Turning 65? 5 Medicare Decisions You Need to Make

Turning 65 comes with a surprising amount of Medicare mail. And unfortunately, most of it makes Medicare seem much more complicated than it needs to be. The good news? You don't need to understand every Medicare rule. But there are five decisions you really do need to get right. Let's make them simple.

First: When do you actually need to enroll? For most people, Medicare gives you a seven-month Initial Enrollment Period around your 65th birthday. It begins three months before the month you turn 65, includes your birthday month, and continues for three months afterward. But there's an important exception. If you or your spouse is still working and you're covered by a qualifying employer health plan, you may be able to delay Part B without a penalty. Don't just assume your current coverage qualifies. Ask your employer or benefits administrator before you turn 65.

Next comes one of the big decisions: Original Medicare or Medicare Advantage? And there isn't one right answer for everyone. Original Medicare includes Part A for hospital coverage and Part B for medical coverage. You can generally use any doctor or hospital nationwide that accepts Medicare. Medicare Advantage is offered by private insurers. These plans may bundle prescription coverage and additional benefits, but can also have provider networks and different rules and costs.

If you choose Original Medicare, there's another question: How will you handle the costs Medicare doesn't pay? That's why many people with Original Medicare consider Medicare Supplement insurance, or Medigap. When you're 65 or older and first enrolled in Part B, you generally get a six-month Medigap Open Enrollment Period. During that window, insurers generally can't deny you a Medigap policy because of health problems.

Even if you don't take prescription medications today, don't automatically ignore Part D. Going too long without Part D or other creditable drug coverage could mean a late-enrollment penalty later. If you're keeping employer coverage, ask whether its prescription coverage is considered creditable, and keep the documentation they send you.

And number five surprises a lot of people. If you contribute to a Health Savings Account, check the rules before enrolling in Medicare. Once you're enrolled in Medicare, you can no longer contribute to an HSA. And when you enroll after 65, Part A can sometimes be retroactive. So if you're working past 65 and contributing to an HSA, talk with your benefits or tax professional before enrolling.

So remember these five questions. When should I enroll? Original Medicare or Advantage? Do I need supplemental coverage? What about prescription drugs? And do I have an HSA to consider? Answer those five questions, and Medicare starts looking a whole lot less intimidating. I'm Margot, and this is Medicare in 3 Minutes from The Health Almanac.