Medicare at 65: What You Actually Need to Do Step-by-Step

Turning 65 comes with plenty of milestones. Medicare is one of the important ones, and it can be difficult to know exactly when to start.

You might receive information from Medicare, Social Security, your employer, insurance companies and other organizations. Your mailbox can fill up pretty quickly! Meanwhile, you could still be working, planning to retire, covered through a spouse's employer, or simply trying to understand what Medicare will mean for you.

After more than 22 years helping people with Medicare, I've found that having a clear timeline makes the process much easier.

Here is a practical way to approach Medicare as you get closer to 65.

Start by finding your Medicare timeline

For most people, the Initial Enrollment Period is seven months long. It begins three months before the month you turn 65, includes your birthday month, and ends three months after the month you turn 65.

Your exact timeline matters because the month you enroll can affect when your coverage begins.

For example, if you sign up before the month you turn 65, Medicare coverage generally begins the month you turn 65. If you wait until your birthday month or one of the three months afterward, your coverage generally begins the following month. There are special rules for people whose birthday falls on the first day of the month.

Put your Medicare enrollment dates on your calendar early.

You don't want your first introduction to Medicare to happen when a deadline is already approaching.

Figure out what health coverage you will have when you turn 65

This is one of the first questions I would ask anyone approaching Medicare eligibility:

What health insurance will you have on your 65th birthday?

If you're working, you might have coverage through your employer. Your spouse may have employer coverage that includes you. You may have individual coverage, retiree coverage or another arrangement.

Your answer can affect when you need to enroll in Medicare.

If you have health coverage through your or your spouse's current employment, Medicare provides a Special Enrollment Period in many circumstances. Once the employment or job-based coverage ends, the Special Enrollment Period for Part B generally lasts eight months.

There are important details, though. The size and type of employer coverage can matter, and COBRA or retiree coverage does not necessarily work the same way as coverage based on current employment. Medicare specifically recommends checking with the employer providing your health insurance to determine how their coverage works with Medicare.

If you're still working at 65, don't make assumptions based on what a friend or coworker did. Find out how your particular coverage coordinates with Medicare.

Learn what Part A and Part B actually do

Medicare has several pieces, and understanding the foundation will make the rest of your decisions easier.

Medicare Part A generally helps cover inpatient hospital care, skilled nursing facility care, hospice care and certain home health services.

Medicare Part B generally helps cover doctors' services, outpatient care, durable medical equipment and other medically necessary services.

Most people don't pay a monthly premium for Part A because they or a spouse have enough Medicare-covered work history. Part B has a monthly premium.

Once you understand Parts A and B, you can start looking at the coverage choices that work alongside or through Medicare.

Find out whether you need to enroll yourself

Some people are automatically enrolled in Medicare.

For example, if you're already receiving Social Security benefits when you become eligible, you may be automatically enrolled in Part A and Part B. Others need to actively enroll.

If you're not receiving Social Security and need to enroll in Medicare yourself, the Social Security Administration handles enrollment for Part A and Part B. Medicare.gov directs people to Social Security to complete the enrollment process.

This is a good reason to find out your situation before your enrollment window opens.

Knowing whether you need to take action removes one more piece of uncertainty from the process.

Make a list of your doctors

Before you start comparing Medicare coverage, write down the healthcare providers you actually use.

Include:

• Primary care physician
• Specialists
• Preferred hospitals
• Physical therapists
• Other healthcare providers you see regularly

If keeping a particular doctor is important to you, put that at the top of the list.

Your doctors and healthcare providers can be an important part of evaluating Medicare Advantage plans because those plans have provider networks and service areas.

If you're considering Medicare Supplement insurance with Original Medicare, you'll want to understand how that coverage works as well.

The point is simple: start with your healthcare needs.

Your insurance should work with the way you actually receive care.

Make a prescription list

Do the same thing with your medications.

Write down:

• Medication name
• Brand
• Dosage
• How often you take it
• Preferred pharmacy

Having this information ready will make it much easier to compare prescription coverage.

