Myth #1: Medicare is free.

The truth: While most people don’t pay a premium for Part A (hospital insurance), Part B (medical insurance) does come with a monthly premium. There are also deductibles, copays, and coinsurance to consider.

Myth #2: You’re automatically enrolled in Medicare at 65.

The truth: You’re automatically enrolled only if you’re already receiving Social Security benefits. Otherwise, you need to sign up when you become eligible.

Myth #3: You can enroll in Medicare anytime.

The truth: Enrollment happens at specific times. If you miss your Initial Enrollment Period (or don’t have creditable coverage), you could face late enrollment penalties for Part B or Part D.

Myth #4: Medicare covers everything.

The truth: Medicare covers a lot, but not everything. For example, most dental, vision, hearing aids, and long-term care are not included.

Myth #5: Medicare covers your spouse automatically.

The truth: Medicare is individual coverage. Your spouse will need to qualify and enroll separately.

The more you know about Medicare, the fewer surprises you’ll face when it’s time to enroll. By separating fact from fiction, you can make confident decisions about your health coverage.

Reference:
Medicare.gov – Get Started with Medicare

AEP is October 15 – December 7 each year. Any changes you make take effect on January 1 of the following year.

During AEP, you can do the following:

• Switch from Original Medicare to a Medicare Advantage (Part C) plan

• Switch from a Medicare Advantage plan back to Original Medicare

• Change from one Medicare Advantage plan to another

• Enroll in, change, or drop a Medicare Part D (prescription drug) plan

Why AEP Matters

• Plans can change: Your premiums, co-pays, networks, and drug formularies may look different next year.

• Your needs may change: New prescriptions or health conditions might mean a different plan works better for you.

• Avoid surprises: Reviewing your coverage now helps ensure you’re set for the year ahead.

Think of AEP as your yearly “check-up” for Medicare. Taking the time to review your options between October 15 and December 7 ensures you’ll have coverage that fits your needs for the year ahead.

Reference:
Medicare.gov – When Can I Sign Up?

Employer Coverage vs. Medicare

Things to Consider

• Employer size matters: If your employer has fewer than 20 employees, Medicare generally becomes your primary coverage at age 65.

• Penalties: If you delay enrolling in Part B or Part D without creditable coverage, you may face late enrollment penalties.

• Spouse coverage: If your spouse depends on your employer plan, make sure you know how Medicare affects them.

• Costs: Compare premiums, deductibles, co-pays, and out-of-pocket maximums.

Deciding between staying on your employer’s coverage or moving to Medicare is a big step. The right choice depends on your employer plan, your personal health needs, and your retirement timeline.

Reference:
Medicare.gov – When to Sign Up

Premium: The amount you pay each month to keep your coverage active.

• Example: Most people pay $0 for Part A, but Part B has a standard monthly premium.

Copay (Copayment): A set dollar amount you pay for a covered service or prescription.

• Example: You might pay $20 for a doctor visit or $10 for a generic prescription.

Deductible: The amount you must pay out-of-pocket each year before your insurance starts to share the costs.

• Example: With Medicare Part B, you pay the yearly deductible before Medicare begins covering services.

Coinsurance: A percentage of the cost you pay for a covered service after your deductible is met.

• Example: With Part B, Medicare pays 80% of the cost and you pay 20%.

Out-of-Pocket Maximum: The most you’ll pay in deductibles, copays, and coinsurance during a plan year.

• Once you reach this limit, the plan pays 100% of covered costs for the rest of the year.

• Note: Original Medicare (Parts A & B) does not have an out-of-pocket maximum, but most Medicare Advantage plans do.

Reference:
Medicare.gov – Costs of Medicare

Part A – Hospital Insurance

Helps cover inpatient hospital stays, skilled nursing facility care, hospice care, and some home health care. Most people don’t pay a monthly premium for Part A because they paid Medicare taxes while working.

Part B – Medical Insurance

Helps cover doctor visits, outpatient care, preventive services, and medical equipment. Most people do pay a monthly premium for Part B.

Part C – Medicare Advantage

An alternative to Original Medicare (Parts A & B), offered through private insurance companies approved by Medicare. These plans bundle Part A and Part B, and many also include prescription drug coverage and extra benefits (like dental or vision). Costs, coverage, and provider networks vary by plan.

Part D – Prescription Drug Coverage (PDP)

PDP plans help cover the cost of prescription medications. These plans are offered by private insurance companies approved by Medicare. Premiums and formularies (the list of covered drugs) vary by plan.

