Turning 65 Soon? Here’s What Medicare Doesn’t Tell You
If you’re nearing age 65, it’s time to start thinking about Medicare enrollment. But Medicare can be confusing, with many rules and caveats. Here are some key facts Medicare may not advertise that you should know before signing up.
Do I get Medicare when I turn 65? You Aren’t Automatically Enrolled in Medicare when you turn 65
One big misunderstanding is that you will be automatically enrolled in Medicare when you turn 65. That is not the case with Medicare eligibility. You may need to actively enroll in Medicare yourself. Coverage doesn’t begin automatically for everyone once you hit 65.
During your Initial Enrollment Period – the 3 months before, the month of, and 3 months you turn 65 – you have to take action to enroll in Medicare Part A and B to establish coverage. Don’t assume it will just happen without applying you need to sign for it.
When you get Medicare at age 65 It Doesn’t Cover Everything
Many people think that once they get Medicare, all their healthcare costs will be fully covered. In reality, Medicare does not cover 100% of medical services and expenses.
There are deductibles, copays, and coinsurance costs you pay out of pocket for care unless you have supplemental coverage through Medigap, retiree plans, or Medicare Advantage. Understanding Medicare’s cost sharing rules can help avoid surprises.
You May Face Lifelong Late Penalties if you don’t sign up for Medicare early
If you don’t sign up for Medicare Parts A and/or Medicare part B during your initial enrollment period from age 65-67, you may face late enrollment penalties that permanently increase your premium costs. You can only enroll after your initial window during General Enrollment each year from January 1 – March 31 with coverage beginning July 1.
Missing your initial window to avoid penalties is one key fact Medicare does not readily advertise. Make sure you get Parts A and B covered within the first 3 months before or after your 65th birthday.
You Need Separate Part D Drug Coverage
Basic Medicare does not include prescription drug coverage under Part D. To get this, you have to actively choose and enroll in a standalone Part D prescription drug plan or a Medicare Advantage plan that has drug coverage built in.
If you go more than 63 days without Part D or other creditable drug coverage after initial eligibility, you will also face lifelong penalties added to your Part D premiums.
You can delay Medicare enrollment if you still working past 65
If you plan to be still working past 65, you don’t necessarily have to enroll in Medicare right away and drop your employer health insurance plan. In some cases, you can delay Medicare enrollment.
But the rules depend on your employer size and whether Medicare will be primary or secondary coverage. Understand how the two coordinate before making changes to avoid gaps in coverage.
Medicare Doesn’t Cover Dental, Vision, Hearing
Three healthcare services many seniors need – dental, vision and hearing care – are NOT covered by Medicare Parts A and B. Some Medicare Advantage plans may offer these as extra benefits, but Original Medicare does not.
You will need separate insurance policies like dental plans or vision plans to cover routine dental cleanings, eye exams, glasses, contacts, and hearing aids, along with the costs of any dental or vision procedures.
Medicare Plan Choices Can Be Overwhelming
When you first become eligible for Medicare, the array of plan choices can be overwhelming. There’s Original Medicare part a and part b, Medicare Advantage, Part D prescription plans, Medicare supplement or Medigap policies, group health plans, and advantage plans with built-in Part D coverage.
Working with an independent insurance broker or resources like your State Health Insurance Assistance Program (SHIP) can help narrow down your options. Don’t just default to plans advertised on TV – make sure you understand all the costs and coverage.
Medicare Doesn’t Cover Long-Term Care
Many assume that Medicare will pay for nursing home or long-term care costs. This is not the case. Medicare provides only limited coverage for certain skilled short-term nursing facility rehabilitation care.
Custodial long-term care costs in nursing homes, assisted living, or at home are not covered. You need private long-term care insurance or other resources to cover extended long-term care services.
Medicare Coverage Ends Overseas
If you want to spend extended time traveling or living overseas in retirement, be aware that Original Medicare does not provide coverage for care outside of the United States.
Some Medicare Advantage plans offer limited emergency foreign travel benefits, but otherwise you’ll need to look into expat or travel insurance policies before leaving the country for any lengthy periods of time.
Higher-income seniors pay more for Medicare coverage, but you won’t find this fact advertised often. Monthly premiums when you sign up for Part B and D can increase based on your taxable income from two years prior over set thresholds.
In 2023, individuals with income above $97,000 or couples above $194,000 may pay several hundred dollars more per month just for their Medicare premium costs. Factor this into your retirement budget or health savings account.
