Turning 65? Here’s What You Need to Know About Medicare

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Turning 65 comes with plenty of questions, and Medicare is usually near the top of the list.

When do I sign up? Do I have to enroll if I’m still working? What if my spouse is still working? What happens if I already have health insurance?

The answers aren't exactly the same for everyone. But the good news is that Medicare doesn't have to be as complicated as it first appears.

Here are the most important things to know as you approach 65.

1. Start Thinking About Medicare Before Your 65th Birthday

You don't have to wait until you turn 65 to get started.

Your Medicare Initial Enrollment Period is a seven-month window surrounding your 65th birthday. That gives you time before your birthday to understand your choices and determine when you should enroll.

I generally encourage people to start looking at their options a few months ahead of time rather than waiting until the last minute.

That gives us time to answer an important question first:

Do you actually need to enroll in Medicare at 65?

2. If You're Retired or Don't Have Employer Coverage

If you don't have qualifying coverage through your or your spouse's current employment, you'll generally want to enroll in Medicare around age 65.

The flow chart from the Louisiana Senior Health Insurance Information Program recommends beginning the enrollment process as early as three months before turning 65.

Medicare enrollment is handled through the Social Security Administration.

Once you're enrolled in Medicare Parts A and B, you can then decide how you want your Medicare coverage structured.

3. If You're Still Working at 65, Don't Automatically Enroll—or Automatically Delay

This is probably one of the most common questions I hear.

If you or your spouse are still actively working and you have health insurance through that employer, you may be able to delay certain parts of Medicare.

But don't assume that employer insurance automatically means you're safe to delay Medicare.

One of the first questions to ask is:

How many employees does the employer have?

The flow chart specifically distinguishes coverage through an employer with at least 20 employees when determining the path someone should take at 65.

You should also find out how your employer coverage coordinates with Medicare before deciding what to do.

4. Don't Forget About Your Prescription Coverage

If you're considering delaying Medicare Part D because you have prescription coverage through an employer, there's another phrase you need to know:

Creditable coverage.

Your employer should tell you in writing whether your prescription coverage is considered creditable—meaning it is expected to pay, on average, at least as much as Medicare's standard prescription drug coverage.

If you have appropriate employer coverage and creditable drug coverage, you may be able to delay Parts B and D and later qualify for a Special Enrollment Period when that job-related coverage ends.

Keep any creditable coverage notices you receive. They can be important later.

5. What If You Have VA or TRICARE Coverage?

Having VA or TRICARE coverage adds another layer to the decision.

The Louisiana SHIP flow chart recommends checking how Medicare will work with your existing VA or TRICARE benefits before deciding how and when to enroll.

This is an area where I wouldn't recommend making a decision based on what a friend or coworker did. Your specific coverage matters.

6. Will Medicare Automatically Start at 65?

Not necessarily.

Some people receiving certain Social Security or Railroad Retirement benefits may be automatically enrolled when they become eligible. Others need to enroll themselves through Social Security.

That's why I don't recommend simply waiting for a Medicare card to show up.

As your 65th birthday approaches, confirm whether you'll be automatically enrolled or need to take action.

7. What Happens After You Enroll in Medicare?

Getting your Medicare card isn't the end of the decision-making process.

You'll still need to decide how you want to receive your Medicare coverage.

For many people, that means comparing options such as:

• Original Medicare with a Medicare Supplement and prescription drug plan

• A Medicare Advantage plan

• Employer or retiree coverage

• VA or TRICARE benefits coordinated with Medicare

That's where your doctors, prescriptions, healthcare needs, budget and personal preferences really matter.

Your Medicare Decision Should Be About More Than Turning 65

Turning 65 is the milestone that gets everyone's attention, but your birthday alone doesn't determine the right Medicare decision.

Your employment status, employer size, current health insurance, prescription coverage and other benefits can all affect what you should do.

That's why one person's answer may be completely different from another's.

Turning 65 Soon? Let's Look at Your Situation.

If you're approaching 65, you don't have to sort through all of this on your own.

I can help you look at what you have now, understand when you need to enroll, and compare your Medicare options so you can make a decision that fits your situation.

The goal isn't to make Medicare complicated. It's to make sure you understand your choices before you make them.

This article is for educational purposes and is based in part on information from the Louisiana Department of Insurance's Medicare resources. Medicare eligibility and enrollment rules depend on individual circumstances.