Your Medicare Starting Point
Turning 65? Here Is How to Prepare for Medicare
Turning 65 is an important Medicare milestone, but it does not mean that every person should follow exactly the same enrollment path.
Your next steps depend on whether you are already receiving Social Security, still working, covered through a spouse, using Marketplace insurance, receiving disability Medicare or preparing to retire.
For most people, the process comes down to four questions:
- Will Medicare enrollment be automatic, or must you apply?
- Should you enroll at 65 or delay part of Medicare?
- When should your Medicare coverage begin?
- How do you want to receive your Medicare coverage?
Start at least three months before your 65th birthday month.
This gives you time to confirm your enrollment responsibilities, coordinate Medicare with existing insurance and compare coverage without feeling rushed.
Your first enrollment window
Understanding Your Initial Enrollment Period
For most people becoming eligible because of age, the Medicare Initial Enrollment Period lasts seven months:
Quick answer:
Most people first become eligible for Medicare around age 65. Your Initial Enrollment Period generally lasts seven months: the three months before the month you turn 65, your birthday month, and the three months afterward.
Step one
Will You Be Enrolled Automatically?
Some people are automatically enrolled in Medicare Parts A and B, while others must actively sign up.
Automatic enrollment commonly applies when someone has been receiving qualifying Social Security or Railroad Retirement benefits before turning 65. If you are not receiving those benefits, you may need to apply through Social Security.
Do not assume your enrollment is automatic.
Watch for your Medicare card and enrollment materials. If you are uncertain, contact Social Security or review your status before your intended coverage date.
If you already receive Medicare because of a disability, turning 65 generally does not mean starting Medicareedicare-coverage-start/” target=”_blank” rel=”noopener”> Medicare.gov .
Automatic versus active enrollment
Will Medicare Enroll You Automatically?
Some people are automatically enrolled in Medicare Parts A and B, while others must actively apply.
You May Be Enrolled Automatically
Automatic enrollment may apply when you have been receiving qualifying Social Security or Railroad Retirement benefits before turning 65.
Watch for a Medicare welcome package and verify the effective dates printed on your Medicare card.
You May Need to Apply
If you are not receiving qualifying retirement benefits before age 65, you will generally need to apply for Medicare yourself.
Do not assume that paying Medicare taxes during your working years automatically completes enrollment.
Confirm your individual status.
Medicare enrollment rules depend on your circumstances. Check with Social Security or the Railroad Retirement Board rather than relying only on a general rule.
The foundation
What Are Medicare Parts A and B?
Medicare Part A
Part A primarily helps cover inpatient hospital care, skilled nursing facility care under qualifying circumstances, hospice and certain home healthcare services.
Many people qualify for premium-free Part A based on their own or a spouse’s work history, but not everyone does.
Medicare Part B
Part B primarily helps cover physician services, outpatient care, preventive services, durable medical equipment and other medically necessary services.
Part B generally has a monthly premium. The amount can vary depending on income and other circumstances.
Original Medicare does not cover every healthcare expense.
Parts A and B include deductibles and cost sharing and generally do not include routine outpatient prescription drug coverage. Many people add other coverage to address these gaps.
Still working?
Do You Have to Enroll If You Work Past 65?
Not everyone needs to enroll in every part of Medicare immediately at 65. You may be able to delay Part B without a penalty if you have qualifying group health coverage based on your or your spouse’s current employment.
The answer depends on the source of the coverage, employer size and how the employer plan coordinates with Medicare.
Ask the employer or benefits administrator:
- Is this coverage based on current employment?
- How many employees does the employer have?
- Does the employer plan pay before or after Medicare?
- Do I need Part A or Part B for the employer plan to pay correctly?
- Is the prescription coverage creditable?
- What will the employer coverage cost after I turn 65?
- What happens to my spouse or dependents if I leave the plan?
Do not delay Medicare based on an assumption.
Retiree coverage, COBRA, Marketplace coverage and insurance that is not based on current employment may follow different rules.
Medicare provides a situation-specific guide for people working past age 65 .
Other coverage
COBRA, Retiree and Marketplace Coverage
COBRA
COBRA generally does not extend your Part B Special Enrollment Period based on active employment. Do not wait until COBRA ends to investigate Medicare.
Retiree Coverage
Retiree insurance may expect Medicare to pay first. Ask whether Parts A and B are required and what happens if you join coverage outside the retiree plan.
Marketplace Coverage
Eligibility for premium-free Part A can affect Marketplace financial assistance. Coordinate the end of Marketplace coverage with the start of Medicare.
Health Savings Accounts
Medicare and HSA Contributions
Once your Medicare coverage begins, you can no longer contribute to a Health Savings Account. This can require advance planning if you continue working past 65.
Premium-free Part A can begin retroactively when someone enrolls after age 65, generally for up to six months but not before the month they first became eligible.
Plan ahead before applying for Medicare.
If you contribute to an HSA, speak with your employer, tax professional or benefits advisor about when contributions should stop. HSA tax rules are separate from Medicare plan-selection advice.