Medicare prescription drug coverage can vary by plan, including which medications are covered and what you pay for them. If you take several prescriptions, this can become an important part of your overall Medicare decision.

Don't rely on remembering your medications from memory when you're comparing plans. Bring the actual list.

Understand your main coverage paths

Once you know your timeline, current insurance, doctors and prescriptions, you can start learning about your coverage options.

There are two broad paths many people consider.

Original Medicare

Original Medicare includes Part A and Part B.

People with Original Medicare can also consider Medicare Supplement insurance, commonly called Medigap, and prescription drug coverage through Part D.

Medicare Advantage

Medicare Advantage plans are offered by private insurance companies approved by Medicare. These plans provide Medicare-covered benefits through the plan and may include prescription drug coverage and other benefits, depending on the plan.

The two approaches work differently.

You'll want to understand how each handles doctors, hospitals, prescriptions, costs and the way you receive your benefits before choosing one.

You generally need both Part A and Part B to join a Medicare Advantage plan.

Look beyond the monthly premium

Cost matters, but there are several numbers worth looking at.

When comparing coverage, consider:

• Monthly premiums
• Deductibles
• Copayments
• Coinsurance
• Prescription costs
• Provider networks
• Maximum out-of-pocket costs for Medicare Advantage plans
• Additional coverage you may need

Think about how you expect to use healthcare during the coming year.

Someone who rarely sees a doctor may look at costs differently from someone who sees several specialists and takes multiple medications.

Your health situation can change, too. A plan that looks good based on one narrow number may not be the best fit when you consider the full picture.

Don't assume your current insurance will simply continue

This deserves special attention for people who are still working.

If you have employer coverage, talk to your benefits administrator before deciding what to do with Medicare.

Ask specific questions:

• How does our group health plan coordinate with Medicare?
• Do I need to enroll in Part A?
• Do I need to enroll in Part B?
• What happens to my coverage when I retire?
• What happens if my spouse is covered through my plan?
• Does my prescription coverage continue to be creditable?

Get the answers from the people responsible for your benefits.

Medicare also recommends checking with your employer about how job-based coverage works with Medicare.

Give yourself time to compare your options

You don't have to learn everything about Medicare in one evening.

Start with the timeline.

Then understand your current coverage.

Then make your doctor and prescription lists.

Then learn about your Medicare coverage choices.

Finally, compare the options based on your own needs.

That sequence can make the process much less overwhelming.

What if you are already 65?

If you're already 65 and haven't enrolled, don't assume you have missed your opportunity.

Your next step depends on why you delayed enrollment and what coverage you currently have.

For example, people who delayed Part B because they had qualifying group health coverage based on current employment may have a Special Enrollment Period. Other circumstances have different rules.

If you're unsure, find out which enrollment period applies to you before taking action.

Your simple Medicare-at-65 checklist

If you are approaching 65, start here:

• ☐ Find your Initial Enrollment Period
• ☐ Determine whether you will be automatically enrolled
• ☐ Identify your current health insurance
• ☐ If you're working, ask your employer how its coverage works with Medicare
• ☐ Make a list of your doctors and hospitals
• ☐ Make a list of your prescriptions
• ☐ Learn the difference between Original Medicare and Medicare Advantage
• ☐ Learn how Medicare Supplement and Part D fit into Original Medicare
• ☐ Compare the costs that matter to your situation
• ☐ Confirm when your Medicare coverage should begin
• ☐ Keep track of your enrollment deadlines

Medicare becomes much easier to navigate when you break the process into individual decisions.

You don't need to understand every Medicare plan available in your state before you begin. Start with your own situation, your timeline and the healthcare you expect to use.

Then work outward from there.

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About the Author: Drew Bismack is a licensed Medicare insurance agent in Michigan with 23 years of experience helping individuals understand their Medicare options. He focuses on making the Medicare process easier to understand so people can make informed decisions about their healthcare coverage and choose what best suits their specific needs.