Turning 65 in Ohio: Your Medicare Checklist | Health Shield
Turning 65 is the moment Medicare moves from "someday" to "right now." If you live in Ohio, this checklist will help you understand your timeline, your choices, and the steps to take so nothing slips through the cracks.
Step 1: Mark Your Initial Enrollment Period
Your Initial Enrollment Period (IEP) is your first chance to sign up for Medicare. It lasts seven months:
- The three months before the month you turn 65
- The month you turn 65
- The three months after the month you turn 65
If you sign up during the three months before your birthday month, your coverage generally starts on the first day of your birthday month. Otherwise, it usually begins the month after you sign up.
Good to know: If you already receive Social Security or Railroad Retirement benefits at least four months before you turn 65, you'll usually be enrolled in Parts A and B automatically, and your Medicare card will arrive in the mail. Otherwise, sign up through Social Security at ssa.gov, by phone, or at a local office.
Step 2: Understand Parts A, B, C, and D
Here's a quick refresher on the pieces of Medicare:
- Part A (hospital insurance): Helps cover inpatient hospital care, skilled nursing facility care after a qualifying stay, hospice, and some home health care. Most people qualify for premium-free Part A based on their or their spouse's work history.
- Part B (medical insurance): Helps cover doctor visits, outpatient services, preventive care, and medical equipment. Part B has a monthly premium set each year.
- Part C (Medicare Advantage): Plans offered by private insurers approved by Medicare that provide your Part A and Part B benefits. Most use provider networks, and many include drug coverage.
- Part D (prescription drug coverage): Offered by private insurers, either as a stand-alone plan with Original Medicare or built into many Medicare Advantage plans.
Step 3: Decide Between Original Medicare and Medicare Advantage
This is the big decision. With Original Medicare, you can generally see any doctor or hospital in the country that accepts Medicare, and many people add a Medigap policy and a Part D plan. With Medicare Advantage, coverage comes through one private plan, usually with a local network.
Think about your doctors, your prescriptions, how often you travel, and how you prefer to balance monthly costs against costs when you get care.
Step 4: Consider a Medicare Supplement (Medigap) Plan
If you choose Original Medicare, a Medigap policy can help pay some of the costs Original Medicare doesn't, such as deductibles, coinsurance, and copayments. Medigap plans are standardized and identified by letters, so a plan with a given letter offers the same basic benefits no matter which company sells it. Prices can differ by company.
Timing is especially important here. Your Medigap Open Enrollment Period is a six-month window that starts the first month you're 65 or older and enrolled in Part B. During this window, you can buy any Medigap policy sold in Ohio, and insurers generally can't deny you coverage or charge you more because of health conditions. Afterward, you may face health questions.
Keep in mind that Medigap policies don't include prescription drug coverage, so most people pair Medigap with a stand-alone Part D plan.
Step 5: Don't Forget Prescription Drug Coverage
Even if you don't take many medications today, think carefully before skipping Part D. If you go 63 days or more in a row without Part D or other creditable drug coverage after your Initial Enrollment Period ends, you may owe a late enrollment penalty that generally lasts as long as you have Medicare drug coverage.
When comparing drug plans, check that your medications are on the plan's drug list (formulary) and which pharmacies are preferred.
If you have limited income and resources, you may qualify for Extra Help, a program that helps pay Part D costs.
Step 6: If You're Still Working at 65
Many Ohioans keep working past 65. Whether to enroll right away depends on your employer coverage.
- If your employer has 20 or more employees, your group health plan is usually your primary coverage. Many people enroll in premium-free Part A and delay Part B without a penalty while they're covered by that plan through current employment.
- If your employer has fewer than 20 employees, Medicare usually pays first, and you may need to enroll in Parts A and B on time to avoid gaps in coverage. Check with your benefits administrator.
- When your job or employer coverage ends, you generally have an eight-month Special Enrollment Period to sign up for Part B without a late penalty. Don't wait too long: COBRA and retiree coverage don't count as coverage based on current employment for this purpose.
- If you have a Health Savings Account (HSA), you can't contribute to it once you're enrolled in any part of Medicare. Part A can be retroactive up to six months, so ask a tax advisor when to stop contributing.
Ask your benefits office how its plan works with Medicare and whether its drug coverage is creditable.
Your Quick Turning-65 Checklist
- Mark your seven-month Initial Enrollment Period
- Confirm whether you'll be enrolled automatically
- Ask your employer how its coverage works with Medicare
- List your doctors, pharmacies, and prescriptions
- Decide between Original Medicare (plus Medigap and Part D) or Medicare Advantage
- Note your six-month Medigap Open Enrollment Period and avoid gaps in drug coverage
Frequently Asked Questions
When can I sign up for Medicare when I turn 65?
Your Initial Enrollment Period lasts seven months: the three months before your 65th birthday month, your birthday month, and the three months after. Signing up before your birthday month generally means coverage starts the first day of your birthday month.
Do I have to sign up for Medicare if I'm still working at 65?
Not always. If you have group health coverage through your own or your spouse's current employment at a company with 20 or more employees, you may be able to delay Part B without a penalty. Check with your employer's benefits office, because rules differ for smaller employers.
When is the best time to buy a Medigap policy in Ohio?
Your Medigap Open Enrollment Period is the six months starting the first month you're 65 or older and enrolled in Part B. During that window, you can buy any Medigap policy sold in Ohio, and insurers generally can't deny you or charge more due to health conditions.
Can I sign up for Medicare before I start Social Security?
Yes. You can enroll in Medicare Parts A and B during your Initial Enrollment Period even if you haven't started collecting Social Security retirement benefits. In that case, you'll need to sign up through Social Security rather than being enrolled automatically.
What happens if I don't sign up for Part D when I'm first eligible?
If you go 63 or more days in a row without Part D or other creditable drug coverage after your Initial Enrollment Period, you may owe a late enrollment penalty that is generally added for as long as you have Medicare drug coverage.
Let's Build Your Medicare Plan Together
You don't have to do this alone. A licensed independent agent can compare the plans they offer and help you enroll. Health Shield Insurance is based in Newark, Ohio. Our founder, Dalton Alexander, is licensed in 37 states (NPN 20315737). Learn more about how we help on our Medicare page or on our About & Contact page.
Call Health Shield Insurance at 740-272-5655, Monday through Friday, 9 AM to 6 PM ET, or email [email protected]. Prefer to start online? Request a quote on our Medicare page.
Written by Dalton Alexander, licensed insurance agent, Health Shield Insurance, Newark, Ohio. NPN 20315737. Licensed in 37 states.
We do not offer every plan available in your area. Any information we provide is limited to those plans we do offer in your area. Please contact Medicare.gov, 1-800-MEDICARE, or your local State Health Insurance Program (SHIP) to get information on all of your options.
Not affiliated with or endorsed by the U.S. government or the federal Medicare program.