After Parts A and B
How Do You Want to Receive Your Medicare Coverage?
Once Parts A and B are established, most people consider two broad approaches.
Approach one
Original Medicare With Additional Coverage
This may include:
- Original Medicare Parts A and B
- A Medicare Supplement, also called Medigap
- A separate Part D prescription drug plan
A Supplement helps pay certain costs left by Original Medicare according to the standardized plan letter selected.
Approach two
Medicare Advantage
Medicare Advantage plans provide Part A and Part B benefits through private insurance companies approved by Medicare.
Most plans include Part D coverage and may offer additional benefits. They may also use provider networks, prior authorization and plan-specific cost sharing.
Neither approach is automatically better.
Compare your doctors, prescriptions, travel habits, healthcare usage, budget and tolerance for different types of financial risk.
Prescription coverage
Do You Need Medicare Part D?
Original Medicare generally does not include routine outpatient prescription drug coverage. Prescription coverage is commonly obtained through either:
- A standalone Medicare Part D plan, or
- A Medicare Advantage plan that includes Part D coverage.
When comparing prescription coverage, review:
- Every medication and dosage
- The plan’s formulary and coverage rules
- The plan’s pharmacy network
- Deductibles, copayments and estimated annual costs
Going without creditable prescription drug coverage after becoming eligible may result in a Part D late-enrollment penalty unless an exception applies.
Prepare for comparison
What Information Should You Gather?
Medicare preparation checklist
- Your expected Medicare effective dates
- Your Medicare card, if it has arrived
- Current employer or other insurance information
- Your primary care physician’s full name and address
- Every specialist’s full name and address
- Preferred hospitals and healthcare facilities
- Complete prescription list, including dosage and frequency
- Preferred local and mail-order pharmacies
- Medical equipment suppliers
- Expected surgeries, treatments or specialist visits
- Your healthcare budget and coverage priorities
Avoid preventable problems
Common Medicare Enrollment Mistakes
Assuming Enrollment Is Automatic
Automatic enrollment applies to some people, while others must actively apply.
Waiting Until Insurance Ends
Start early enough to coordinate Medicare with employer, COBRA, retiree or Marketplace coverage.
Looking Only at Premiums
Also consider doctors, prescriptions, deductibles, copays, coinsurance and maximum out-of-pocket exposure.
Ignoring Provider Networks
Verify individual physicians, facilities and locations under the exact plan being considered.
Missing the Medigap Window
Understand when your Medigap Open Enrollment Period begins and what protections it provides.
Using Outdated Information
Medicare costs, plan benefits, formularies and networks can change. Verify current information before enrolling.
Local Medicare resources
Turning 65 in Missouri
These local guides include additional information for people living in the Springfield and Texas County service areas.
Springfield, Missouri
Turning 65 in Springfield
Review enrollment timing, local provider considerations and the information to gather before comparing Springfield-area coverage.
Read the Springfield guide →Texas County, Missouri
Turning 65 in Texas County
Learn about Medicare preparation for Bucyrus, Houston and nearby rural Missouri communities.
Read the Texas County guide →Frequently asked questions
Turning 65 Medicare Questions
Do I automatically receive Medicare when I turn 65?
Not always. People receiving qualifying Social Security or Railroad Retirement benefits before age 65 may be enrolled automatically. Others generally need to apply.
Do I have to retire when I turn 65?
No. Medicare eligibility and retirement are separate. If you continue working, verify how your employer insurance coordinates with Medicare.
Can I delay Medicare Part B while working?
You may be able to delay Part B without a penalty if you have qualifying group health coverage based on your own or your spouse’s current employment. Confirm the rules for your employer coverage.
Does COBRA let me delay Medicare?
COBRA generally does not extend the employment-based Medicare Part B Special Enrollment Period. Investigate Medicare enrollment before active-employment coverage ends.
Can I contribute to an HSA after enrolling in Medicare?
No. You cannot continue making HSA contributions after Medicare enrollment. Existing funds can generally still be used for qualified expenses.
Do I need Medicare Part D if I take no prescriptions?
You should still consider whether you have creditable drug coverage. Going 63 days or longer without creditable coverage may result in a Part D late-enrollment penalty unless an exception applies.
Can I use a Medicare Advantage plan and a Supplement together?
No. A Medicare Supplement is designed to work with Original Medicare and cannot be used to pay Medicare Advantage plan costs.
Do Medicare consultations cost anything?
Thompson Medicare Brokerage provides Medicare consultations at no cost and without obligation.
Get Help Preparing for Medicare
Benjamin Thompson can help you understand your enrollment timeline, coordinate existing coverage and compare Medicare options using your doctors, prescriptions, healthcare needs and budget.
This guide provides general educational information. Medicare enrollment responsibilities depend on individual circumstances. Confirm current rules with Medicare, Social Security, the Railroad Retirement Board, an employer benefits administrator or another appropriate agency before making an enrollment decision.