Changing health insurance is never easy, but once Americans reach 65, we all have the same option: Medicare. While it is always best to consult with an insurance professional when considering health insurance changes, this overview will be a good place to start with what you need to know to transition from your current insurance to Medicare. One great thing about Medicare is that you can travel anywhere in the United States and be covered, as 98% of doctors take Medicare.
Because there are penalties associated with signing up late, it’s important to start thinking about Medicare when your 64th birthday rolls around. At Linden House Assisted Living and Memory Care, residents can use their Medicare Part D plans for medications and Part B for the physical, speech, and occupational therapy services offered onsite.
A short drive from Branchlands, The Center at Belvedere regularly offers free classes hosted by local insurance providers on the ins and outs of Medicare. You can also consult with them privately as a client.
Disclaimer: This blog is provided for educational and informational purposes only and does not constitute providing medical advice or professional services.
How to Get Started on Medicare
If you decide to start taking your Social Security benefits at age 65 or earlier, then you will automatically be signed up to get Medicare Part A (hospital insurance coverage) and Part B (medical insurance) on the first day of your birth month.
If you are choosing to delay your Social Security benefits until after age 65, you will need to sign up for Medicare through the Social Security Administration. You can do this either online or at your local Social Security office.
It’s important to know that you have a limited window of time in which to do this as you approach your 65th birthday: three months prior to your birthday month, the month itself, and three months after your birthday month.
What if I am still working at 65?
If your employer has 20 or more employees, then you can delay Medicare without penalty. But the special enrollment period works differently than if you enroll at 65: instead, it starts 90 days before your retirement date. Coming off the large employer group health plan, either voluntarily or involuntarily due to retirement, triggers a Special Enrollment Period to enroll in Medicare Parts A and B without penalties or gaps in coverage. Since Medicare only starts on the first of the month, it’s important to coordinate your coverage dates with your employer to ensure you don’t have any lapse in coverage.
It’s also important to have your employer fill out Medicare form CMS-L564 (“Request for Employment Information”) as you approach retirement. The form proves you had creditable coverage and prevents penalties for not enrolling in Medicare at age 65. Angela Windett is an independent broker at Steinlage Insurance Agency and frequent presenter at The Center on the subject of Medicare. She says, “I recommend having the appropriate Medicare forms, CMS-L564 and CMS-40B, completed 90 days before your planned retirement date to ensure a seamless transition into Medicare, avoiding gaps and penalties.”
Explaining the Parts of Medicare
Medicare Part A
Part A covers hospital visits. Part A has no fees if you paid into Medicare taxes for at least 10 years, but there is a deductible. As of 2025, the current deductible is $1,676 per 60-day occurrence. This means that every 60 days, your deductible resets and you will have to pay it again if you check in to the hospital beyond that 60-day window.
Medicare Part B
Part B is the standard medical coverage that you use for things like trips to the doctor’s office. Despite a common misconception that Medicare is free, there are fees associated with Part B. The monthly premium for Part B is $185 in 2025, plus the IRMAA (Income-Related Monthly Adjustment Amount) if your income is over a certain threshold. In addition, the current yearly deductible is $257.
Once you meet your deductibles, Medicare Parts A and B, also referred to as Original Medicare, cover around 80% of your hospital and medical coverage costs. Because many people prefer to have even greater coverage, there are further options that seniors can choose to help . Medicare Parts A and B do not cover prescriptions, dental, or vision care, so those are factors to take into consideration.
Medicare Part C (Medicare Advantage)
Part C is a Medicare-approved plan provided by a private insurance company. It’s also known as Medicare Advantage and usually combines Parts A, B, and D, but can also include vision, hearing, and dental insurance. You must sign up for Part A and B before you can sign up for Medicare Advantage. For more information on this program, see below.
Medicare Part D
Part D, or Medicare Drug Coverage, refers to prescription drug plans that can help cover your prescriptions. Although plans vary, they cannot have a deductible of more than $590. Once you meet that amount in the deductible phase, you then pay a maximum out of pocket of $2,000 in copays for medication coverage plans during the initial coverage phase.
Your copay will vary depending on what type of plan you have and the plan tier structure on each of your medications, but it will not exceed 25%. Once you reach that out-of-pocket maximum, prescriptions that are on your plan’s formulary are now 100% covered. You will pay nothing until January 1, when everything resets and you return to the deductible phase.
Income Related Monthly Adjustment Amount (IRMAA)
For Medicare Part B, most peo
ple will pay the standard premium, which is $185 a month as of June 2025. However, if your modified adjusted gross income from two years ago (2023 in this case) is over a certain amount, then a surcharge called the IRMAA is added to your premiums for Part B and Part D. For example, if a couple has a modified adjusted gross income between $212,000 and $266,000 when filing jointly in 2023, they will add $74 for Part B and $13.70 for Part D, for a new monthly premium of $272.70.
How Seniors Can Fill in Gaps of Their Medicare Coverage
Each year, you have the chance to reassess what plans would be best for you. The annual enrollment period to shop for Part D and Medicare Advantage plans is from October 15 to December 7. If you wish to drop Part C and move to Original Medicare with a supplement plan, January 1 to March 31 is the open enrollment period. Be aware that if you drop your Part C and move to Original Medicare, the supplement plan will require medical underwriting in most circumstances.
If you need assistance in making a decision, a professional insurance provider can walk you through these options and answer any questions you may have.
Medicare Supplement
Some seniors may not realize that they have options other than Part C (Medicare Advantage), but there is also the option of the Medicare Supplement, also known as a Medigap plan. These plans may have slightly higher premiums than the Medicare Advantage plan, but they also have benefits.
With a supplement plan, Medicare is the primary plan and the supplement is secondary. While there are several options, according to Windett with Steinlage Insurance Agency, Plan G has been the most popular option for those who turned 65 in 2020 or after as it covers all hospital and medical gaps in Original Medicare, aside from the Part B medical deductible of $257/year. If you turned 65 prior to 2020, Plan F offered the best coverage and picked up 100% of the hospital and medical gaps in Original Medicare.
Because plans change and new plans become available, you may opt to swap which supplement plan you are currently on. The good news is that you may do so at any time throughout the year, as these plans are not subject to the enrollment period restrictions. The downside of a supplement is that it will have a higher monthly premium ($100–$200/month on average in Central Virginia) than the Medicare Advantage Part C options, and this rate adjusts annually. You would also need to purchase a separate Part D drug plan (costing $0-$100 per month), as well as dental and vision policies if desired.
Medicare Advantage (Medicare Part C)
With this coverage option, you will need to maintain enrollment in Original Medicare Parts A and B when you enroll in a free-to-low-premium Medicare Advantage plan. Once enrolled in Medicare Advantage, the Advantage plan becomes your primary payor: you would show the Advantage plan card to all providers, whether medical, dental, vision, or the pharmacy. It’s important to make sure you select the correct Advantage plan each year to keep your providers in-network and avoid high out-of-pocket costs.
In addition to lower premiums, another benefit of this plan is that it includes dental, vision, and drug coverage. A downside is that there are copays and out-of-pocket costs for medical services, which range from $2,000 to $11,000+ a year, in addition to the $2,000/year drug cap. Plans can and will change each year, so it is important to review your coverage selection during the fall annual enrollment period.
Medicare Supplement and Medicare Advantage plans vary in the coverage they provide while traveling outside of the U.S. Most insurance providers recommend obtaining a separate policy for travel.
Tricare
If you are a veteran or retired military and are currently participating in a Tricare plan, then once you enroll in Medicare you will be automatically enrolled in Tricare for Life. Tricare for Life serves as a supplemental plan, with Medicare acting as the primary for those living in the U.S. For more information on how Medicare and Tricare work together, or make an appointment at your local Virginia Department of Veterans Services office.
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It’s never easy to navigate changes in health care, but you’re not alone, as millions of Americans sign up for Medicare every year, and there are professionals out there who can help you. Your health is one of your most valuable possessions as you age. Here at Branchlands, we aim to help you live life to the fullest in a community with a caring staff and friendly atmosphere. Because Branchlands offers independent living, assisted living, and memory care options, residents who experience changes in health or mental capacity can take advantage of our continuum of care. Reach out to us if you’d like more information about joining our community.
