Turning 65: Medicare Checklist

If you are nearing age 65, Medicare enrollment is right around the corner. While applying for Medicare may seem like a daunting task to many, with the right resources, it does not have to be complicated.

Medicare Enrollment Checklist

Signing up for Medicare looks different for everyone. However, we have compiled an itemized Medicare enrollment checklist to help ease you into your Medicare journey.

The Medicare Checklist will breakdown when you should be completing essential tasks:

• Six months before you turn 65
• Four months before you turn 65
• One to three months before you turn 65

Medicare Pre-Enrollment Checklist: Six Months Before You Turn 65

Medicare enrollment typically begins up to six months before you turn 65. During this time, it is vital to start educating yourself on Medicare, its coverage, and the benefits of Medicare enrollment.

During this time, thinking about the most important benefits and how you wish to be covered is essential. Below are the five steps you should check off your Medicare Checklist six months before your Medicare eligibility start date.

1. Understand the four parts of Medicare

First on the Medicare checklist, understanding the different parts of Medicare is vital. Medicare Part A and Part B make up Original Medicare. Original Medicare covers hospital inpatient and outpatient doctors’ services, respectively. These two parts of Medicare work hand-in-hand to cover your typical medical expenses.

Medicare Part C and Part D cover additional benefits not incorporated in Original Medicare. These two parts of Medicare are available through private insurance companies, not the federal government, like Original Medicare.

Medicare Part C, or Medicare Advantage, combines Original Medicare and other benefits like prescription drugs, vision, hearing, and dental to provide an all-in-one coverage option. When you have Medicare Advantage, it stands in for Original Medicare.

Medicare Part D helps cover prescription drugs when you have Original Medicare. You must choose between enrolling in Medicare Part C or Medicare Part D. You cannot enroll in both types of coverage as many Medicare Advantage plans cover drug benefits.

2. Educate yourself on Medicare Supplement plans

In addition to the four parts of Medicare, educating yourself on Medicare Supplement plans is another essential task to add to the Medicare checklist. Ten standardized Medicare Supplement plans help cover costs Original Medicare leaves behind. These plans can combine with Medicare Part D benefits to give you the most comprehensive Medicare coverage possible.

You can enroll in a Medicare Supplement plan to help cover Medicare Part A and Part B’s out-of-pocket costs. However, you must decide between enrolling in Medicare Advantage or a Medicare Supplement plan, as you cannot have both at the same time.

3. Review additional vision and hearing plans

One of the most significant holes in Original Medicare coverage is the lack of vision and hearing coverage. Often, those on Medicare will enroll in stand-alone dental, vision, and hearing plans to cover this hole in benefits.

Learning how these ancillary plans work alongside your chosen Medicare coverage is essential to ensure you receive the best benefits possible.

However, suppose you enroll in a Medicare Advantage plan. In that case, you may want to compare ancillary plan benefits to your Medicare Advantage plan, as your plan may cover vision and hearing.

4. Learn how Medicare works with other insurance

The next item on our Medicare checklist is to learn how Medicare works with other insurance coverage. If you receive health insurance from an employer or union, the VA, or another entity outside of Medicare, you will need to understand how that coverage works with Medicare.

Whether you are actively working or retired will play a massive role in whether your insurance coverage is creditable for Medicare or not. In some cases, if your coverage is considered creditable, you may delay Medicare Part B benefits without penalty.

Those with active employer coverage often enroll in Medicare Part A if they qualify for a zero-premium and delay Medicare Part B until they lose group benefits. To ensure your coverage is creditable, it must provide at least equal benefits to Original Medicare.

On the other hand, if your coverage is not creditable, you will need to enroll in Medicare Part B. Medicare is your primary coverage when your other coverage is not creditable for Medicare so that the additional insurance plan will pay secondary.

This includes if you are eligible for Medicaid. In this case, Medicare would be your primary coverage, and Medicaid would pay secondary.

5. Understand Medicare enrollment periods

The next item to note in the Medicare enrollment checklist is to understand the different Medicare enrollment periods.

Initial Enrollment Period

The first enrollment period you will encounter is your Initial Enrollment Period.

The Initial Enrollment Period is your chance to enroll in:

• Original Medicare (Part A and Part B)
• Medicare Part C
• Medicare Part D

You can enroll beginning three months before you turn 65 and lasting three months after you turn 65.

General Enrollment Period

If you miss your Initial Enrollment Period and do not qualify for a Special Enrollment period, your next chance to enroll in Original Medicare is during the General Enrollment Period. This enrollment period happens annually from January 1 to March 31.

