If you’re approaching your 65th birthday, you’d be wise to start preparing—at least mentally—to enroll for Medicare. Unless you’re already receiving social security benefits when you turn 65, it’s not likely that you’ll be signed up automatically. There are several strict deadlines within the Medicare program, and you could face lifelong penalties if you miss them. As you begin your countdown to 65, use this basic outline to create your own custom Medicare timeline.
7 months – 1 year before turning 65
Find out if you qualify for Medicare, and how much you will have to pay for it each month.
Typically, if you or your spouse has worked and paid taxes for at least ten years, you will be eligible for premium-free Part A. Your premium for Part B, however, will vary based on the total amount of years worked, as well as income.
Ensure that your current doctors accept Medicare.
If you have doctors that you see on a regular basis, you should ensure that these providers accept Medicare. 96% doctors accept Original Medicare. While it is rare for doctors to “opt-out” of Medicare, some specialists–like dermatologists and gynecologists–prefer to treat patients on a private-pay basis. If a specialist you see does not accept Medicare, you may want to consider purchasing additional coverage. Medicare Advantage plans and Medigap policies are popular options for enrollees in this position. If this is not an option, you can at least use this extra time to find a new doctor to resume your care when you begin your coverage under Medicare.
6 months before turning 65
Begin researching plans available in your area
Even though your birthday is still half a year away, your initial enrollment period will begin three months prior. Starting your search for the right plan now will give you plenty of time to consider and compare your options, including Medicare Advantage plans, stand-alone Part D prescription drug plans, and Medicare Supplement (i.e. “Medigap”) plans.
Here are some of the most important considerations you’ll want to prioritize as you compare plans:
- Are all (or most) of your prescription drugs covered?
- Are your doctors and specialists in the plan’s network?
- Is your regular pharmacy in-network?
- What will your out-of-pocket costs be?
3 months before turning 65
Sign up for Original Medicare
If you are already receiving social security benefits, you will be automatically enrolled in Medicare Parts A and B. If you are not automatically enrolled, and you are no longer covered by an employer-based health plan, you should sign up for Medicare within your 7-month initial enrollment period, or IEP.
This initial enrollment period will begin three months prior to the first day of your birthday month and end three months after. If you enroll in these first three months, your coverage will begin on your 65th birthday. If you wait until after your birthday, your coverage will be delayed by 1-3 months, depending on how long you wait. For this reason, we recommend making it a priority to enroll before your birthday.
You can sign up online, by phone, or in-person at your local social security office. Find out which method is best for you, as well as which documents you will need to prepare, here.
Your 65th birthday month (Congrats!)
Get the coverage you need
If at this point you haven’t yet enrolled for Medicare, you should do so now to minimize any delay of your coverage. This is also an excellent time to enroll in a Part D or Medicare Supplement plan. Most people enrolled in traditional Medicare elect to purchase some type of supplemental coverage to help cover their costs and fill gaps in their coverage.
Remember that enrolling in a Part D plan after your IEP will result in permanent monthly penalties, so even if you are not currently taking any prescription drugs, you might consider enrolling in the most affordable Part D plan now, within your IEP, to cover your bases in the likely event that you will begin taking prescriptions in the future. In the United States, 25% of people between 65 and 69 take more than 5 prescriptions every day, and that figure rises to 46% for people in the 70-75 range.
This is also the best time to purchase a Medicare Supplement plan. Your 6-month Medigap Open Enrollment Period begins on the first day of the month in which you are 65 or older and enrolled in Medicare Part B. During this period, insurance companies cannot charge you higher premiums, place delays on coverage, or deny coverage based on pre-existing health conditions. If you do not enroll for a Medigap policy within this time frame, you will likely be subject to medical underwriting. This can result in higher premiums or denial of coverage if you attempt to purchase one of these plans later.
3 months after turning 65
Don’t miss your last chance to enroll
While your coverage will be delayed exponentially for each month you wait to sign up after your birthday, if you neglect to enroll now and you are not otherwise covered by a qualified employer-based health plan, you will also be subject to late enrollment penalties for your Part B coverage, as well as any Part D or Medicare Supplement plans you elect to purchase in the future. You can read more about the various penalties for delaying your Medicare enrollment in the article below.