Explain Medicare & Supplement Insurance at Age 65

Medicare is a national health insurance program that was started in the United States in 1965. Medicare was designed primarily for people 65 years of age or older, and the vast majority of those who use it fall into this category. People under 65 may also enroll in Medicare if they have certain health conditions, however. Medicare for those 65 or older comes with its own set of rules, but also offers more choices than that for users younger than 65.

Original Medicare Premiums

• Original Medicare Part A is free of monthly premiums if you are 65 years of age or older and have paid Medicare taxes for 40 quarters, or 10 years. You must also be a citizen or legal resident of the U.S. People who are 65 or older and who also get retirement benefits from the Railroad Retirement Board or Social Security also qualify for premium-free Part A, as do those who are eligible for Social Security but haven't yet filed, or individuals and their spouses who had government employment that covered Medicare. Everyone must pay a monthly premium for Part B, but people who have their premiums withheld from their Social Security benefits can often avoid an increase in rates.

Original Medicare Enrollment

• If you 65 or older and are already receiving Social Security benefits, you will automatically be enrolled in Medicare Part A and Part B when you turn 65. If not, you will have to enroll yourself when your 65th birthday approaches. You can sign up for Medicare three months before the month you turn 65, your birthday month and for three months afterwards, totaling an initial enrollment period of seven months. The earlier you enroll, the earlier your Part B benefits begin.

Medicare Advantage and Part D Medicare

• Medicare Advantage plans allow Medicare beneficiaries to combine their Part A and Part B benefits with additional coverage for hearing, dental, prescription drugs and/or vision. Medicare Advantage plans are not sold by the federal government, but are instead offered by private health insurance companies. The individual companies are free to decide their own extra benefits, but must offer all of the same Part A and B benefits as original Medicare, except for hospice, which is covered by original Medicare whether or not you decide to buy an Medicare Advantage plan. Part D Medicare offers benefits only for prescription drug coverage and is also sold by private companies, either bundled with Medicare Advantage or as a stand-alone plan. The initial enrollment period for Medicare Advantage and Part D is the same as that for original Medicare.

Medigap

• Medicare beneficiaries who are 65 or older may also purchase supplemental Medicare policies, often called Medigap. Medigap in most states cannot be bought by beneficiaries under the age of 65. Medigap policies have standardized benefits, which are the same no matter from which company you buy them from. Medigap plan benefits include coverage of the Part A and B deductibles, coverage of Part A and B copays, the coinsurance for skilled nursing facility care and hospice, and coverage for medical emergencies that happen outside the United States. Twelve standardized Medigap policies were available as of 2011, but not all states allow all plans to be sold. You must already have original Medicare Part A and B before you can enroll in a Medigap plan.