5 Medicare questions to ask before turning 65

As you get closer to your 65th birthday, you’ll need to make decisions about your Medicare coverage. From what options are available to how to enroll, there are a variety of things to consider.

Don Truong, director of sales at Sharp Health Plan, says that the more you know, the easier enrollment can be. He offers answers to five common Medicare questions for folks getting started.

1. What Medicare options are available?
   “Medicare has three main parts,” Truong says. “Part A covers hospital insurance, Part B covers medical insurance and Part D provides drug coverage.”
   
   Original Medicare includes Parts A and B. According to Truong, you must enroll in a separate Part D plan for prescription drug coverage. Unlike other types of health insurance, Medicare doesn’t offer plans for couples or families. This means you, your spouse and any dependents can enroll in separate plans.
   
   For those who’d like more coverage, a Medicare Advantage plan (Part C) could be ideal.
   
   “A Medicare Advantage plan combines Parts A and B and often Part D coverage into one plan,” Truong says. “It can offer extra benefits, such as dental, hearing and vision.”
   
   Medicare supplements, known as Medigap, are available too. Medigap plans help to cover the costs that aren’t included in Original Medicare. And while these plans may have high monthly premiums and do not cover Part D prescription drugs, you can be seen by any doctor nationwide who accepts Medicare.
    

2. When can I enroll in Medicare?
   You can only sign up for Part B (and Part A if you need to buy it) during certain enrollment periods. It's important to enroll in Medicare on time – if you don't you may need to pay extra fees called late enrollment penalties.
   
   Initial enrollment period
   Your initial sign-up period is based on your birthday and your existing health coverage. “The initial enrollment period gives you seven months to sign up for Medicare,” Truong explains. “It typically starts three months before your 65th birthday and ends three months after the month you turn 65.”
   
   If your birthday falls on the first day of the month, your initial enrollment period will begin and end earlier — starting four months before you turn 65 and ending two months after the month you turn 65
   

   Special enrollment period
   A special enrollment period may be available for certain situations. For example, if you have health insurance through a job and you’re still working at 65, you probably qualify for a special enrollment period.
   
   General enrollment period
   Medicare’s general enrollment period is Jan. 1 to March 31 each year. If you don’t qualify for special enrollment and you don’t sign up for Part B (or Part A if you have to buy it) during your initial sign-up period, you can enroll during the general enrollment period.

   “Remember, enrolling late for Medicare can lead to penalty fees,” cautions Truong. “The best way to avoid penalties is to sign up at the right time for you.”
   
   To check if you qualify for an enrollment period, visit medicare.gov or call 1-800-MEDICARE (1-800-633-4227). TTY users can call 1-877-486-2048.
   

3. When will my coverage start?
   When you receive your red, white and blue Medicare card in the mail, check the lower right corner for the exact date your Part A or Part B coverage will begin.
   

   “If you sign up in the first three months of your initial enrollment period, your coverage will start on the first day of your birthday month,” Truong says. “In most other cases, your coverage begins the first day of the month after you sign up. But the exact date will depend on the month you enroll.”
   

4. How does retirement affect my Medicare coverage?
   “Consider your health insurance options several months before you retire,” Truong says. “You should also check with your employer to find out when your coverage will end to avoid penalties or a gap in coverage.”
   
   When your job-based health insurance coverage ends, you’ll be able to enroll in Medicare during a special enrollment period. Additionally, you don’t need to retire to qualify for Medicare coverage. If you or your spouse are still working, you can keep your employer-based health insurance until you’re ready to disenroll or you can enroll in Original Medicare.
    

5. How do I know which Medicare plan is right for me?
   “Before you turn 65, take time to evaluate your health needs and compare plans,” Truong says.
   
   Every year, Medicare evaluates plans based on a five-star rating system. The star ratings are published annually to help consumers compare the quality of different Medicare health and drug plans. Medicare’s plan finder tool allows you to compare your options and see which plans got Medicare’s highest rating.
   
   “If you look up 2023 plans, you’ll see Sharp Health Plan received five stars*,” says Truong. “For folks already enrolled in a plan, Medicare actually allows you to switch from your current Medicare plan to one with a five-star quality rating. You can use this five-star special enrollment period once during the year.”

Truong encourages people not to wait to learn more about Medicare. Avoid gaps in coverage and other fees by researching the different plans and enrollment periods before your 65th birthday.

Learn more about Sharp Health Plan’s free Medicare seminars and consultations, available in English and Spanish. Sharp Health Plan also offers additional resources explaining the parts of Medicare and the services they cover, eligibility and enrollment information, and more.

*Based on a 91% base group in the area of members’ overall rating of their health plan from the 2021 Consumer Assessment of Healthcare Providers and Systems® score survey results achieved by Sharp Health Plan and SCAN Health Plan.