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Senior couple at home reviewing documents for application for Medicare at 64.

What You Need to Know About Medicare at 64

Medicare is a federal health insurance program for people aged 65 and over. If you’re nearing Medicare eligibility, it’s important to understand the basics of the program so that you can make the most of your benefits. You can also purchase supplemental insurance to help cover costs not covered by Medicare.

Also, keep in mind that Medicare benefits are not free—you will have to pay premiums, deductibles, and copayments. But with careful planning, Medicare can help you maintain your health and financial security in retirement. Getting the right Medicare insurance can be overwhelming, but the good news is that The Medicare Family will take you through the process.

Here’s what you need to know about Medicare at 64.

Parts of Medicare

Parts of MEDICARE Concept with icons and signs - Medicare at 64

Since its inception in 1966, Medicare health coverage has benefited elderly Americans aged 65 and above and consists of the following Parts.

Part A: Hospital Insurance

Part A covers in-patient care in the hospital. It covers home health, hospice, skilled nursing facility, and nursing home care. Your monthly Medicare cost will be $0 if you’ve worked for ten years as an American citizen and have been paying into FICA (Federal Insurance Contributions Act) through your payroll taxes.

Part B: Medical Insurance

Part B covers outpatient procedures such as doctor visits, x-rays, lab tests, emergency room visits, and durable medical equipment. Part B’s minimum monthly cost is $164.90 (2023). Please note that the amount tends to rise by a certain percentage yearly.

You should be automatically enrolled in Part B of Medicare if you’re a social security beneficiary. You should also receive official documentation at your address three months before you turn 65.

Part C: Medicare Advantage

Private insurance companies offer Part C as another option to parts A and B. Medicare Advantage is gaining popularity due to the low monthly premiums. However, there may be co-pays and network requirements for the providers you’ll be using.

Medicare Advantage should be an ideal plan for you if you’re not planning to spend much on a supplement plan, don’t travel much, and are in generally good health.

Types of Medicare Advantage Plans

There are a variety of Medicare Advantage plans available. Some plans are more flexible than others, depending on your network provider. Some of the popular types of Medicare Advantage plans include:

  • Medicare Advantage PPO Plans: Most of the PPO plans don’t require a referral to see a specialist and cost more for out-of-network coverage   
  • Medicare Advantage HMO Plans: HMOs use providers in a closed network that you use to get your health care. Additionally, a referral from your primary care doctor will be required to see a specialist.

Part D: Drug Coverage

Part D covers prescription drugs. It’s a crucial aspect of health coverage as most senior citizens use some prescription medication. Ensure you have creditable drug coverage to avoid Medicare penalties.

Monthly plans for drug coverage range from $7 to over $100. Before you sign up for any plan, factor in your expected health conditions and compare out-of-pocket costs to choose the one that best suits you.

When to Sign Up for Medicare

A concept of applying for Medicare at 64 - Approved Medicare forms spread on a table.

Ideally, you should sign up for Medicare benefits three months before turning 65, hence the coined “Medicare at 64.” The Medicare initial enrollment period (IEP) begins three months before your 65th birthday and proceeds for the next three months, running for a total of seven months.

When the enrollment period expires, you can incur penalties that negatively affect your Medicare coverage if you have not enrolled. To avoid the penalties, ensure you sign up within the seven-month window surrounding your 65th birthday.

The burden of illness can quickly become a hardship situation for the elderly. One in every five senior American citizens is prone to unexpected medical expenses due to illness. Medicare coverage contributes to your ability to handle these problems as it will cover some of those costs. For this reason, you want to sign up in a timely fashion and understand all the other options available during these enrollment periods.

What Else Do You Need to Know?

Get Ready for the Spam

Medicare can be confusing, and one thing that can make it even more confusing is the explosion of spam calls and junk mail you will begin to receive as you approach age 65. Never provide your Social Security number, credit card information, or personally identifiable information to these unsolicited inquiries.

It can be overwhelming, but working with The Medicare Family, a trusted broker will help you navigate your Medicare choices.

When to Stop Contributing to Your HSA

If you’re enrolled in a high-deductible health plan (HDHP), you may open a health savings account (HSA). An HSA is a special tax-advantaged account that you can use to save for healthcare expenses. You can only contribute pre-tax dollars to your HSA if enrolled in a high-deductible health plan (HDHP), and you cannot have any other form of insurance – including Medicare.

You will pay tax penalties if your Medicare enrollment and HSA contributions overlap. For this reason, the IRS and Medicare recommend that you stop funding your HSA six months before enrolling in Medicare to avoid penalties.

Medigap Policy Eligibility

Medigap policies are supplemental insurance policies that can help cover Medicare deductibles and co-insurance costs. The preferred time to purchase a Medigap policy is within the first six months after enrolling in Medicare Part B. 

This six-month period starts the first day of the month in which you enroll in Part B. During that time, insurers are required to offer you all the Medigap policies available in your area with no health questions asked. 

After that period, Medigap insurers can charge you higher premiums or reject your application because of pre-existing medical conditions.

Enroll in Medicare Today

Prepare for the start of a new medical financial chapter by learning what you need to know about Medicare at 64. Avoid penalties and get the best rates for your health and financial circumstances.
Since the 1980s, we’ve been at the forefront of helping senior citizens navigate Medicare. Start by watching our Medicare Basics video and then contact The Medicare Family to learn more, and our experts will take you through every aspect of enrollment and eligibility.

Sylvia Gordon, aka Medicare Mama®, is an expert on all things Medicare and Social Security. She is the 2nd Generation here at The Medicare Family and has served on the advisory boards of major insurance companies like UnitedHealthcare®, Cigna, and Anthem. In her free time, she can be found taking care of her animals (dogs, goats, peacocks, chickens), and reading a good book. Learn More.
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