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Am I required to sign up for Medicare when I turn 65?

No, you don’t have to enroll in Medicare when you turn 65, but whether you should depends on your situation. Here are the key considerations:

When You Should Enroll at 65

You should sign up during your Initial Enrollment Period (IEP) (the 7-month window around your 65th birthday) if:

  • You aren’t covered by employer-sponsored health insurance (from an employer with 20 or more employees).

  • You have retiree health coverage, COBRA, or individual insurance (Medicare usually becomes primary, so delaying could result in coverage gaps and penalties).

  • You receive Social Security benefits (you’ll be automatically enrolled in Part A & Part B unless you opt out of Part B).

When You Can Delay Enrollment Without a Penalty

You can delay Medicare Part B (Medical Insurance) and Part D (Prescription Drug Coverage) without penalties if:

  • You (or your spouse) are still working and have creditable employer health coverage from a job with 20 or more employees.

  • You have Veterans Affairs (VA) coverage (but Medicare can provide additional benefits).

Once you stop working or lose employer coverage, you have an 8-month Special Enrollment Period (SEP) to sign up for Part B and 2 months for Part D to avoid late penalties.

Penalties for Late Enrollment

If you don’t qualify for an exception and delay:

  • Part B: You’ll pay a 10% penalty for each full year you were eligible but didn’t enroll.

  • Part D: A 1% penalty per month of delay may apply if you don’t have creditable drug coverage.

Let me know if you need help deciding based on your specific situation!

When Should I enroll in Medicare?

Enrolling in Medicare depends on your situation and whether you are automatically enrolled or need to sign up. Here’s how it works:

Automatic Enrollment

You’re automatically enrolled in Medicare Part A (Hospital Insurance) and Part B (Medical Insurance) if:

  • You’re already receiving Social Security or Railroad Retirement Board (RRB) benefits at least 4 months before you turn 65.

  • You’ve been getting disability benefits from Social Security or the RRB for 24 months.

If you’re automatically enrolled, you’ll get a Medicare card in the mail about 3 months before your 65th birthday.

When to Sign Up

If you’re not automatically enrolled, you’ll need to sign up during one of these periods:

  1. Initial Enrollment Period (IEP)

    • This is a 7-month window around your 65th birthday:

      • 3 months before your birthday month

      • Your birthday month

      • 3 months after your birthday month

    • Signing up early ensures coverage starts on time.

  2. Special Enrollment Period (SEP)

    • If you’re still working and have health insurance through your or your spouse’s employer, you can delay Medicare enrollment.

    • You can sign up within 8 months of losing employer coverage without a penalty.

  3. General Enrollment Period (GEP)

    • If you missed the IEP and don’t qualify for an SEP, you can sign up between January 1 – March 31 each year.

    • Coverage starts the following month, and a late penalty may apply.

How do I enroll in Medicare?

How to Enroll

You may sign up for Medicare up to three months before you would like for it to begin in these ways:

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What is a Medicare Supplement (Medigap) and how does it work with Original Medicare?

What is a Supplement?
- Your supplement covers everything Medicare covers. The supplement’s only job is to
come behind Medicare and pay the bills.
- Supplements are standardized by Medicare. A G Plan is a G plan (an N plan is an N
plan, etc) regardless of where you are in the country or what company you buy your
supplement from.
- There is no difference in COVERAGE from one company to another. The only
differences are (1) the cost of the premium (2) the logo on your supplement card
and (3) their customer service.

What does a supplement cover?
- Short Answer: It works with Medicare and covers anything Medicare covers.
- The general rule of thumb for Medicare: If your doctors says a treatment or procedure is
medically necessary, Medicare will cover it. If it is not medically necessary, they will not
cover it.
- If you need a cosmetic surgery after a car accident to correct disfiguration, that is
medically necessary.
- If you want a cosmetic surgery (you want an eye lift so that you look younger),
Medicare will NOT cover that.
- Your supplement does not make any decisions about what is covered or not. If Medicare
covers it, your supplement will cover it. If Medicare does not cover it, your supplement
won’t cover it either. There is one exception:  some Supplement plans will cover you in a foreign travel emergency (up t plan limits where Original Medicare won't.
- See the Medicare and You handbook for more information on what Medicare covers.

Are there networks I have to stay within?
- No. You can go to any doctor anywhere in the country. As long as they take Medicare,
they will take you and your supplement.

