Starting Medicare: What You Need to Know Before Enrolling

Are you turning 65 soon? Or are you considering a switch from employer insurance to Medicare? Getting started with Medicare can feel overwhelming. However, understanding your options and timing can make the process much smoother. Here’s a complete guide for anyone new to Medicare, designed to answer your biggest questions and help you make confident choices.

Who Should Apply for Medicare?

Medicare is primarily for individuals who are:

• Turning 65

• Under 65 with certain disabilities

• Diagnosed with ALS (Amyotrophic Lateral Sclerosis) or End-Stage Renal Disease

  
  

Most people become eligible for Medicare at age 65. If you’re already receiving Social Security benefits at least four months before your 65th birthday, you’ll be enrolled in Medicare Parts A and B automatically. If not, you’ll need to sign up yourself.

When Should You Apply for Medicare?

Timing matters! Here are the key enrollment periods.

Initial Enrollment Period (IEP)

• Starts: 3 months before your 65th birthday

• Ends: 3 months after your birthday month

• Total window: 7 months

  
  

Enrolling during your IEP ensures you avoid late penalties and have continuous coverage.

Special Enrollment Period (SEP)

If you (or your spouse) are still working and covered by an employer health plan, you may delay Medicare without penalty. When that coverage ends, you’ll have an 8-month SEP to enroll in Medicare.

General Enrollment Period (GEP)

• When: January 1 – March 31 each year

• Coverage starts: July 1

  
  

If you miss your IEP and don’t qualify for a SEP, you can enroll during the GEP, but you may face late penalties.

Medicare Basics: What Does It Cover?

Medicare is divided into several parts:

Part A: Hospital Insurance

• Covers inpatient hospital stays, skilled nursing care, hospice, and some home health services.

• Usually premium-free if you or your spouse paid Medicare taxes for at least 10 years.

  
  

Part B: Medical Insurance

• Covers doctor visits, outpatient care, preventive services, and some home health care.

• Monthly premium required.

  
  

Part C: Medicare Advantage

• Offered by private insurers, these plans bundle Parts A and B (and often Part D).

• May include extra benefits like dental, vision, and hearing.

  
  

Part D: Prescription Drug Coverage

• Helps pay for prescription medications.

• Offered through private insurers.

  
  

Medicare Supplement (Medigap)

Optional policies that help cover out-of-pocket costs (like deductibles and copays) not paid by Original Medicare.

Should You Drop Employer Group Coverage for Medicare?

If you’re still working at 65, you have a choice: keep your employer group coverage or switch to Medicare. Here are some pros and cons to consider:

Pros of Switching to Medicare

• Potentially lower premiums: Especially if your employer plan is costly.

• Comprehensive coverage: Medicare Advantage or Medigap can fill gaps in Original Medicare.

• No network restrictions: Original Medicare lets you see any provider that accepts Medicare.

• Avoid late penalties: Enrolling on time prevents costly penalties later.

  
  

Cons of Leaving Group Coverage

• Loss of family coverage: Medicare is individual; dependents might lose coverage if you leave your group plan.

• Prescription costs: Medicare Part D may differ from your employer plan’s drug coverage.

• Coverage differences: Some employer plans offer benefits that Medicare doesn’t, like certain dental or vision services.

  
  

Tip: Always compare your employer plan’s costs and coverage to Medicare options before making a switch. If your employer has fewer than 20 employees, Medicare usually becomes your primary insurance at 65.

Frequently Asked Questions About Starting Medicare

Q. When am I eligible for Medicare?

A. Most people become eligible for Medicare when they turn 65. You may also qualify earlier if you have certain disabilities or specific medical conditions like ALS or End-Stage Renal Disease.

Q. Do I need to sign up for Medicare if I’m still working?

A. If you have health coverage through your or your spouse’s employer, you may be able to delay Medicare enrollment without penalty. However, it’s important to compare your employer plan and Medicare to decide what’s best for you.

Q. What happens if I miss my Initial Enrollment Period?

A. If you miss your Initial Enrollment Period, you can sign up during the General Enrollment Period (Jan 1–Mar 31), but you might face late enrollment penalties and a gap in coverage.

Q. What’s the difference between Original Medicare and Medicare Advantage?

A. Original Medicare includes Part A (hospital) and Part B (medical) coverage. Medicare Advantage (Part C) is offered by private insurers and often includes extra benefits like dental, vision, and prescription drugs.

Q. Is prescription drug coverage included in Medicare?

A. Prescription drug coverage is available through Medicare Part D, which you can add to Original Medicare or receive through many Medicare Advantage plans.

Q. Can my spouse or dependents be covered under my Medicare plan?

A. No, Medicare is individual coverage. Your spouse and dependents will need their own separate coverage.

Q. Will I lose my employer coverage if I enroll in Medicare?

A. Not necessarily. Some people keep both Medicare and employer coverage, but your employer plan may change once you’re eligible for Medicare. Always check with your benefits administrator.

Q. Are there penalties for enrolling late?

A. Yes. If you delay enrolling in Part B or Part D without other qualifying coverage, you may have to pay a late enrollment penalty.

Q. Can I change my Medicare plan later?

A. Yes, you can review and change your Medicare coverage during the Annual Enrollment Period (Oct 15–Dec 7) or if you qualify for a Special Enrollment Period.

Q. How can I get help choosing the right Medicare plan?

A. You can get unbiased, personalized help from E-Advise Insurance. We offer real quotes online and direct support from a licensed agent—no robocalls, just real answers.

Understanding the Importance of Comparison

When it comes to Medicare, it's crucial to understand your available options. Many people are unsure whether to stick with their employer's health plan or transition to Medicare. Each option carries its own benefits and drawbacks.

Review your health needs. For instance, if you regularly see specialists or require certain medications, consider a plan that provides comprehensive coverage. Understanding your health situation can help you make informed decisions.

Look Out for Hidden Benefits

Some people are not aware that Medicare has additional benefits they might be interested in. Programs that offer wellness visits, preventive services, and even some alternatives like telehealth options can be important considerations.

Final Thoughts: Making the Right Medicare Choice

Starting Medicare is a big step, but you don’t have to do it alone. Review your options early, compare plans, and ask questions. Whether you choose Original Medicare, Medicare Advantage, or stay with your employer plan for now, the right choice depends on your health needs, budget, and future goals.

Still have questions? E-Advise Insurance offers unbiased guidance and actual quotes online—no robocalls, just real help from a licensed agent. Ready to explore your Medicare options? Contact us or call 855-855-8301 for personal support.