Important to Know

• To have complete Medicare coverage, you are required to have Part A and Part B.

• Prescription drug coverage is also required, which means enrolling in a Part D plan (unless you have it included in a Medicare Advantage plan or have other creditable coverage).

• If you do not have creditable prescription drug coverage and don’t enroll in Part D when first eligible, you may face a late enrollment penalty later.

The “alphabet soup” of Medicare can feel overwhelming at first, but breaking it into Parts A, B, C, and D makes it easier to understand. In upcoming posts, I’ll dive deeper into how these pieces fit together so you can see which options may work for you.

Reference:
Medicare.gov – Learn About Medicare

Here’s what you need to know:

Your Filing Options

• Early (as early as age 62): You can claim benefits before your “full retirement age,” but your monthly check will be reduced permanently.

• At Full Retirement Age (FRA): FRA is based on the year you were born (for most people retiring now, it’s between 66 and 67). Filing at this age means you’ll receive 100% of your benefit.

• Delayed (up to age 70): For each year you delay past FRA, your benefit grows—up to 8% more per year. After 70, there’s no further increase.

How Social Security Ties Into Health Coverage

• If you file for Social Security at or after 65, you’re automatically enrolled in Medicare Part A and Part B (unless you actively decline Part B).

• If you delay Social Security, you’ll need to apply for Medicare separately at 65 (or later if you’re still working with creditable coverage).

• The timing of these decisions matters—both for your retirement income and avoiding any gaps in health insurance.

Key Considerations

• Do you need the income now, or can you afford to wait for a larger benefit?

• Are you still working, and does your employer offer health coverage?

• How does your spouse’s retirement timing affect your decision?

There’s no one-size-fits-all answer to “When should I file?” It depends on your personal finances, health, and retirement goals. The key is to understand your options so you can make the decision that fits your situation best.

Reference:
SSA.gov – Retirement Benefits

When to Enroll:

• If you retire at 65: You’ll use your Initial Enrollment Period (IEP). This is a 7-month window that starts 3 months before your 65th birthday, includes the month you turn 65, and ends 3 months after.

• If you delay retirement past 65 and keep employer coverage: You’ll use a Special Enrollment Period (SEP) when you retire. This SEP gives you 8 months after your employer coverage ends to sign up for Medicare Part A and Part B without penalty, as long as your employer coverage was considered creditable.

How to Enroll:

What You’ll Need

• Your Social Security number

• Proof of employment and health insurance coverage (for those using a Special Enrollment Period)

• Employer forms (such as CMS-L564) to verify creditable coverage

Avoiding Penalties

• If you don’t sign up for Part B within your 8-month Special Enrollment Period after employer coverage ends, you could face a late enrollment penalty.

• To avoid this, it’s important to know your deadlines and plan ahead.

Retirement is a big milestone, and making sure your Medicare is in place is an important step in the process. Whether you enroll at 65 or later during a Special Enrollment Period, the key is knowing your timeline and gathering the right documents. Reference: SSA.gov – When to Sign Up for Medicare

Reference:
SSA.gov – When to Sign Up for Medicare

Key Scenarios:

If your employer has fewer than 20 employees:

Medicare generally becomes your primary coverage at age 65. In most cases, you’ll need to enroll in both Medicare Part A and Part B, even if you’re still working.

If your employer has 20 or more employees:

You may be able to delay enrolling in Medicare Part B without penalty, as long as your group health plan is considered creditable coverage. You can also choose to enroll in Part A only, since most people qualify for it without a monthly premium.

Everyone’s situation is different. It’s important to compare your employer plan with Medicare to see which offers the best value and coverage for your needs.

A licensed, independent insurance agent can help you review:

• Monthly premiums

• Coverage details

• Out-of-pocket costs

• Prescription drug coverage

And if you’re covered by employer insurance that meets Medicare’s standards, there’s no late enrollment penalty when you sign up later. It’s always good to double-check this before delaying enrollment.

You also have the option to only sign up for Medicare Part A which generally helps cover hospital stays, limited home health care, the first 20 days of skilled nursing care, and hospice. If you enroll in Part A while still working, it usually acts as secondary coverage to your employer plan.

Turning 65 doesn't always mean you have to retire—or enroll in full Medicare coverage right away. The right choice depends on your employer size, your current insurance, and your personal situation.

In my next post, I’ll cover what to do when you do retire - including how and when to enroll.

Reference:
SSA.gov – When to Sign Up for Medicare