If you’re closing in on your 65th birthday you might be thinking about Medicare. Today in the U.S. there are over 62.6 million people enrolled in the federal program that has been providing health care coverage since 1965.
You can sign up for Medicare at age 65 or older if you meet the following qualification requirements:
- You are a citizen of the United States or a permanent legal resident who has lived in the country for at least five years.
- You are currently receiving Social Security or Railroad Retirement Board benefits, or you have worked enough and are eligible for retirement benefits but not currently receiving them.
- You or your spouse is an employee, or retiree, of the U.S. government and have paid Medicare taxes during employment.
Here’s a look at what Medicare benefits you can get if you sign up at age 65.
Original Medicare is divided into Part A which is hospital insurance, and Part B which is medical insurance.
Medicare Part A covers the following:
- Inpatient hospital care
- Skilled nursing facility care
- Nursing home care that isn’t custodial or long-term care
- Hospice care
- Home health care services
Medicare Part B covers medically necessary and preventive medical services which include the following:
- Visits to primary care physicians and specialists
- Laboratory tests and X-rays
- Emergency ambulance services
- Durable medical equipment
- Inpatient and outpatient mental health care services
- Preventive tests and vaccines such as flu, COVID-19, etc.
- Physical, occupational, and speech/language therapies
- Certain prescription drugs administered by a physician in an outpatient setting
Medicare Part D prescription drug coverage
If you enroll in Original Medicare Parts A and B at age 65 and you need additional coverage for prescription drugs, you can enroll in a stand-alone Medicare Part D plan. These plans are sold by private insurance companies that work with Medicare. All Part D plans are required to cover a range of prescription medications that are commonly taken by Medicare beneficiaries.
Every Part D plan provider has its own formulary (list of covered drugs). These drugs are categorized into tiers and carry different copay amounts. Generic drugs generally have the lowest copayment amount, and special brand-name drugs have higher copayments.
Medicare Advantage (Part C)
When you become eligible for Medicare benefits at age 65, you can enroll in a Medicare Advantage plan as an alternative to Original Medicare Parts A and B coverage. Medicare Part C plans are sold by private insurance companies that work with Medicare. Providers are required by law to provide all the same benefits that Original Medicare Parts A and B do. But they also have the option to provide additional benefits that aren’t included in Original Medicare.
Most Medicare Advantage plans include prescription drug coverage and the following extra benefits:
- Routine dental care like cleaning, extraction, X-rays, and dentures.
- Routine vision care like exams, eyeglasses, and contact lenses.
- Routine hearing care like examinations and hearing aids.
- Fitness club memberships
- Other benefits depending on the plan you enroll in.
Medicare Supplement insurance
Medicare Supplement, also known as Medigap, are supplemental insurance plans that can help you fill in the gaps left by Original Medicare benefits. These plans are sold by private insurance companies and are not available for those whose coverage is with Medicare Advantage.
There are ten standardized Medigap plans that help cover health care costs like copayments, coinsurance, and deductibles.
The best time to purchase a Medigap plan is when you first become eligible – during your six-month Medigap Initial Enrollment Period. Doing so can ensure that you get more plan options at better prices, and you can purchase a plan even if you have health issues. Your Medigap Initial Enrollment Period begins the first month that you have Medicare Part B and you are 65 years old or older.