Medicare Doesn’t Pay 100% Forever
Another lesser-known fact is that while Medicare covers 100% of costs for the first 60 days in the hospital and 20 days of skilled nursing care, coverage drops to 80% after that initial period. And hospital stays beyond 90 days require a daily copay.
Understanding the cost sharing rules for hospital, nursing care, and deductibles will help you financially plan for the potential of extensive medical needs in retirement. Supplemental coverage can fill these gaps.
The key is not making assumptions and verifying how Medicare will actually work once you enroll. While a valuable program, Medicare does have many limitations and requirements you need to be aware of. Doing your homework will ensure you choose the right coverage and avoid any gaps or surprises after turning 65.
How do I enroll in Medicare?
If you’re already receiving Social Security or Railroad Retirement Board benefits, you’ll automatically enroll in original Medicare Part A (hospital insurance) and Part B (medical insurance) when you turn 65. You’ll receive your Medicare card in the mail about three months before your 65th birthday. If you’re not receiving these benefits, you’ll need to sign up for Medicare Part A and Part B during your initial enrollment period, which starts three months before you turn 65 and ends three months after you turn 65.
What are the different parts of Medicare?
Medicare has four main parts: Part A, Part B, Part C, and Part D.
- Part A covers inpatient hospital stays, skilled nursing facility care, hospice care, and some home health care. Most people don’t pay a premium for Part A if they or their spouse paid Medicare taxes while working.
- Medicare Part B premium covers doctor visits, outpatient services, preventive care, and some medical equipment and supplies. Most people pay a monthly premium for Part B, which is based on their income.
- Part C, also called Medicare Advantage, is an alternative way to get your Medicare coverage. It’s offered by private insurance companies approved by Medicare. Medicare Advantage plans include all the benefits of Part A and Part B, and often include extra benefits such as vision, dental, hearing, and prescription drug coverage. You pay a monthly premium for Part C, which varies by plan and location.
- Part D covers Medicare prescription drugs. It’s also offered by private insurance companies approved by Medicare. You can get Part D as a standalone plan or as part of a Medicare Advantage plan. You pay a monthly premium for Part D, which varies by plan and drug costs.
Do I need to get a Medicare supplement plan?
A Medicare supplement plan, also called Medigap, is a type of private insurance that helps pay for some of the costs that Medicare doesn’t cover, such as deductibles, coinsurance, and copayments. Medigap plans are standardized and regulated by the federal government, but sold by private companies. You can choose from 10 different Medigap plans, labeled A through N. Each plan offers a different level of coverage and cost. You pay a monthly premium for a Medigap plan, which varies by plan and company.
You don’t need to get a Medigap plan if you have a Medicare Advantage plan, because they cover most of the same things. However, if you have original Medicare (Part A and Part B), you may want to consider getting a Medigap plan to help lower your out-of-pocket expenses.
Q: When can I change my Medicare coverage?
A: You can change your Medicare coverage during certain times of the year. The most common ones are:
- The annual enrollment period (AEP), which runs from October 15 to December 7 every year. During this time, you can switch from original Medicare to a Medicare Advantage plan or vice versa, change your Medicare Advantage plan or Part D plan, or join a Medicare Advantage plan or Part D plan for the first time.
- The open enrollment period (OEP), which runs from January 1 to March 31 every year. During this time, you can switch from one Medicare Advantage plan to another or go back to original Medicare with or without a Part D plan. You can’t join a Medicare Advantage plan or Part D plan for the first time during this period.
- The special enrollment period (SEP), which is available in certain situations such as moving to a new area, losing your current coverage, qualifying for extra help with drug costs, or having a change in your health status. The rules and time frames for SEPs vary depending on the situation.
Q: What are some things that Medicare doesn’t cover?
A: While Medicare covers many health care services and supplies, there are some things that it doesn’t cover or only covers partially. Some examples are:
- Long-term care, such as nursing home care or assisted living facilities
- Routine dental care, such as exams, cleanings, fillings, crowns, and dentures
- Routine vision care, such as exams, glasses, and contacts
- Routine hearing care, such as exams and hearing aids
- Cosmetic surgery
- Alternative medicine
Some of these services may be covered by a Medicare Advantage plan or a Medigap plan, depending on the plan and the provider. You may also want to look into other options, such as Medicaid, veterans benefits, or private insurance, to help pay for these services.