Turning 65 is a time of adjustments and decisions. One critical decision is signing up for Medicare coverage for healthcare and choosing what’s suitable for you. And you can always tell when it is time for a decision. You will be drowning in the mail on the various plans for coverage under private insurers.
You will make your options much more accessible and reduce your stress around enrollment if you start doing your homework at least three to six months before enrolling. Just remember that Medicare enrollment is not optional or automatic. You must sign up, even if you are not retiring until you are 66 or older. You can enroll three months before your birthday or up to three months after, but there are financial penalties if you don’t sign up on time.
How Do You Decide Beyond Enrollment?
Aside from enrolling, you will have many decisions to make that will determine the kind of healthcare coverage you get. Make a list of everything you know about your current health conditions and the medications you are on. It might be an excellent time to visit your doctor to get screened for diabetes, high blood pressure, and other chronic disease.
When looking at coverage, don’t overlook your family health history as you contemplate your future health needs. While many people only look at their current health, most people heading into 65 already know that things can change at a moment’s notice. No real crystal ball can predict what will happen or what you will need as you age. Every day has the potential to present a new ache, pain, or diagnosis. To gamble on having less coverage than we have now with our employer-sponsored plan.
We have all heard horror stories of the choices that older people on fixed incomes must make between high-cost medications and services and food.
Medicare Choices
Let’s start with the Original Medicare, known as Part A. It is the basic and premium-free coverage that the government requires once you turn 65. It covers inpatient, hospitalization, and short-term care in a skilled nursing facility, usually at 80 percent, after a deductible of around $1,400 for the first day of care.
“Part B addresses doctor visits and preventative care, including screenings and treatment. The standard premium starts at approximately $147 a month,” Edward McFarland, a Medicare specialist, explains. Note that Medicare Part B only pays for medically necessary procedures and does not cover dental care.
The Medicare Advantage plans are the one-stop plans that combine everything into one plan. You must still enroll in Medicare’s Parts A and B, but the Advantage plans are run through private insurers. They could include dental and vision care coverage, telemedicine, and other services, depending on what you select and how much you can afford to pay. Some plans do not require extra fees. Open enrollment for most Medicare Advantage enrollees ended March 31, but changes can be made again in November 2024 for 2025.
Part D is the easiest to remember because this is the much-needed drug coverage. Most Part D plans have an annual deductible, about 25 percent of your annual drug costs, until you hit the $2,500 cap.
McFarland says, “Look carefully at your medication needs.” Once you are enrolled, you can make changes to your Medicare options once a year.
Yet Medicare doesn’t cover everything. One big discussion is on the new weight loss drugs, such as Wegovy, that have made an impact on obesity. Medicare just approved coverage for people who are overweight and obese and also are at high risk of heart attack or stroke. The out-of-pocket expenses for this class of medications, without coverage, is over $1,000 per month.
In addition, it has improved and expanded preventative care programs that pay for office visits, screenings such as colon and breast cancer, mental health screening, and vaccines.
Where to Get the Best Information
Figuring out what makes medical and financial sense for you should start with a call to Medicare at 800-772-1213. One of their trained specialists can help you understand your needs for your situation and circumstances. The good news is that specialists are available by phone 24 hours a day. Or go to www.medicare.gov for more information.
Also, visit the State’s Health Insurance Assistance Program (SHIP). It’s a free resource that provides information on the state’s free services and programs. Find the state’s website and connect with a counselor who can guide you through the options.
Note: Consider helping your parent or loved one negotiate these decisions.Â
