Turning 65 Medicare Checklist
If you are approaching your 65th birthday, planning ahead can help prevent enrollment mistakes, coverage gaps, and unnecessary penalties.
Approximately 4–6 Months Before Turning 65
Determine how you currently receive health insurance.
Ask:
Am I insured through my own current employer?
Am I insured through my spouse's current employer?
Is this actually active employer group health coverage?
Is it retiree insurance?
Is it COBRA?
Is it Marketplace coverage?
Do I have VA or TRICARE coverage?
How many employees does the employer have?
Will my employer coverage continue after I turn 65?
Do not automatically assume that having insurance means you should delay Medicare.
Ask your employer benefits department how the plan coordinates with Medicare.
You want to determine:
Who will pay first after I turn 65, Medicare or my employer insurance?
For beneficiaries age 65 or older covered through current employment, employer size can be extremely important.
Current employer coverage and employer has 20 or more employees, employer group plan pays first.
Current employer coverage and employer has fewer than 20 employees, Medicare pays first.
Retiree coverage, Medicare pays first.
COBRA after employment ends, Medicare generally becomes important; COBRA does not extend the Part B employer SEP
Generally:Special rules and exceptions exist, including multi-employer plans, so beneficiaries should confirm their exact situation with their employer benefits administrator and Medicare when appropriate.
Determine whether your prescription coverage is creditable.
Ask your employer whether your prescription drug coverage is creditable coverage for Medicare Part D.
Creditable drug coverage generally means the coverage is expected to pay, on average, at least as much as standard Medicare prescription drug coverage.
Keep your employer's annual Notice of Creditable Coverage.
You may need this notice later to demonstrate that you maintained qualifying prescription coverage.
Consider whether you contribute to an HSA.
This is extremely important.
Once you are enrolled in Medicare, you generally may no longer contribute to a Health Savings Account.
In addition, if you enroll in premium-free Part A after age 65, Part A may be retroactive for as many as six months, but not earlier than the first month you were eligible for Medicare.
Someone continuing HSA contributions after age 65 should therefore carefully coordinate the timing of Medicare enrollment and HSA contributions.
Consider discussing your HSA contribution timeline with:
Your employer benefits administrator
Medicare or Social Security
A qualified tax professional
Approximately 3 Months Before Turning 65
Your Medicare Initial Enrollment Period has begun.
Determine whether Medicare enrollment will be automatic.
Ask:
Am I already receiving Social Security retirement benefits?
If you have been receiving Social Security retirement benefits at least four months before turning 65, you generally will be automatically enrolled in Part A and Part B.
If you are not receiving Social Security, Medicare enrollment generally is not automatic, and you may need to apply through Social Security.
Review your doctors.
Make a list of:
Primary care physician
Cardiologist
Oncologist
Endocrinologist
Neurologist
Gastroenterologist
Orthopedist
Ophthalmologist
Other specialists
Hospitals and healthcare systems you prefer
Provider access can be an important consideration when deciding between Original Medicare and Medicare Advantage or when comparing Medicare Advantage plans.
Review your prescriptions.
Make a complete medication list including:
Medication name
Dosage
Frequency
Preferred pharmacy
Prescription formularies and pharmacy pricing can vary substantially between plans.
Consider your preferred Medicare coverage structure.
Ask yourself whether you want to explore:
Original Medicare + Part D + potentially Medigap
or
Medicare Advantage
Compare the entire healthcare structure, not simply one benefit or premium.
Understand your Medigap enrollment rights.
If you plan to choose Original Medicare and are interested in Medicare Supplement coverage, understand when your six-month federal Medigap Open Enrollment Period begins.
This period generally does not repeat annually.
Before Your Medicare Coverage Starts
Verify:
Medicare Part A effective date
Medicare Part B effective date
Medicare card received
Medicare Beneficiary Identifier is correct
Prescription coverage is arranged
Medicare Advantage or Medigap decision has been made, if applicable
Doctors have been reviewed
Specialists have been reviewed
Hospitals have been reviewed
Prescriptions have been reviewed
Pharmacy has been reviewed
Employer benefits department has been notified if appropriate
HSA contributions have been addressed if applicable
Premium payment method has been confirmed