Important: When to Enroll in Medicare
You can delay Medicare Part B past age 65 without penalty IF:
- You’re covered by an employer/union group health plan through active employment (yours or your spouse’s)
- This is called a Special Enrollment Period (SEP)
- Note: Small employers (20 or fewer employees) may require Medicare enrollment at 65
If you’re delaying enrollment, have HSA contributions, or have individual/family insurance, please read the CMS publication “Medicare and You” Section 1 at medicare.gov.
How to Apply for Medicare Part A & Part B
Application Process:
- Takes 3-6 weeks to process
- Apply up to 3 months before you want coverage to start
- Coverage starts the first day of the month you turn 65
Timeline Example: If your 65th birthday is June 15:
- Apply March 1 – May 31 → Coverage starts June 1
- Apply June 1 – September 30 → Coverage starts first of month after application
Apply here: ssa.gov/medicare
Note: If you’re already receiving Social Security benefits, you’ll automatically receive your Medicare card.
Your Medicare Coverage Options
After enrolling in Medicare Part A and Part B, you’ll choose additional coverage from the private insurance marketplace. Remember: You’ll always pay the federal Part B premium (starting at $203/month in 2026) regardless of which option you choose.
Option 1: Medicare Supplement + Part D Prescription Plan
Best for: Comprehensive coverage with provider flexibility
Chosen by: About 25% of clients
Key Features:
- No network restrictions – use any provider that accepts Medicare
- Guaranteed acceptance if you apply within 6 months of Part B start date
- Standardized plans – Plan G benefits are identical across all insurers
- No basic vision, dental, or hearing aid benefits
- Separate dental and hearing is available
Most Popular Plan:
- Plan G: 100% coverage after paying Part B annual deductible (~$290 in 2026)
Typical Monthly Costs:
- Part A: $0
- Part B: $203
- Medicare Supplement Plan G: ~$290
- Premiums increase an average of 4-6% per year, often outpacing inflation. In 2026, many plans saw increases near 20%.
- Part D Prescription: $0-$50
- Total: ~$490/month
Important: After 6 months on Part B, insurers can medically underwrite and refuse coverage. No annual open enrollment period.
Option 2: Medicare Advantage with Prescription Coverage
Best for: Lower premiums with managed care
Chosen by: About 75% of clients
Key Features:
- HMO or PPO networks – must use in-network providers (except emergencies)
- HMO: Primary care referrals required for specialists
- PPO: No referrals needed, plus out-of-network benefits
- No medical underwriting – guaranteed acceptance
- Includes vision, dental, and hearing aid benefits
PPO Plans Are Becoming Rare
PPO Medicare Advantage plans are increasingly hard to find. Many insurers have pulled them from the market, and availability is shrinking each year.
Cost Structure:
- Low premiums but copayments/coinsurance for services
- Plans can change benefits annually
- Pre-authorization required for many high-cost services
Sample Costs (example only):
- Primary care visit: $0
- Specialist visit: $55
- Emergency room: $130
- Hospital stay: $555/day (first 5 days)
- X-rays: $30
- Generic prescriptions: $0/month
- Brand name prescriptions: 15% coinsurance
- Chemotherapy/dialysis: 20% coinsurance
- Annual out-of-pocket limits: $6,700 medical, $2,100 prescription
Typical Monthly Costs:
- Part A: $0
- Part B: $203
- Medicare Advantage premium: $0-$100
- Total: ~$203/month
Important Enrollment Rules
Medicare Advantage
- Best time: Within 3 months of Part B start date
- Also during: Annual Enrollment Period (Oct 15 – Dec 7) for Jan 1 start
Medicare Supplement
- Guaranteed issue: Within 6 months of Part B start
- After 6 months: May require medical underwriting
Special “Trial Right” Protection
If you join Medicare Advantage when first eligible at 65, or switch from Medicare Supplement to Medicare Advantage for the first time, you have a one-year trial period to return to Medicare Supplement with guaranteed acceptance.
After one year on Medicare Advantage, switching to Medicare Supplement may require medical underwriting.
For more information, search “Trial Right” at medicare.gov.
Annual Changes
You can change Medicare Advantage or Part D prescription plans once yearly during the Annual Enrollment Period (October 15 – December 7) with no medical underwriting.
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