Medicare Eligibility at 65: What You Need to Know

NOVEMBER 10, 2014 VOLUME 21 NUMBER 41

Almost ten thousand Americans turned 65 today. Almost all of them will be eligible for Medicare coverage. Those who are new to Medicare will need to make some decisions about whether to sign up for Part B, what to do about Part D, whether to choose Medicare Advantage or “traditional” Medicare, and whether to purchase a “Medigap” policy. Generally speaking, today’s new 65-year-olds have a seven-month period to make their decisions — starting three months ago and running through this month and the next three months.

If you are in that group, you might wonder where you can go to find information about your options. There are a few reliable, unbiased options out there, but our favorite by far is your local Area Agency on Aging. If you live in Tucson, that would be the Pima Council on Aging. If you’re planning on turning 65 in the next few months, or if you just did and you haven’t done anything about it yet, get on the phone and call the PCOA right now. They’ll probably suggest that you sign up for their monthly New to Medicare Workshop, held once a month at the PCOA offices. Go.

There are a number of common Medicare mistakes new 65-year-olds make. You can learn about your options, and how to avoid those mistakes. Some of the things to watch out for:

  • When you sign up for Medicare, you have the option of skipping Part B coverage. Very, very few new Medicare beneficiaries should skip that coverage — even if you feel that you just don’t need it (or can’t afford it) now. Generally, the only people who should skip Part B are those who have current employer-provided health coverage (including active-duty members of the military). Covered by COBRA, Tricare or other private insurance? Get Part B coverage. What happens if you don’t? Later, when you do sign up for Part B (and you almost certainly will), the premiums will be high enough to essentially recapture your “missed” contributions. And don’t assume that your existing coverage qualifies to avoid the increased premiums in the future — check with your Area Agency on Aging, Medicare and/or your employer.
  • You get coverage for medications one of two ways: either you sign up for a “Part D” plan or drug coverage is part of your Medicare Advantage plan. Make sure you sign up for Part D one way or the other. As with Part B, failure to sign up now just means your premiums will be higher later. Don’t think you need (or can afford) Part D coverage? Consider AARP’s suggestion: sign up for the cheapest plan available in your community, primarily so that you don’t pay a penalty later when you do need medication coverage.
  • Don’t think you qualify for Medicare because you haven’t worked for 40 quarters? Get more information. You might want to sign up for Part B and Part D coverage now. You might be better off getting Medicare coverage even if you have to pay a premium (it might, for example, be cheaper and better than your current coverage). You might qualify under a spouse’s work history. Check it out.
  • Still working at 65? You still qualify for Medicare. It’s not tied to your work status, and the eligibility age hasn’t increased to 66, as Social Security already has — and Social Security’s retirement age is headed to 67. But not Medicare.
  • Are you already receiving Social Security benefits? If you are on Social Security Disability, your Medicare card will automatically arrive in the mail after you’ve had two years of SSDI benefits. If you’re receiving Social Security retirement benefits (because you signed up for Social Security between ages 62 and 65), your card will arrive automatically three months before your 65th birthday. When you get that card, you have seven months to sign up for Part A and Part B, choose your plan and select drug coverage.

Those are some of the basic rules (and things to watch out for). The program is complicated, though, and there is much uncovered here. There are special rules for people who are volunteering out of the country on their 65th birthday. There are new rules for same-sex spouses (expanding their coverage to match prior rules covering opposite-sex couples). There are issues of overlap between Affordable Care Act policies and Medicare. There are other benefits that help poor Medicare beneficiaries pay for their premiums, deductibles and co-payments. There is a high likelihood that one of the special rules has some effect on you, so get in touch with your Area Agency on Aging to find out more about your Medicare coverage.

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