North Texas

Medicare programs can be complicated. Here are tips your clients can share with their employees, who are 65, or will soon be 65.

What you should know about Medicare.

You might think milestone birthdays stop when you turn 50, but that’s not true. Your 65th birthday is an important milestone, too. That’s when you become eligible for the federal Medicare health insurance program. 

“Turning 65 is an opportunity for Americans to consider Medicare – an affordable health care option that offers hospital coverage and physician visits for those who qualify,” said Aparna Abburi, president of Cigna’s Medicare Advantage business. “Medicare programs can be complicated. Individuals should take inventory of where they are -- from health care, work and financial perspectives -- and also where they are headed, including personal preferences and goals.” 

Don’t wait – timing is important.

Medicare has a seven-month window around your 65th birthday called the Initial Enrollment Period. This period begins three months before your 65^th birthday and extends three months past your birthday month. Enrolling outside this window could result in higher premiums on Medicare add-ons, such as Medicare Part B, for the rest of your life due to late enrollment. 

For those who plan to keep working, your path forward depends on the size of your company. If you work for a company with fewer than 20 employees, you generally must sign up for Medicare at age 65. If you work for a larger company, you can keep your company’s plan and enroll in Medicare without penalty later – usually when you retire – or you can enroll in Medicare immediately. However, if you switch to Medicare, your spouse could lose their coverage if they are currently on your company’s insurance. 

If you’ve decided to retire and you’ve already filed for Social Security, the process is much easier. You’ll automatically be enrolled in Medicare Parts A and B, which cover hospital stays and visits to the doctor, when you turn 65. This is sometimes called Original Medicare. Original Medicare, however, doesn’t include coverage of prescription drugs. 

Original Medicare doesn’t cover everything.

Original Medicare covers hospital and physician expenses, but there are cost-sharing requirements and limits on what is covered. You’ll need to think about how you want to cover things like dental, vision, hearing and pharmacy. You can buy plans to supplement what Medicare covers, or you can buy a Medicare Advantage plan (also known as Part C) that covers everything that Medicare covers and provides additional benefits, including, in many cases, prescription drugs (also known as Part D). 

You’ve got options – and lots of them.

With Original Medicare, Medicare Advantage, Medicare Supplement and Prescription Drug Plans, there are a lot of choices to make when it comes to what coverage will be best for you. Understanding your budget, health needs, doctor preferences and lifestyle will be important to making the best choice for your particular needs. 

There are plenty of ways to get help.

For more information, visit the Medicare Plan Finder website, call 1-800-MEDICARE, or find local assistance through your State Health Insurance Assistance Program. We encourage you to speak with your benefits administrator, who can help you better understand your various options. What’s more, it’s always a good idea to talk with friends and family members who have been through the process. 

Once you’ve chosen your plan, it’s time to use it.

Know the benefits that are available to you. Find out about which wellness checks and preventive screenings are needed for your age and health status, and be sure to get them. Some Medicare Advantage plans have extras, such as gym memberships. These extras can help you actively engage in your own health and well-being.