Medicare Advantage Open Enrollment Period

From January 1 to March 31, Medicare Advantage enrollees can use the Medicare Advantage Open Enrollment Period. During this time, those with Medicare Advantage plans can make one change (switch or disenroll) if they are unhappy with the benefits of their current policy.

Annual Enrollment Period

Each year from October 15 to December 7, the Medicare Annual Enrollment Period allows beneficiaries to make changes to their Medicare coverage for the upcoming year. Since Medicare Part D and Medicare Advantage plan benefits change each year, reviewing your coverage for the forthcoming year is essential. 

Any changes to your Medicare benefits you make in this window will go into effect on January 1.

Special Enrollment Period

A Special Enrollment Period is a Medicare enrollment window that opens when you undergo a significant life-changing event. These events can include:

• Moving
• Loss of Medicaid
• Loss of group benefits
• Released from jail
• Your plan changing its contract with Medicare

If one of these circumstances happens to you, you may qualify for a Special Enrollment Period. A Special Enrollment Period allows you to sign up for Medicare coverage outside a typical enrollment period.

Medicare Supplement Open Enrollment

Medicare Supplement Open Enrollment begins on the first day of the month your Medicare Part B is active and lasts six months. During this enrollment window, you can sign up for a Medicare Supplement plan without having to answer medical underwriting questions, so you cannot face denial due to pre-existing health conditions.

This only applies to those who choose to keep their Original Medicare coverage and do not enroll in a Medicare Advantage plan. If you enroll in a Medicare Advantage plan, you will lose your Medicare Supplement Open Enrollment.

Medicare Pre-Enrollment Checklist: Four Months Before You Turn 65

Four months before you turn 65, it is crucial to begin pinpointing which Medicare plans you wish to enroll in so you are prepared to become eligible for coverage. Comparing benefits, costs, and availability is essential during this time to ensure you receive the best coverage possible.

Below are the four items you should check off your Medicare Checklist four months before enrolling in coverage.

1. Check with your doctors and hospitals to ensure they accept Medicare

First on the Medicare checklist is to ensure your preferred doctors and hospitals accept Original Medicare. While approximately 93% of doctors nationwide accept Original Medicare, checking with your doctors to ensure they take the coverage beforehand is essential.

When you enroll in a Medicare Supplement plan, you will not need to double-check with your doctors. If your doctor accepts Original Medicare, they will take your Medicare Supplement plan regardless of the carrier.

However, if you enroll in a Medicare Advantage plan, you must ensure that the doctor you see accepts your coverage. Just because a physician accepts Original Medicare does not mean they will take your Medicare Advantage plan, as Medicare Advantage involves networks.

Enrolling in coverage accepted by the doctors you are comfortable working with and who understand your health history is important to many seniors on Medicare.

2. Understand your out-of-pocket responsibilities with Medicare

Second on the Medicare checklist is to better understand the out-of-pocket costs you may be responsible for covering.

Unfortunately, Original Medicare does not cover 100% of your healthcare costs once you enroll in the federal healthcare program. This means you are responsible for out-of-pocket expenses when you use the coverage.

Medicare Part A has a per-occurrence deductible that you will be responsible for each time you are admitted to the hospital. Additionally, you are responsible for per-day copayments when admitted to the hospital.

Medicare Part B requires you to cover an annual deductible before coverage begins. Once you meet the annual deductible, Medicare Part B will cover 80% of your Medicare-approved costs, leaving you responsible for 20% of the total cost of your medical bills.

Medicare Part C plans can create their own cost-sharing regulations and set their maximum out-of-pocket limits. Because of this, it is crucial to fully understand your coverage before enrolling if you choose to enroll in Medicare Advantage.

Medicare Part D plans require copayments and deductibles that vary by policy. Each Medicare Part D plan offers different benefits, so, like Medicare Part C, it is vital to fully understand your Medicare Part D plan before enrolling in coverage.

3. Decide on which extra coverage to get after signing up for Original Medicare

Next on the Medicare checklist is understanding your options for extra coverage to your Original Medicare coverage.

Four months before enrolling in Original Medicare, it is crucial to know whether you will be enrolling in a Medicare Supplement or Medicare Advantage plan.

If you decide to only have Original Medicare coverage and not enroll in additional coverage, you will not need to do anything during this time. However, it is essential to note that you will not have a maximum out-of-pocket limit. This means there is no cap on your out-of-pocket costs.

Often, Medicare Supplement carriers will allow you to choose your plan up to six months before your Medicare Part B start date. This allows you ample time to budget and understand your plan’s benefits.

Additionally, if you choose to enroll in a Medicare Advantage plan, you can begin enrolling in your plan three months before you turn 65.

