Overview

Reaching age 65 is a big deal because it means you’re now eligible for Medicare. This change brings new benefits and decisions to think about, making sure you’re covered health-wise in your later years. It’s important to get the lowdown on Medicare, like who can get it, what it might cost you, and how to sign up, so you’re all set for this next chapter.

Who Can Get Medicare

For most individuals, Medicare starts at 65. You’re in if you or your spouse have worked and paid into Medicare for 10 years or more. Some people under 65 can also get Medicare if they have certain disabilities or conditions like End-Stage Renal Disease (ESRD) or Amyotrophic Lateral Sclerosis (ALS).

What It Costs

Medicare has different parts that cover various health needs.

• Part A (Hospital Insurance) is usually free if you’ve paid enough Medicare taxes.
• Part B (Medical Insurance) has a monthly premium that changes based on how much you make.

Other costs, like deductibles, copays, and coinsurance, vary depending on what services you use and if you have additional coverage.

Signing Up

Signing up for Medicare isn’t automatic for everyone. If you’re already getting Social Security or Railroad Retirement Board benefits, you’ll automatically get Medicare Parts A and B. If not, you’ve got a 7-month Initial Enrollment Period (IEP) around your 65th birthday—3 months before, the month of, and 3 months after—to sign up. If you miss this period, you might face penalties and a delay in coverage. For those looking for additional benefits, Medicare Advantage (Part C) and Prescription Drug Plans (Part D) can have sign-up times outside of IEP.

Next Steps

As you approach 65, it’s crucial to understand Medicare and your enrollment options. Start by confirming your eligibility and reviewing the costs associated with Medicare Parts A and B. Plan to enroll during your Initial Enrollment Period to avoid penalties and ensure timely coverage. Explore additional benefits through Medicare Advantage (Part C) and Prescription Drug Plans (Part D) if needed. Taking these steps now will help secure comprehensive health coverage for your future.

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Medicare Resources

Understanding Medicare

Medicare does not cover all healthcare expenses, leaving you responsible for certain out-of-pocket costs and services like long-term care.

To manage these gaps, you have several options:

– Original Medicare: Includes Part A (Hospital Insurance) and Part B (Medical Insurance)

– Medicare Supplement: Also known as Medigap, this insurance helps cover the costs not included in Original Medicare

– Medicare Advantage (Part C): An all-in-one plan that may include additional benefits

– Part D: Prescription drug coverage provided by independent insurers.

Medicare Plan Options

– Original Medicare Part A: Covers inpatient hospital care, skilled nursing facility care, hospice care, and home health care.

– Original Medicare Part B: Covers doctor services, outpatient care, durable medical equipment, and preventive services.

– Medicare Advantage (Part C): Offers an alternative to Original Medicare with potential additional benefits and access to HMO or PPO networks.

– Part D: Helps with the cost of prescription drugs and some recommended vaccines.

– Medicare Supplement (Medigap): Plans A-N fill gaps in Original Medicare coverage, such as deductibles, copayments, and coinsurance.

How to Enroll in Medicare

How/when do I enroll in Medicare?  

Most people should apply for Medicare during their Initial Enrollment Period (IEP), which spans seven months around your 65th birthday. The fall Open Enrollment Period runs from October 15 through December 7 each year for making changes to your Medicare coverage. If you miss your initial enrollment period and don’t qualify for an exception, you can enroll during the General Enrollment Period (GEP) from January 1 to March 31 each year. Keep in mind, that this may incur higher premiums.

How do I switch Medicare plans?  

You can switch Medicare plans during the Open Enrollment Period or Special Enrollment Periods if you qualify. This is also when you can switch between Original Medicare and Medicare Advantage or add Part D coverage.

When is the deadline to enroll into Medicare?  

The Initial Enrollment Period is your main opportunity to enroll in Medicare without penalties. For changes or new enrollments outside this period, be aware of the Open Enrollment Period from October 15 to December 7, and the General Enrollment Period from January 1 to March 31.

Health Insurance Plan Options For Those Under Age 65

Affordable Care Act (ACA or Obamacare) Plans:

What is an ACA Plan?
The Affordable Care Act (ACA), commonly known as Obamacare, offers a range of health insurance plans designed to make coverage more accessible and affordable for millions of Americans. 

Whether you’re self-employed, between jobs, or not eligible for employer-sponsored coverage, ACA plans provide a marketplace for purchasing health insurance with protections and subsidies.

Key Features of ACA Plans:

• Marketplace: You can enroll in ACA plans through the federal Marketplace at HealthCare.gov or state-based Marketplaces if available in your state. The ACA established these platforms to help individuals and families find and compare health insurance options.
• Pre-Existing Conditions: Insurance companies cannot deny coverage based on pre-existing medical conditions.
• Subsidies: Financial assistance in the form of tax credits is available to help reduce monthly premiums for eligible individuals and families.

When is the deadline to enroll in ACA Plans?
You can purchase ACA coverage during the annual Open Enrollment Period, which typically runs from November 1 through January 15 each year. During this time, you can enroll in or switch ACA plans. If you miss this period, you may qualify for Special Enrollment Periods based on life events or changes in your situation.

How Much Do ACA Plans Cost?
ACA plans vary in cost depending on the metal tier you select, your location, age, and insurer. The metal levels are:

• Bronze: Covers about 60% of your healthcare costs, usually with lower premiums.
• Silver: Covers around 70% of your healthcare costs, and is the most commonly chosen plan.
• Gold: Covers approximately 80% of your healthcare costs, with higher premiums.
• Platinum: Provides the highest coverage at 90% but comes with the highest premiums.

The average monthly premium for HealthCare.gov enrollees was $111 in 2024. Compare premiums, deductibles, copays, and coinsurance when choosing a plan.

Short-Term Medical Plans:

What is short-term medical?

Short-term health insurance is meant to be temporary until you can get coverage under a traditional plan. It’s available for up to 3 months with a 1-month extension. Unlike plans purchased through the Health Insurance Marketplace, short-term health insurance is not required to include the 10 essential health benefits outlined in the ACA, and it generally doesn’t cover pre-existing conditions.

Short-term insurance is beneficial when you’re transitioning between health plans. 

Whether you are waiting to enroll in another plan, between jobs, or taking a break from school, this can be a viable option.

Key Features of Short-Term Medical Plans:

• Enrollment: Applying for short-term medical insurance is fast and straightforward. Coverage can start as soon as the next day after your application and payment. You can choose a start date within the next 60 days.
• Coverage Details:
  • Financial Protection: Provides coverage for unexpected medical emergencies and is generally less expensive than long-term plans.
  • Emergency Care: Includes coverage for sudden health issues, and you may continue seeing your regular healthcare providers.
  • Limitations: Does not cover long-term conditions, dental, or vision care. Coverage for pre-existing conditions is also typically excluded.

Health Conditions
Short-term plans may not cover pre-existing conditions such as chronic illnesses and might exclude certain diagnostic tests. It’s essential to understand these limitations before enrolling to ensure it meets your needs.