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.
- 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 will need to 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. 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, also 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.
- When can I enroll in Medicare?
There are a few important enrollment periods to keep in mind. When you turn 65, your initial enrollment period begins.
Initial enrollment period
“You’ll have seven months to sign up for Medicare,” Truong explains. “This is the initial enrollment period, which 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 2 months after the month you turn 65.
Open enrollment periods
If you miss the initial enrollment period, you can sign up for Medicare during the annual open enrollment period, October 15 through December 7. Medicare Advantage also has an annual general enrollment period from January 1 through March 31.
According to Truong, signing up during the general enrollment period may require you to pay a monthly late penalty if you don’t qualify for a special enrollment period. These periods are determined by qualifying life events, such as losing your current coverage or retiring after age 65. To avoid penalties, be sure to sign up within the initial enrollment period.
- When will my coverage start?
“Generally, coverage begins on the first of the month,” Truong says. “But the exact date will depend on the month you enroll.”
When you receive your red, white and blue Medicare card in the mail, you can check the lower right corner for the date that your Part A or Part B coverage will begin. If you have a Medicare Advantage plan, you’ll find your coverage effective date — the day your coverage begins — on the member ID card from your health plan.
- 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.
- How do I know which Medicare plan is right for me?
“Before you turn 65, take some time to evaluate your health needs and compare plans,” Truong says.
Medicare evaluates plans based on a five-star rating system each year. Plans are rated on a scale of one to five stars, where one star indicates poor performance, and five stars indicates excellent performance. “Sharp Health Plan received five out of five stars from Medicare for 2022 and was the highest member-rated Medicare Advantage plan in San Diego,” Truong says.*
“The quality of your health plan matters too,” adds Truong. “Sharp Health Plan’s newest offering, the Sharp Direct Advantage® VIP Plan, provides all the benefits of Original Medicare, with more value and savings to enjoy.”
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.