4. Compare top plans in your area

Once you decide whether to enroll in a Medicare Supplement or Medicare Part C plan, it is essential to compare the available plans in your area.

When it comes to Medicare Part C, you will find several different Medicare plans available through different carriers that offer other price points, out-of-pocket costs, and benefits.

Suppose you are enrolling in a Medicare Part C plan. In that case, it is essential to review each plan as additional benefits could be available with one plan that are not available in another. One significant additional benefit is gym membership options like SilverSneakers, available on several Medicare Part C plans.

When it comes to Medicare Supplement plans, since benefits are standardized, it is essential to use this time to decide which plan letter you wish to enroll in and which carrier offers the coverage for the lowest cost in your area.

The lowest cost plan could often be the best carrier in your area. There are ten standardized plans identified by letters A through N and two high deductible plans.

Each Medicare Supplement plan offers different benefits and levels of coverage. Medicare Supplement Plan F, Plan G, and Plan N are the most popular Medicare Supplement plans.

Knowing which Medicare Part D Plan you want is essential if you plan on enrolling in a Medicare Supplement plan. Remember, if you enroll in a Medicare Advantage plan, you are not eligible for Medicare Part D.

Medicare Checklist One to Three Months Before Turning 65

Three months before you turn 65, you can finally enroll in Original Medicare. For some, this process is automatic. Others will need to sign up through Social Security.

1. Apply for Original Medicare through Social Security

As you are closing in on your 65th birthday, starting your application for Original Medicare is essential. You can apply for Medicare through Social Security up to three months before you turn 65.

If you are receiving Social Security benefits, you can skip this step. You will automatically be enrolled in Medicare and receive your Red, White, and Blue card.

If you are not enrolled in Social Security benefits, you must contact Social Security to enroll in Original Medicare. This process can take up to a month before you receive your cards. It is recommended to begin this step as soon as possible, three months before your 65th birthday.

When you are enrolling in Original Medicare, it is essential to provide the following documents:

• Birth certificate
• Proof of citizenship or legal residency if you were not born in the United States
• Income statements
• W-2 and other tax forms
• Discharge papers or other records of military service before 1968

Additionally, to qualify for zero-premium Medicare Part A, you must have worked at least 40 quarters (ten years) in the U.S., paying Medicare taxes. You will not need to pay a monthly Medicare Part A premium if you qualify.

Your Medicare Part B premium will be determined based on your income two years before the current year.

2. Enroll in Medicare Part C or Medicare Supplement

After applying for Original Medicare, it is time to enroll in Medicare Part C or a Medicare Supplement plan.

If you decide to enroll in a Medicare Part C plan, you can do so once you receive your Medicare Identification Number. This number allows you to enroll in a Medicare Part C plan through an agent. A licensed agent can help you enroll in the right plan. This is because they are more experienced and may provide helpful tips for enrolling in a Medicare Part C plan.

On the other hand, you do not need a Medicare Identification Number yet to enroll in a Medicare Supplement plan with most carriers. However, they ask you to provide the number once you receive your Medicare Red, White, and Blue Card.

Once you know which Medicare Supplement plan you are enrolling in, contact your licensed Medicare agent. The agent can walk you through the application process. Enrolling with an agent ensures you miss no steps in the application process. This also ensures that you will receive guaranteed issue to the plan of your choice when you are new to Medicare.

3. Enroll in Medicare Part D

The last step of the Medicare checklist at this time is to look into Medicare Part D enrollment. If you enroll in a Medicare Supplement plan or have Original Medicare coverage only, you will need to enroll in Medicare Part D.

Once you receive your Medicare Identification Number (located on your Red, White, and Blue Card), you can enroll in Medicare Part D. You will complete this step through a licensed agent or with a Medicare representative over the phone. Your Medicare Part D benefits will begin on the first day of your 65th birth month.

You may be responsible for paying a monthly penalty if you do not enroll in Medicare Part D when you first become eligible. The Medicare Part D penalty adds 1% of the average premium cost for each month you go without creditable drug coverage. Once you are assessed the premium, it never goes away.

What Should You Do the Month You Turn 65?

If you followed the Medicare Checklist above, you could begin enjoying your Medicare benefits on the first day of your 65th birth month.

However, Medicare enrollment does not end here. Each year you will be given opportunities to change your plans or enroll in new coverage if you wish.

Every Medicare beneficiary can utilize the Annual Enrollment Period. Each year you can make changes to your coverage for the upcoming year. This enrollment period runs from October 15 to December 7. Be sure to select new coverage during this time if you are unhappy with your current plan.