Medicare Is Not a One-Size-Fits-All Decision: Key Things to Know Before 65

Article by Bridgette Paoletta, Coordinator of Aging Services

Approaching 65 often raises an important question: what should you do about Medicare? The answer depends on your circumstances. If you are still employed, have coverage through work, take prescription drugs, or want to better manage healthcare expenses, your Medicare choices may differ from someone else’s. Medicare is not a one-size-fits-all plan.

You May Not Need to Sign Up Right Away

If you or your spouse is still working and you have health coverage through current employment that qualifies, you may be able to postpone Medicare Part B without facing a late-enrollment penalty.

That said, employer coverage, COBRA, retiree insurance, and HSA rules can all work differently. Before deciding to delay Medicare, speak with your employer’s benefits administrator and make sure you understand how your current plan coordinates with Medicare.

Medicare Is Not Free

Many people qualify for premium-free Part A, but Part B usually comes with a monthly premium. Depending on the coverage you choose, you may also be responsible for deductibles, copayments, and coinsurance.

Look beyond the monthly premium and think about what your out-of-pocket costs could be when you actually need care.

Medicare Does Not Pay for Everything

Medicare does not cover every healthcare expense. Original Medicare generally does not include routine dental care, hearing aids, long-term care, and some other services.

Original Medicare also does not set an annual out-of-pocket maximum for covered services. To help manage those costs, some people choose Medigap or Medicare Advantage.

Medicare is insurance, not a guarantee that every medical bill will be paid in full.

You Have Options

In general, Medicare coverage can come through Original Medicare or Medicare Advantage. Original Medicare includes Part A and Part B, and you can add Part D prescription drug coverage and possibly a Medigap policy.

Medicare Advantage plans are offered by private insurers and combine Part A and Part B coverage. Most also include prescription drug coverage and may offer extra benefits, though they may also involve provider networks and other rules.

Neither choice is automatically best for everyone. Your doctors, medications, budget, travel plans, and healthcare needs all play a role.

Begin Planning Before 65

Your Initial Enrollment Period generally lasts seven months: the three months before you turn 65, your birthday month, and the three months after.

Do not wait until your birthday to start looking into your options. Learning about your coverage and enrollment deadlines in advance can help you avoid expensive mistakes.

The goal is not to choose Medicare quickly. It is to choose coverage that fits your life.

Medicare Open Enrollment is approaching. During that period, Medicare beneficiaries can review their current health and prescription drug coverage and make changes for the next coverage year. It is a good time to compare plans, check prescription costs, and make sure your coverage still meets your needs. NY Connects and the Office for Aging Services can help. Call 716-753-4582 or email [email protected] to learn more about Medicare assistance and available resources.