to your drug coverage. Fortunately, there are plenty of options to help bridge this time, including:

Don’t let your search stop here. Instead, check out our New to Medicare Guide. We’ve broken down what you need to know before, during, and after your Medicare enrollment. If you have specific questions about your coverage and options, give GoHealth a call. Our licensed insurance agents can provide the answers and guidance you need to prepare for Medicare.

FAQs

Your income will play a pretty big role, especially when it comes to your costs. Medicare Parts A, B and D all have income-based premium payments. The higher your income, the more you’ll pay each month for Original Medicare.
If you or your spouse worked 10 or more years, you’ll probably receive no-cost Medicare Part A. This is the portion of your Medicare that provides your hospital coverage. If you worked less than 10 years, you may have a Medicare Part A premium to pay each month.
To help your enrollment go smoothly, here is the information you’ll want to have with you when you sign up for Medicare:[i]
  • Employment start and end dates
  • Group health plan start and end dates
  • Marital history
  • Current doctors and prescriptions
  • Military service history
  • Employer details for the current year, and the two years before
My Social Security is the Social Security Administration’s online portal that lets you view and manage your Social Security. If you’re planning to enroll in Medicare by yourself or need to order a replacement Medicare ID card, you’ll need to have an active account. To set up an account, the SSA recommends you have a W-2 and tax forms handy.[i]

Sources

This website is operated by GoHealth, LLC., a licensed health insurance company. The website and its contents are for informational and educational purposes; helping people understand Medicare in a simple way. The purpose of this website is the solicitation of insurance. Contact will be made by a licensed insurance agent/producer or insurance company. Medicare Supplement insurance plans are not connected with or endorsed by the U.S. government or the federal Medicare program. Our mission is to help every American get better health insurance and save money.

Any information we provide is limited to those plans we do offer in your area. Please contact Medicare.gov or 1-800-MEDICARE to get information on all of your options.