Key Takeaways:
- Understand how aging into Medicare works when you turn 65 to avoid late penalties and coverage gaps.
- Compare Original Medicare and Medicare Advantage plans to find optimal coverage at acceptable costs.
- Evaluate supplemental options like Medicare Part D and Medigap to enhance benefits and cut costs.
Medicare is a federal health insurance program for eligible Americans aged 65 years and above, and younger individuals with certain covered diseases and disabilities.
Signing up for Medicare at the right time is key to preventing late enrolment penalties, coverage delays, and potentially higher premiums
Let’s learn how aging into Medicare works.
When and How to Enroll in Medicare at 65
Your first and most important opportunity to enroll in Medicare is the Initial Enrollment Period (IEP).
This seven-month period begins three months before your 65th birthday, includes the month of your birth, and extends for three months thereafter.
This is when you can enroll in Original Medicare (Part A and Part B), Medicare Advantage, and Part D prescription drug plans. You can also buy Medicare Supplement or Medigap plans during this period as long as you first sign up for Part B.
Consequences of Failing to Enroll During IEP
If you do not enroll in Medicare during the IEP, you can still do it during the Annual Enrollment Period (AEP), which runs from October 15 to December 7 of each calendar year.
There are notable downsides, however, to delaying Medicare enrollment.
For one, you may have to pay late enrollment penalties for Medicare Part A, Part B, and Part D, which mean higher monthly premiums.
Depending on your unique situation, you may also face some coverage gaps.
Special Enrollment Periods
A Special Enrollment Period (SEP) can be triggered by several qualifying life events, such as relocating, losing employer coverage, or becoming eligible for Medicaid.
You can also have an SEP if you choose to:
- Enroll or disenroll from an employer or union-sponsored Medicare Advantage or Part D plan.
- Disenroll from a Medicare Advantage or Part D plan to take employer or union-sponsored coverage.
- Disenroll from employer or union-sponsored health insurance coverage of any kind.
Learn more: What are Medicare Special Enrollment Periods?
A Quick Guide to Medicare Enrollment
Here’s a simple two-step guide to Medicare enrollment:
- Prepare Your Paperwork: This includes your Social Security card, proof of citizenship or legal residency, list of medications, and current healthcare providers.
- Choose How to Enroll: You have four options.
- Online: Through the Social Security Administration1 (SSA) or the Medicare website2.
- By Phone: Call 1-800-MEDICARE (1-800-633-4227) to enroll.
- In-Person: Visit your local SSA office to apply in person. Find it through the SSA office locator3.
- Through an Agent: Licensed insurance agencies like CoverRight offer personalized guidance and support throughout enrollment.
Comparing Medicare Coverage Options
Medicare benefits can be accessed through either of two broad alternatives.
Original Medicare
Original Medicare is a public health insurance program run by the federal government.
It has two components:
- Part A (Hospital Insurance): It covers inpatient hospital stays, some home health care, hospice care, and skilled nursing facility care.
- Part B (Medical Insurance): It covers outpatient care, doctor visits, lab tests, preventive services, and medical equipment.
Those who have paid Medicare taxes for at least 10 years are eligible for zero-premium Part A coverage. Others have to pay $285 or $518 per month, depending on how long you or your spouse paid Medicare taxes.
In 2025, the annual deductible for Part B will be $257, while the monthly premium will be $185.
Apart from deductibles and monthly premiums, Original Medicare involves various out-of-pocket costs in the form of copayments and coinsurance.
In Part A, for instance, beneficiaries must pay a $1,676 deductible for every benefit period they avail.
In Part B, likewise, they are liable for 20% of the approved cost of a service or item after meeting the annual deductible.
Medicare Advantage
Medicare Advantage or Part C plans are a private alternative to Original Medicare.
Federal law mandates that all Part C plans must provide at least all the benefits accorded under Original Medicare. This leaves private insurers free to bundle additional benefits to their plans.
That can include prescription drug coverage, dental, hearing, and vision services, and, in some cases, alternative therapies and wellness programs.
Let’s break down the key differences between Original Medicare and Medicare Advantage:
| Medicare Part A | Medicare Part B | Medicare Advantage |
|---|---|---|
| $0 or $285 – $518 if you do not qualify for free coverage. | $185 | $17 |
| $1,676 | $257 | ($0 – $590) Varies by plan. |
| Inpatient care, such as hospital stays, skilled nursing facility care, and hospice care. | Outpatient care, preventative services, and medical equipment. | All benefits provided by Part A and Part B. |
| None. | None. | Paid add-on coverage for additional benefits like prescription drugs, dental, vision, and hearing services, alternative therapies, and wellness programs. |
Data sourced from Medicare.gov and MedicareWire. Information reflects publicly available data as of 2025.
