For many, your 65th birthday is synonymous with becoming eligible for Medicare, but did you know that you could be eligible for Medicare before age 65…or even after age 65?
Medicare at Age 65
Most people are eligible for Original Medicare if they are:
- A U.S. citizen or permanent legal resident for at least 5 consecutive years
- Age 65 or older and eligible for Social Security
- Permanently disabled and receiving disability benefits for at least two years
- Have End Stage Renal Disease (ESRD)
- Have Lou Gehrig’s disease
This also depends largely on your employment situation. If you are still working, there may be some other considerations.
The short answer is no. If you are working or have employer group coverage through a spouse, you may want to consider deferring Medicare.
However, we strongly caution that you to get some advice on what to do if you aren’t sure. Sometimes individuals are given misinformation about how and when to defer or delay Medicare. Not enrolling at the right time can lead to lifelong penalties and even periods without health insurance. Trust us…that can be costly!
Retirement doesn’t always mean a clean break from work the day you turn 65. For many individuals, working beyond the age 65 is the best choice for a variety a reasons including benefits, personality, life and retirement goals and more. If you or your spouse plan on working past age 65 and have employer coverage, then it may make sense for you to defer some or all of your Medicare benefits.
Roadmap Tip: At age 65 or older (rules are different under 65), Part B deferment or delay is only available to individuals who work for an employer with 20 or more employees. If your company has less than 20 employees, you must sign up for Part A and Part B when you turn 65, and then Medicare pays your insurance claims first and your employer coverage pays second (if a balance remains).
How and when you should enroll in Medicare depends on your personal situation. Your eligibility, enrollment period and plan options can all be impacted by your employment situation, benefits you may already have, your health needs and more.
- Know when you can enroll in Medicare.
- Decide if delaying Medicare Part B upon turning 65 is right for you.
- Know your Medicare plan options.
The best way to make sure you understand what to do when…is to speak with a trusted advisor.
We know this is confusing. If you have questions, we are here to provide answers. Call us at 859-356-2416
If you began receiving Social Security income prior to age 65 or you receive Social Security disability income, your enrollment is automatic.
Everyone else must apply for Medicare through the Social Security office.
- You may apply online – https://www.ssa.gov/medicare/
- Visit the local Social Security office
- Call Social Security at 1-800-772-1213
Some people qualify for both Medicare and Medicaid. You may think that Medicaid and Medicare are the same. Actually, they are two different programs.
Medicare is federal health insurance for people age 65 or older, under 65 with certain disabilities and any age with End Stage Renal Disease (permanent kidney failure) requiring dialysis or a kidney transplant.
Medicaid is a joint federal and state program that helps pay health care costs for certain people and families with limited income and resources. Different programs under the Medicaid umbrella are designed to help specific populations. Medicaid does not pay money to you; instead, it sends payments directly to your health care providers.
Roadmap Tip: Each state has its own rules about who is eligible and what is covered under Medicaid.
Kentucky Medicaid – https://www.chfs.ky.gov/agencies/dms/Pages/default.aspx
Ohio Medicaid – https://benefits.ohio.gov/
Indiana Medicaid – https://secure.in.gov/fssa/2408.htm
Most people do not pay a premium for Part A. However, Part B is not premium free. The Part B standard monthly premium is set by Medicare annually.
To qualify for Medicare you must have contributed to it through U.S. payroll taxes for at least 10 years (40 quarters) before turning 65. For this fact alone, it’s not free.
Medicare Advantage plans (Part C) are part of the Medicare Program. However, these plans are offered by private insurance companies. With Medicare Advantage plans you generally get all your Medicare-covered health benefits through that plan. Coverage may include prescription drug coverage and/or extra benefits, such as coverage for vision, hearing and preventive dental, along with health and wellness programs like SilverSneakers. You may be required use the plan’s network providers and get referrals to access services. These plans may or may not require a monthly premium in addition to your Part B premium.
If you are turning 65, you have a total of seven months to enroll. This begins the three months before the month of your 65th birthday and ends three months after the month of your 65th birthday. If you apply before your birth month, your Medicare coverage usually starts on the first day of your birth month.
If you don’t enroll in Medicare during your initial seven-month enrollment period, you must wait to apply during the next general enrollment period (January through March each year and the effective date will be July 1). You may also owe a 10 percent penalty on your Part B premium for each year you delay Part B.
We can! Call us…859-356-2416
Whatever you do, we recommend that you speak with someone who can ask the right questions, analyze your circumstances, needs and budget, and guide you to a plan that is right for you.
There are other ways to learn about Medicare coverage.
- You can review the CMS website at www.medicare.gov or call 1-800-MEDICARE
- You may contact any health plan directly for information about the options they offer.
Original Medicare does not pay all medical expenses. A Medicare Supplement policy fills most of Medicare’s coverage gaps. You have options. Call us at 859-356-2416 to learn more
As your trusted advisor, we help you prepare for Medicare’s Open Enrollment period. We are eager to work with you this fall to help you achieve your peace of mind and meet your budget requirements
As we gear up for this year’s Medicare’s Open Enrollment period, please keep these important dates in mind.
September 30 – Review Your Annual Notice of Change
This information is sent to you from your current insurance company. It outlines all the changes to your Medicare Advantage or Part D Prescription Drug plan for next year.
October 1 – New Plans & Changes Released to Public
This is the first day we are permitted (by Medicare) to discuss changes to the Medicare Advantage and Prescription Drug plans with you.
October 15 – 1st Day of Medicare’s Annual Election Period
This is the first day you are permitted to enroll in a new Medicare Advantage or Prescription Drug plan.
December 7 – Last Day of Medicare’s Annual Election Period
Whichever plan you are enrolled in by this date will be your plan in the new calendar year.
January 1 – Effective Date of New Plan Election or Change
Your new coverage will start on this date.
January 1 – 31st Medicare’s Open Enrollment Period
Please call us at 859-356-2416 if you wish assistance or have questions about these dates.
Medicare does not cover long-term care in a nursing home. However, you may be covered for short stays in a skilled-care facility. You must meet certain pre-entrance requirements in order to qualify for such benefits. If you’re eligible, Medicare will cover skilled care for the first 20 days at no cost and a specific amount each day for days 21-100. After 100 days per benefit period, Medicare pays nothing.
Yes, but only if your doctor orders part-time skilled care and you are homebound. If you meet Medicare’s requirements for home health care, it is paid at 100 percent.
No. Original Medicare does not cover hearing aids, dentures, annual eye exams, eyeglasses, etc.
However, coverage is available through stand-alone insurance plans or through most Medicare Advantage plans.