When Should I Begin Thinking About Medicare?

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The Medicare eligibility age is typically age 65, however, you may begin receiving information about enrollment into Medicare as early as age 55. While this can feel much too early, it can be important to review and plan your retirement, financials, and health insurance coverage early and often. Typically, people begin truly researching the Medicare enrollment process the year before they first become eligible for Medicare or if they are under 65 and have a disability. There is a 7-month period that people are eligible to join Medicare, the 3 months before the month you turn 65, the month you turn 65, and 3 months after the month you turn 65. However, you may be eligible for Medicare if you are under the age of 65 with a disability and you have been collecting disability benefits from Social Security for at least 24 months.

senior couple enjoying a fall walk

Two Main Ways to Have Medicare Coverage

Original Medicare: Original Medicare has 2 parts, Part A (Hospital Insurance) and Part B (Medical Insurance).

  • Part A (Hospital Insurance) – This coverage can help cover inpatient hospital care, skilled nursing care, hospice care, and other home health care options.
  • Part B (Medical Insurance) – This coverage can help cover services provided by doctors, primary care providers and other health care providers in an outpatient setting.

Medicare coverage works similarly to most individual or employer sponsored health insurance plans. You pay a deductible, Medicare pays its share of the approved amount, and you pay your coinsurance.

If you are interested in additional coverage to lower your cost sharing, you may be able to add a supplemental plan. A common supplemental plan is Medicare part D. Medicare part D can help with prescription drug coverage. There are a variety of different types of part D plans in the market. Another benefit of Medicare supplement plans is that a variety of carriers offer supplement plans, so you can research and join the plan that works best for you.

One of the biggest advantages about Original Medicare is that you can use any doctor or hospital that accepts Medicare anywhere in the U.S. Additionally, you typically do not need a referral to see a specialist.

Medicare Advantage: As an alternative to Original Medicare, Medicare Advantage plans are health plans offered by a private company contracted with Medicare. These plans include Part A, Part B and usually Part D Medicare drug coverage. These plans typically offer additional benefits Original Medicare does not offer. However, unlike Original Medicare, in most cases you can only use providers that are in the plan’s network. Alternatively, you may be able to use providers outside of the network for a higher cost share.

elderly woman spending time with her grandchild

Nuances to Medicare Enrollment

If you choose to enroll in an Original Medicare plan or a Medicare Advantage plan, there are a few nuances to the enrollment process that you should be aware of. Nuances may include but are not limited to the below.

  • You typically must be enrolled in both Medicare Part A and Part B to enroll in a Medicare Supplement Plan or a Medicare Advantage Plan.
  • You normally cannot enroll in both a Medicare Supplement Plan and a Medicare Advantage Plan.
  • You usually must be enrolled in Part A and eligible for Part B to enroll in a Medicare Part D plan.

Turning 65 And Continuing to Work? Should I Stay on My Group Plan or Switch to Medicare?

Anyone turning 65 and continuing to work should consider their Medicare options. Medicare supplement plans, Medicare Advantage Plans, Medicare Prescription Drug Plans and Original Medicare are all individual plans. The individual considering their options must have their healthcare wants, needs and medications assessed to decide on whether or not they should stay on their group coverage or switch to Medicare coverage while continuing to work. The individual could end up saving money while increasing their coverage or vice versa depending on their current employer sponsored coverage.

What To Consider When Assessing Medicare vs. Group Coverage When Turning 65 And Continuing to Work

  • What did I spend on healthcare last year? Copays, Coinsurances, and premium.
  • What will my monthly Part B premium be if I choose to enroll in Medicare?
  • Do I want a Supplement Plan or a Medicare Advantage Plan? What will the monthly premium be of the plan I am interested in?
  • If I chose a Supplement Plan, what Prescription Drug Coverage Plan am I interested in? What is the premium?
  • Combine monthly Part B premium, Medicare Advantage OR Supplement, Medicare Prescription Drug Coverage Premium (only applicable if individual chose a supplement plan).
  • Is this monthly cost less than what you were spending on group coverage monthly cost?

If the monthly cost to switch to Medicare is more expensive than the monthly cost of the group coverage, this does not always mean the individual should not make the change. The individual should now review healthcare spending in a year based on services rendered. For example, a knee replacement on a Medicare Advantage plan is a flat, low copayment often with no deductible. The coverage on Medicare Advantage plans and Medicare Supplement Plans must be considered after assessing monthly cost on Part B premium and plan premium. If you choose to stay with group coverage when eligible for Medicare, there may be steps you should take to make the enrollment process smoother when the time does come.

senior man looking at paperwork and signing

Medicare Quotes

At Cross Insurance we have a team specializing in Medicare. Our experienced professionals may be able to assess your current coverages and compare them to individual Medicare options in the marketplace. With access to various carriers throughout New England, we have the resources and knowledge to assist current and new clients in making an informed decision to best suit their needs. To find out more, request a quote here today.

Cross Insurance is a private company that is not Medicare, Medicaid, or MaineCare and is not a governmental agency.



This article is for general informational purposes only and is not to be relied upon or used for any particular purpose. Cross Insurance shall not be held responsible in any way for, and specifically disclaims any liability arising out of or in any way connected to, reliance on or use of any of the information contained in this article. The information contained or referenced in this article is not intended to constitute and should not be considered legal, insurance, accounting or other professional advice, nor shall it serve as a substitute for the recipient obtaining such advice. The views expressed in this article are that of its author and do not necessarily represent the views of Cross Financial Corp. and its subsidiaries and affiliates (“Cross Insurance”) or Cross Insurance’s management or shareholders.


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