Turning 65 is a major milestone, one that comes with new freedoms, opportunities, and yes, responsibilities. One of the most important decisions you’ll make around this time is how to handle your healthcare coverage through Medicare.
At Legacy From The Heart in Tulsa, Oklahoma, we know that navigating Medicare can feel overwhelming. As an independent insurance agency, we’re here to make the process easier, clearer, and more personal. If you’re approaching your 65th birthday, this guide is for you. Here’s what you need to know about Medicare and how to make sure you’re fully prepared to take advantage of your benefits.
What Is Medicare?
Medicare is a federal health insurance program for:
- People aged 65 and older
- People under 65 with certain disabilities
- People of any age with End-Stage Renal Disease (ESRD) or ALS
It helps cover a wide range of healthcare services, from hospital stays to doctor visits, prescription drugs, and more. But Medicare isn’t just one plan, it’s a system made up of different parts, and you need to understand how they work together to make the best choice for your situation.
The Parts of Medicare, Explained
When you first become eligible, you’ll be choosing between different parts of Medicare:
Part A – Hospital Insurance
- Covers inpatient care in hospitals
- Also includes skilled nursing facilities, hospice, and some home health care
- Most people don’t pay a premium for Part A if they or a spouse paid Medicare taxes for at least 10 years
Part B – Medical Insurance
- Covers doctor visits, outpatient care, preventive services, and durable medical equipment
- In 2025, the standard monthly premium is $174.70 (this may be higher if your income is above a certain amount)
- You’ll also pay an annual deductible and 20% coinsurance for most services
Part C – Medicare Advantage
- An all-in-one alternative to Original Medicare
- Offered by private insurance companies
- May include additional benefits like dental, vision, hearing, fitness programs, and prescription drug coverage
Part D – Prescription Drug Coverage
- Helps pay for the cost of prescription medications
- Plans vary by insurer and location
- You can add Part D to Original Medicare or enroll in a Medicare Advantage plan that includes drug coverage
Your Initial Enrollment Period (IEP)
Timing is everything when it comes to Medicare. If you’re approaching 65, your Initial Enrollment Period is a seven-month window that includes:
- Three months before your 65th birthday
- The month of your birthday
- Three months after your birthday
This is the ideal time to sign up. If you miss this window and don’t have other credible coverage (like from an employer), you could face late enrollment penalties and gaps in coverage.
Pro Tip from Legacy From The Heart:
Don’t wait until the last minute! Start exploring your options at least 3 months before your birthday month to ensure smooth enrollment.
Do You Need to Enroll in Medicare If You’re Still Working?
It depends on your situation.
- If you have health insurance through your employer and your employer has 20 or more employees, you may be able to delay enrolling in Part B without a penalty.
- However, many people still sign up for Part A at 65 since it’s usually free and doesn’t conflict with employer coverage.
- If your employer has fewer than 20 employees, Medicare usually becomes your primary insurance, and you should enroll in both Part A and Part B.
We can help you assess your work coverage and decide the best timing to enroll based on your unique needs.
Should You Choose Original Medicare or Medicare Advantage?
Once enrolled in Part A and B, you’ll have a big decision to make:
Option 1: Original Medicare (Parts A & B) + Optional Part D + Medigap
- Flexibility to see any doctor or specialist that accepts Medicare
- Add a Part D plan for prescription drugs
- Add a Medigap (Supplement) plan to help pay deductibles, coinsurance, and copayments
Option 2: Medicare Advantage (Part C)
- Combines Parts A & B (and often D) into one plan
- May include extra benefits like dental, vision, and hearing
- May have lower premiums, but provider networks may be more limited
Choosing between Original Medicare and Medicare Advantage is a personal decision. At Legacy From The Heart, we help you compare your options based on your health needs, preferred doctors, medications, and budget without pressure.
What Medicare Doesn’t Cover
Even with comprehensive coverage, Medicare doesn’t pay for everything. Some common services not covered include:
- Long-term care (nursing home or custodial care)
- Most dental care
- Eye exams related to prescribing glasses
- Hearing aids and exams
- Cosmetic surgery
- Routine foot care
Medicare Advantage plans may offer some of these benefits, or you may want to explore supplemental insurance options. We can help you fill in the gaps so you’re not caught off guard.
Watch Out for Medicare Penalties
Late enrollment penalties can add up over time and affect your premiums permanently:
- Part B Late Enrollment Penalty: An extra 10% for each full 12-month period you were eligible but didn’t sign up
- Part D Late Enrollment Penalty: 1% of the “national base beneficiary premium” multiplied by the number of months you were without creditable drug coverage
Avoid penalties by understanding your enrollment timeline and asking for help if you’re unsure!
How Legacy From The Heart Can Help
As an independent insurance agency, Legacy From The Heart is committed to guiding you through the Medicare maze with clarity and compassion. We’re not tied to one carrier, we work with multiple reputable providers to find a solution that fits you.
Here’s what we offer:
Personalized Medicare consultations
Side-by-side plan comparisons
Help understanding your enrollment options
Ongoing support if your needs or plans change
Our mission is to take the stress and confusion out of Medicare so you can enjoy your retirement with peace of mind.
Final Thoughts
Turning 65 should be something to celebrate, not stress about. By learning the basics of Medicare and planning ahead, you can step into this next chapter of life with confidence and control over your healthcare.
Whether you’re retiring soon or continuing to work past 65, there’s a Medicare solution that’s right for you. And with the right partner on your side, you don’t have to figure it out alone.
Ready to Get Started?
Contact Legacy From The Heart in Tulsa, Oklahoma today at (918) 500-3167 for a free, no-pressure Medicare consultation. We’ll walk you through your options, answer your questions, and help you make the best decision for your health and future.
Your Medicare journey starts here, with a team that puts heart into every step.