10 Things to Know About Medicare Before You Turn 65

For many Americans, turning 65 means becoming eligible for Medicare. That sounds simple enough, but Medicare comes with enrollment deadlines, coverage choices, premiums, and terminology that can quickly become confusing.
Fortunately, you do not need to become a Medicare expert. You simply need to understand the major decisions and begin planning early. Here are 10 things to know before you turn 65.

1. Medicare Does Not Cover Everything

Medicare is a federal health insurance program primarily for people age 65 and older. Although it provides valuable coverage, it does not pay for every health care expense. Deductibles, copayments, prescription drugs, and certain services may still come out of your pocket.

2. Learn the Medicare Alphabet

Medicare has four main parts:

• Part A generally covers inpatient hospital care, some skilled nursing care, hospice care, and certain home health care services.
• Part B generally covers doctor visits, outpatient care, preventive services, and certain medical equipment.
• Part C, or Medicare Advantage, offers an alternative way to receive Medicare benefits through a private insurer.
• Part D helps cover prescription drugs.

3. You Have Two Main Coverage Paths

Most people choose between Original Medicare and Medicare Advantage.
Original Medicare includes Parts A and B, allows access to providers who accept Medicare, and is often paired with a separate Part D plan and Medigap policy. Medicare Advantage (Part C) provides this coverage through a private insurer, but may also include prescription drug, dental, vision, or hearing benefits.

4. Medigap Can Help Fill the Gaps

Medigap policies help cover certain costs that Original Medicare does not fully pay. These policies can make health care expenses more predictable, but they generally require an additional monthly premium.

5. Enrollment Timing Matters

Waiting too long to enroll can result in delayed coverage or permanent late-enrollment penalties. The standard seven-month enrollment period is the three months before your 65th birthday, the month of your 65th birthday, and the three months following your 65th birthday, so begin reviewing your options several months before your 65th birthday.

6. Working After 65 Changes the Rules

If you or your spouse will remain employed, you may be able to delay certain parts of Medicare. The answer can depend on your employer’s size and the type of health coverage you have. Importantly, COBRA is generally not treated the same as active employer coverage for Medicare enrollment purposes.

7. Coordinate Medicare with Your HSA

You generally cannot contribute to a Health Savings Account after enrolling in Medicare. Medicare Part A can also be retroactive in certain situations, so people working beyond age 65 should coordinate their Medicare application and final HSA contributions carefully.

8. Higher Income Can Increase Your Premiums

Higher-income individuals may pay additional Part B and Part D premiums through the Income-Related Monthly Adjustment Amount, or IRMAA. Medicare generally uses income from two years earlier when determining whether IRMAA applies. Roth conversions, capital gains, business sales, and large retirement-account withdrawals can therefore affect future Medicare costs.

9. Do Not Choose Based Only on Premiums

A plan with a low monthly premium is not necessarily the least expensive overall. Consider your doctors, prescription drugs, expected health care use, travel plans, deductibles, and potential out-of-pocket costs.

10. Review Your Coverage Regularly

Insurance plans, prescription drug coverage, provider networks, and personal health care needs can change. Reviewing your coverage annually can help ensure it continues to fit your circumstances.

Final Thoughts

Medicare is more than a health care decision. It is also part of your retirement, tax, and cash-flow planning. Starting early and evaluating Medicare alongside your broader financial strategy can help you avoid costly surprises and approach retirement with greater confidence.

The information provided herein is for educational purposes only, and should not be construed as advice, including, but not limited to tax, legal, insurance, investment, or retirement advice. For your specific planning needs, please seek the advice of Integris Wealth Management, your tax accountant, attorney, insurance agent, or other professional as appropriate. Investing involves the risk of loss.