Is your 65th birthday approaching? Congratulations, you’re reaching an important milestone in your life. At 65, you become eligible for Medicare.
It’s not difficult to sign up for Medicare, but a little advance planning will help you arrange the Medicare protection that best covers your needs. Keeping an eye on the calendar can assure that you seamlessly transition from private insurance to Medicare without losing sleep … or a day of coverage.
Assuming that you have paid Medicare taxes for at least 30 quarters (7.5 years), you will pay no premium for Medicare Part A which covers hospital costs. And if you are already receiving Social Security benefits, you’ll be automatically enrolled in Part A, even if your private health insurance coverage continues. (Both will apply to any hospital bills you incur.)
To get Medicare Part B benefits which covers physicians’ fees and a range of miscellaneous costs, you must sign up during the open enrollment period. There is a premium charged for Part B. If you are receiving Social Security benefits, the premium will be deducted from your monthly Social Security payment. And that’s where watching the calendar comes in.
If you are retired, ready to retire, or want to replace private coverage with Medicare, your window for enrollment opens three months prior to the month of your 65th birthday and closes three months after. And there are consequences for missing that seven-month period:
If you are continuing to practice and keep the insurance that is part of your benefit package, or if you are covered by a spouse or partner’s private insurance, you can wait to enroll until your private coverage ends, but then you must enroll in Medicare Part B within eight months of the end of that coverage to avoid the penalties described above. There are exceptions; an insurance counselor can help you decide if they apply in your case.
You should plan to complete your Medicare enrollment at least a month before discontinuing your private health coverage.
Even with Medicare Parts A and B, you, as a patient, will still be responsible for a significant portion of hospital and doctors’ costs. But there are privately insured options that help make up the difference, and they are only available if you are enrolled in Medicare Part B. If you are enrolled In Part B, you are also eligible to enroll in Part C, also called Medicare Advantage; or a Medicare Supplement insurance Plan, also called Medigap; and in Part D, for prescription drug coverage.
Many physicians find Medicare Supplement insurance plans satisfy their needs and preferences more effectively than the managed-care Medicare Advantage plans. Certainly, Medicare Supplement insurance plans offer greater flexibility when choosing a health care provider— they are accepted by every provider who accepts Medicare and there are no geographic limits.
You can choose from Medicare Supplement Insurance plan options offered by private insurers with varying levels of coverage and premiums. Keep in mind that you will continue to pay the Medicare Part B premium, as well as the premium for your Medicare Supplement insurance plan. While these plans can cover most costs, no Medicare Supplement insurance plans offered to people who became Medicare eligible after 2020 cover Part B deductibles.
If you elect to enroll in a Medicare Supplement insurance plan, the best time to sign up is during the six-month open enrollment period that begins in the month when you are 65 and have enrolled in Medicare Part B.
During your six-month period, you are guaranteed acceptance by the insurer at the rate that applies in your state, regardless of your health. If you miss the six-month period, you may be subject to underwriting and charged a higher rate based on your health. It is possible that you might be denied coverage altogether. You also have to wait for an open enrollment period and miss months of coverage. (If you have employer health insurance you may qualify for an exception to this rule.)
Neither Medicare Part A or B cover prescription drugs. Medicare Part D plans are a government benefit that are administered by private insurers. All Part D plans are approved by Medicare and follow certain guidelines. While some Medicare Advantage plans include prescription drug coverage, Medicare Supplement insurance plans do not, so a Part D plan is a valuable addition to your retirement health insurance portfolio if you choose a Medicare Supplement insurance plan. Again, the best course of action is to sign up during the initial enrollment period.
As you approach 65, you’ll be looking at Medicare from a new point of view. It pays to look carefully well in advance of key deadlines. That way, you can arrange the options you are comfortable with, in a timely manner. But realize that there will be opportunities to change the arrangements you have made during designated annual enrollment periods.
Whether you choose supplemental coverage when you turn 65 or when you retire, you must sign up for Medicare Part A when you turn 65 or you may pay a higher monthly premium. If you need help, seek advice from professionals who understand the insurance requirements of physicians and their families. They can help you protect your assets from health care costs and help you enjoy your retirement.
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* Important Information:
Kentucky: IN ORDER TO QUALIFY FOR A MEDICARE SUPPLEMENT INSURANCE PLAN DURING OPEN ENROLLMENT YOU MUST BE TURNING 65 OR OLDER. IF YOU ARE UNDER 65 AND ENROLLED IN BOTH MEDICARE PART A AND PART B AND YOU QUALIFY FOR A MEDICARE SUPPLEMENT INSURANCE PLAN, THE COMPANY MAY PERFORM UNDERWRITING IF YOU ARE NOT ELIGIBLE FOR A GUARANTEED ISSUE PERIOD.
Missouri: In order to qualify for a Medicare Supplement Insurance plan during open enrollment you must be turning 65 or have part B. A Medicare Supplement Insurance Plan may also be available to people under age 65 with certain disabilities and people of any age with End-Stage Renal Disease (ESRD). Persons who are covered by a Medicare Supplement Insurance plan may move to another company within 30 days of their annual policy anniversary date and the company must issues, on a guaranteed issue basis, a policy which is the same as the plan under which the insured was most recently covered.
New York: MEDICARE SUPPLEMENT INSURANCE IS ALWAYS GUARANTEED ISSUE AND OPEN ENROLLED IN NEW YORK.
Texas: Open enrollment is the 6 month period beginning on the first day of the month in which you are enrolled in Medicare Part B. If you are on Medicare under age 65, you will also have a 6 month open enrollment period when you reach age 65.
OUTLINE OF COVERAGE AVAILABLE UPON REQUEST.
Medicare Supplement Insurance products underwritten by Transamerica Life Insurance Company (TLIC), 6400 C Street SW, Cedar Rapids, IA 52499 or Transamerica Financial Life Insurance Company (TFLIC), 440 Mamaroneck Avenue, Harrison, NY 10528. TFLIC is licensed to conduct business new New York. TLIC is authorized to conduct business in all other states. In some states, Medicare Supplement insurance plans are available to qualified individual under age 65.
To maintain these valuable benefits, AMA is reimbursed for administrative expenses incurred in connection with this program.
No portion of AMA membership dues is used by AMA Insurance Agency, Inc. to support the marketing efforts of the AMA-sponsored Medicare Supplement Insurance Program.
EB3 2567908 V 10/23