Choosing Between Original Medicare and Medicare Advantage
Original Medicare has higher out-of-pocket costs and offers more flexibility in choosing healthcare providers and specialists.
Medicare Advantage plans can be cheaper than Original Medicare, but they restrict access to a limited network of specialists and providers.
Original Medicare is ideal for people with complex medical needs and those who need access to care in different locations because they travel frequently.
Medicare Advantage suits those who need extra health benefits, are comfortable with a smaller network of providers, and are not keen on tasks like making appointments and coordinating care.
Learn More: Original Medicare vs. Medicare Advantage.
Enhancing Coverage with Supplemental Plans
Two additional Medicare plans supplement the coverage offered by Original Medicare and Medicare Advantage.
Medicare Part D
Medicare Part D plans cover some costs of prescription drugs and make them more affordable and accessible.
They can work as stand-alone plans alongside Original Medicare or come as a bundled benefit under a Medicare Advantage plan.
The cost of a Part D plan depends on multiple factors, including the specific medications you require, where you live, and your income.
Medigap
Medicare Supplement or Medigap plans cover some of the out-of-pocket costs associated with Original Medicare.
Most US states offer 10 standardized Medigap plans labeled A through N, with some offering additional high-deductible options.
What to Consider When Selecting Supplemental Plans
There are three key considerations to choosing a Medicare Part D plan:
- Each Part D plan comes with a formulary – a list of drugs arranged in different cost-sharing tiers that determines what you’ll pay out-of-pocket for each medication you require.
- Part D plans have their own networks of pharmacies. Make sure your preferred pharmacies are in-network before choosing a Part D plan.
- Consider the availability and cost of mail-order pharmacy services, which can be an easier and cheaper way to fill prescriptions.
Here’s what you need to keep in mind when choosing a Medigap plan:
- Extent of Coverage: Medigap plans come with varying levels of coverage. Plan G, for instance, covers most out-of-pocket costs under Original Medicare. Plan N, meanwhile, involves some cost-sharing on doctor visits and ER care.
- Out-of-Pocket Costs: Compare what each Medigap plan covers and excludes. Plan G, for instance, has higher premiums but does not cover the Part B deductible. Plan N has lower premiums but does not cover the Part B deductible or excess charges.
Don’t forget to also factor in your current health status and plan availability in your area when comparing Medicare supplemental coverage.
Learn more: Medicare Advantage vs. Medicare Supplement: How to Choose?
Avoiding Common Pitfalls When Aging Into Medicare
Here are some common pitfalls you must look out for when it comes to aging into Medicare:
- Assuming Automatic Coverage: That happens only when you’ve been receiving Social Security benefits for at least four months when you turn 65. In all other cases, you have to proactively enroll in Medicare by applying.
- Missing Enrollment Windows: Failing to enroll during the IEP or SEP can result in penalties, loss of coverage, and higher premiums.
- Not Comparing Plans: Don’t just accept default plans. Compare different options to find plans that suit your unique healthcare needs and budget.
- Ignoring Supplemental Insurance: Medicare alone may not cover all your healthcare expenses, so it’s important to consider Part D plans and Medigap policies to cover prescription drugs and out-of-pocket costs, respectively.
- Setting up Automatic Renewal: Medicare introduces new plans and coverage options periodically. Instead of setting up automatic renewal, review your coverage needs annually to optimize your coverage.
- Ignoring Financial Assistance: There are multiple Medicare assistance programs for the elderly, pregnant women, and those with limited incomes. They include Extra Help4 and the Medicare Savings Program5.
- Overlooking Out-of-Pocket Costs and Hidden Expenses: Medicare plans with the lowest or zero premiums are not necessarily your best options. Don’t forget to factor in out-of-pocket costs, hidden expenses, and services not covered when comparing plans.
Planning for Healthcare Needs Beyond Basic Medicare
Many Medicare beneficiaries have complex healthcare needs that basic Medicare may not adequately address.
That includes people who:
- Need frequent care because of terminal or potentially life-threatening conditions.
- Suffer from chronic conditions.
- Depend on life-saving medications.
Anybody in this group must consider available Medicare Advantage, Part D, and Medigap plans to maximize their health insurance coverage.
You can also try for additional financial assistance through various federal and state programs like those mentioned above and others like Medicaid6 and PACE7.
