Turning 65: Is Medicare Or Health Insurance Through Work A Better Option?

July 05, 2023

By Chase Kunkel

Franciscan Insurance Services

When you turn 65 and are still working, you have several options for your medical insurance coverage. If you have creditable coverage through an employer, you have several decisions to make.

Which plan to enroll into?
Do you enroll into a Medicare Advantage plan?
Do you enroll into a Medigap plan?
Do you just keep original Medicare and pick up a drug plan?

The answer depends on each person.

You can keep your employer plan and enroll into original Medicare.
You can keep your employer plan and defer original Medicare.
Or you can leave your employer plan and enroll into Medicare and look at your options, such as enrolling into an Medicare Advantage plan, or enrolling into a supplemental plan.

The ABCs Of Medicare

Medicare is the federal health insurance program for individuals who are over 65, and individuals under 65 with certain disabilities. When it comes to Medicare, there are four parts, often referred to as the ABCs of Medicare.

The four parts of Medicare are part A, part B, part C and part D.

Medicare Part A covers inpatient hospital care.
Medicare Part B covers medical coverage, such as some outpatient medications, labs, physical therapy, or physician payments.
Medicare part C, also known as a Medicare Advantage plan, is offered by private insurance companies. Medicare Part C replaces original Medicare benefits, and often times it has options above and beyond what original Medicare offers, such as vision and dental coverage.
Medicare part D is your prescription drug coverage. Medicare Part D plans are also offered by private insurance companies.

When To Sign Up For Medicare Plans

When you're first eligible for Medicare, you have a seven-month window when you can enroll into Medicare. This window starts three months before your birth month when you turn 65, and lasts three months after your birth month. That's when you can enroll into your part B, which is your medical coverage. You can enroll into part C, also known as an Advantage plan. And you can enroll into part D which is known as a drug plan.

When you're first eligible for Medicare, you have several options to consider. When you turn 65, you have the option of enrolling in original Medicare or a Medicare Advantage plan.

You can enroll into original Medicare, and you can also enroll in a Medigap plan, also known as a supplement plan, and choose a drug plan.
You have the option to enroll into a Medicare Advantage plan, which may have prescription drugs included as part of the insurance coverage.

What Is A Medicare Advantage Plan?

A Medicare Advantage plan is also known as part C, and sometimes it's referred to as a replacement plan. These Medicare plans are offered by private insurance companies. These plans typically have a premium and they have co-payments associated with them, but one of the most important things to know about these plans is that they have networks.

What Is A Medicare Supplemental Plan?

When you have a supplemental plan, you would have original Medicare and your supplement plan, which is helping pay the cost of original Medicare. When you have an Advantage plan, you just have that one Advantage card that you'd give to your healthcare provider, and that would be your Medicare benefits.

Can You Sign Up For Medicare Part D At Any Time?

If you do not enroll into a part D plan when you are first eligible and do not have credible drug coverage, if you later decide to enroll into a part D plan, you may have to pay a penalty. There may be a late enrollment penalty when you do enroll into one of these plans. The amount of the late enrollment penalty is based on how long you went from when you were first eligible for a part D plan without a credible drug plan, into actually enrolling into the part D plan.

The second reason why you may want to enroll into part D plan is that there are only certain times of the year in which you can enroll into these plans. So, even if you are not currently on medications, if you are later prescribed one by your physician, you may not have coverage until the enrollment period.

Is There A Penalty For Not Signing Up For Medicare?

If you do not have creditable health coverage, typically offered through an employer, you may want to enroll into Medicare when you turn 65 because not doing so, there may be penalties in the future. When you're first eligible for Medicare, and you decide not to enroll into a part D plan, there may be a penalty if you do not have creditable coverage. If you delay your enrollment into part B, or part D, there may be penalties associated with that if you do not have creditable coverage, which is typically coverage through an employer plan.

Franciscan Insurance Services assists seniors with Medicare insurance enrollment, including advice on their Medicare options. For more information, call: