Medicare: What You Need to Know About Turning 65

Posted by Heather Woodruff, Client Executive, Specialty Services Division on March 30, 2015 at 10:00 AM

Blowing out 65 candles on your birthday cake means more than just getting a senior discount at the movies. For many of my clients it means deciding whether to stay on their group health plan or switch to Medicare. As a Client Executive, I have the opportunity to help individuals navigate through their options. Over the years, there are two questions I am often asked by clients as they reach 65.

Question 1: I’m enrolled in a group health plan and turning 65. Do I need to enroll in Medicare?

No. According to Medicare guidelines, you may continue on your group health plan if you or your spouse is working and on the group health plan that is associated with that employment.

Seniorandnurse-1 Question 2: I’m retiring at the end of the year, enrolled in a group health plan and am over 65 years old. When do I apply for Medicare?

It is best to apply for Medicare 3 months before retirement. Because you have been on a group health plan, you will not be penalized. Once you have Medicare and supplemental coverage, this will allow you to come off your group health plan outside of Open Enrollment.

Plan Considerations

If you are turning 65 and you continue to be an active employee, we recommend that you consider your options regarding your healthcare plan. Sometimes it is less expensive to join a Medicare plan than remain on the current employer-provided group plan. Every situation is different, so it’s a matter of looking at cost, preferences and your personal needs.

There are two major things to consider when deciding to enroll in Medicare or stay on your group health plan:

  1. Prescriptions. If you take a lot of prescriptions, you’re better off on a group plan. With Medicare, there is a gap in coverage when it comes to prescriptions and depending on the brands or type of prescriptions you have, you may have to pay out of pocket for your medications.  
  2. Network. With Medicare, there is no network, so you can visit any doctor that takes Medicare. Some people decide to enroll in Medicare along with supplemental coverage because they are not happy with the current providers that their group health plan offers.

While enrolling in Medicare may be cost effective for one person, it might also be more expensive for another. It’s important to evaluate your particular situation so that you not only get the best price but the right care, so that you keep on blowing out birthday candles for many, many years to come.

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Topics: Employee Benefits, Individuals

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