Learn more: Finding Medicare Providers: Which One Is Right For You?
Step-by-Step Guide to Enrolling in Medicare
The Medicare enrolment process can be broken down into four steps:
Step 1: Determine Eligibility and Timing
Most people become eligible for Medicare when they turn 65. Only those with a qualifying disability or end-stage renal disease (ESRD) are eligible for early enrolment.
Review your past employment details to make sure you are eligible for Medicare based on your work history.
You can apply for Medicare during the seven-month-long IEP, the three-month-long AEP, or during a SEP triggered by a qualifying life event.
Step 2: Compare Plans
Except for Original Medicare, all other Medicare plans offer choices in terms of both costs and coverage options.
Compare plans diligently to determine which ones best align with your unique healthcare needs and financial situation.
A licensed insurance agent like CoverRight can free of charge walk you through your options and help you make informed Medicare decisions.
Step 3: Review and Confirm Coverage Selection
Before applying, review your application to make sure all details are correct, all boxes are ticked, and all supporting documents are included.
Pay particular attention to your name, date of birth, current mailing address, and phone number.
Make sure you’ve included a list of your medications and current healthcare providers.
Step 4: Choose How to Apply
As mentioned above, you can apply for coverage via the Social Security Administration or the official Medicare website.
You can also apply over the phone by calling 1-800-MEDICARE (1-800-633-4227) or walk into your local SSA office to apply in person.
Pro Tips for a Smooth Enrollment Experience
You can do a lot to ensure a hassle-free experience when aging into Medicare.
For instance:
- Start Early: Get your paperwork ready and start exploring plans well before your IEP kicks in.
- Understand Medicare: Familiarize yourself with the various parts of Medicare and what they cover.
- Compare Plans: Use the ‘care compare’ tool8 on the Medicare website to narrow down your options.
- Contact Your Current Insurer: That will help you understand how the transition to Medicare works.
Learn More: How to Prepare for Medicare Enrollment.
How CoverRight Can Help You Navigate Medicare
CoverRight helps you make the most out of Medicare without any of the headaches usually associated with the process.
Our licensed Medicare advisors take the time to thoroughly understand your unique healthcare needs and budget before making customized plan recommendations that optimize coverage while limiting costs.
We also offer several tools and extensive resources to help you navigate Medicare easily and make confident decisions.
FAQs About Aging Into Medicare
Is Medicare enrollment automatic at 65?
Medicare enrollment is automatic only for individuals who have been receiving Social Security benefits for at least four months when they turn 65.
Those eligible for coverage must proactively apply for enrollment in all other cases.
Can I delay Medicare if I have employer insurance?
Yes. If you lose employer coverage, you can sign up later during a Special Enrollment Period.
What are my coverage options if I retire early?
If you retire before reaching the standard Medicare eligibility age of 65, you can purchase a healthcare insurance plan through the Affordable Care Act (ACA) marketplace.
Medicare enrollment before 65 years is only available for those with a qualifying disease or disability.
How do I switch plans after enrolling?
You can switch Medicare plans during the Annual Enrollment Period, which runs from October 15 to December 7 of each year.
You can switch between Original Medicare and Medicare Advantage, change Medicare Advantage plans, and switch Part D plans during this period.
Get Personalized Medicare Guidance
Navigating Medicare on your own can be overwhelming, although it doesn’t have to be.
Reach out to CoverRight today if you need help understanding your options, comparing plans, and securing the best possible coverage given your healthcare needs and budget.
Let’s make your Medicare experience better.
Sources
- Social Security Administration (SSA)
- Official Social Security Website. Available at: ssa.gov. Last Accessed March 2, 2025.
- Medicare.gov
- Medicare Enrollment and Coverage. Available at: medicare.gov. Last Accessed March 2, 2025.
- Social Security Administration (SSA)
- SSA Office Locator. Available at: ssa.gov. Last Accessed March 2, 2025.
- CoverRight
- What Is the Extra Help Program? Available at: coverright.com. Last Accessed March 2, 2025.
- Medicare.gov
- Medicare Savings Programs. Available at: medicare.gov. Last Accessed March 2, 2025.
- CoverRight
- What Is Medicaid and Do You Need It? Available at: coverright.com. Last Accessed March 2, 2025.
- Medicaid.gov
- Program of All-Inclusive Care for the Elderly (PACE). Available at: medicaid.gov. Last Accessed March 2, 2025.
- Medicare.gov
- Care Compare Tool. Available at: medicare.gov. Last Accessed March 2, 2025.