What about dental, vision, and hearing? Does the supplement cover that?
- In general, no. You would need a separate dental, vision, or hearing plan. Dental plans
with Delta Dental average about $50 / month. Vision plans with Delta average about $15
/ month.
- If you need to see an eye doctor for a medical problem–cataracts, glaucoma, etc–your
supplement WILL cover that.
- Same for dental or hearing. If you need to see a dentist or audiologist for a medical
problem, your supplement will cover that. It will not cover regular dentist visits, hearing
exams, or hearing aids. See the Medicare and You handbook for more information.
The most popular three “Flavors” of Supplements
G Plan: Most Comprehensive, Most Expensive Premium
Total Costs include:
- $202.90 Part B Premium
- Supplement Monthly Premium (this depends upon age and location)
- $283 Part B Deductible
Coverage includes:
- After your deductible ($283), your supplement will cover everything that Medicare covers 100%

N Plan: Lower Premium, Copays to see specialist after deductible
Total Costs include:
- $202.90 Part B Premium
- Supplement Monthly Premium (this depends upon age and location)
- $283 Part B Deductible
Copays
- Up to $20 copay for specialist visits after deductible is met
- Up to $50 copay for emergency room visits that DO NOT result in being
admitted to the hospital.
- Excess charges (Medicare has standardized costs for treatment. On the
rare occasion that a doctor does not take assignment from Medicare–that
is, they don’t accept the Medicare price–they can charge 15% higher than
the Medicare agreed upon price. You pay that 15% difference. Most
doctors take assignment from Medicare. The occasional rogue
anesthesiologist or mental health therapist may not take
assignment.)
- With the exception of your copays, once you meet your deductible, your
supplement will cover anything that Medicare covers 100%.

High Deductible G: Lowest Premium, Highest Deductible
- $202.90 Part B Premium
- Supplement Monthly Premium(this depends upon age and location) 
- $3,000 deductible
- Once you hit your $3000 deductible, your supplement will cover anything
Medicare covers 100%.

Can I switch to a different category of supplement
(like from an N plan to a G plan, or a G plan to an N plan)?
- Yes, but you will have to pass medical underwriting. (They will ask you some medical
questions. If you are generally healthy, this will not be an issue. They are looking for
chronic illnesses that are generally more expensive to treat–cancer, complications from
diabetes, COPD, severe asthma (mild asthma is fine), etc.
I’m worried about the premium increases. What will my options be?
- Prices will rise each year as you get older. That’s true no matter what company you have
your supplement with. Some companies increase at slower rates than others. N plans
generally increase more slowly than G plans.
- Every 3-5 years it’s a good idea to shop around and see if you can get a lower premium
with a different company. The coverage will remain the same, just a new company and a
new premium.
- You have two options when it comes time to switch to a lower premium:
- If you are generally healthy and can pass medical underwriting: You can switch at
any time of year. There are no enrollment periods for supplements! You can
switch from within the same category plan to another company ( A G plan to a G
plan, or an N plan to an N plan) OR you can switch from a G plan to an N plan or
an N plan to a G plan.
- If you cannot pass medical underwriting: In Virginia, there is a Birthday Rule which allows you to switch to a new company within the same category plan (that is, you can switch from one G plan to another G plan, or one N plan to another N
plan)for 60 days following your birthday . You cannot switch from a G to an N or an N to a G.

What will it cost to use your services?
 

Our help does not cost you anything. Like all Medicare brokers, we am paid by the insurance company when you enroll in a plan, so you don’t have to pay for our assistance. We work with multiple carriers so that we can find the right fit for you.

How Medicare Brokers Work

  • We will help you compare Medicare plans, including Medicare Advantage (Part C), Medicare Supplement (Medigap), and Part D (prescription drug plans).

  • We am independent and offer multiple insurance company options, unlike captive agents who work for just one company.

  • Our commissions are built into the premiums of the plans, so you pay the same price whether you use our help or enroll directly with the insurance company.

Things to Keep in Mind

  • A good broker should offer unbiased advice and focus on your best interests

  • Independent brokers represent multiple insurance companies, giving you a wider range of options.

  • Avoid “captive agents” who only sell plans from one company.

  • Make sure whoever you work with is licensed in your state (you can verify this through your state’s insurance department).

A good broker should be educational, not pushy. Ask them:
✔️ Do you represent multiple insurance companies?
✔️ How do you determine the best plan for me?
✔️ Can you compare Medicare Advantage, Medigap, and Part D plans?
✔️ Will you continue to assist me after enrollment?

A reliable broker should consider:

  • Your doctors & preferred hospitals (to ensure they are in-network).

  • Your prescriptions (to find the best Part D or Advantage plan).

  • Your budget (to balance premiums, copays, and out-of-pocket costs).

Beware of Red Flags

🚩 They push one company’s plan without discussing alternatives.
🚩 They rush you into signing up.
🚩 They promise “free” Medicare plans (Medicare has costs, even with $0 premium plans).
🚩 They cold-call you (Medicare brokers aren’t allowed to call you unless you request information).

Betty Brickhouse, Your Trusted Medicare Spcialist

Brickhouse Medicare Solutions

434-252-3889

CMS Disclaimer:  “We do not offer every plan available in your area. Currently we represent 10 organizations which offer 42 products in your area. Please contact Medicare.gov, 1-800-MEDICARE, or your local State Health Insurance Assistance Program (SHIP) to get information on all of your options.” 

©2023 by Brickhouse Medicare Solutions. 
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