Turning 65 brings a lot of mail. Much of it is about Medicare, and much of it is trying to sell you something. What is often missing is a clear explanation of the decisions in front of you and how they connect to the rest of your retirement.
Medicare is not just a health insurance decision. It involves deadlines, penalties, premiums tied to your income, and choices that can be difficult to undo later. Here are five decisions worth understanding before your 65th birthday.
1. When to Enroll
Your Initial Enrollment Period is a seven-month window: the three months before your 65th birthday month, your birthday month, and the three months after. Enrolling in the months before your birthday is generally how coverage begins on time.
Missing this window can be costly. The Part B late enrollment penalty generally adds to your premium for each full 12-month period you could have had Part B but did not sign up, and it typically lasts for as long as you have Part B. Part D has its own late enrollment penalty if you go without creditable prescription drug coverage, even if you take no medications today. These penalties generally do not go away, which is why knowing your timeline ahead of time matters.
2. Whether to Delay Because You Are Still Working
Many people are still working at 65, and employer coverage may allow you to delay Part B and Part D without a penalty. Whether that applies to you depends largely on the size of your employer. In general, if your employer has 20 or more employees, the employer plan pays first and delaying may be an option. If your employer is smaller, Medicare typically pays first, and delaying enrollment could leave gaps in coverage.
If you contribute to a Health Savings Account, timing becomes even more important, because you generally cannot contribute to an HSA once you are enrolled in Medicare, and Part A coverage can be applied retroactively in some cases. This is one of the most common places where a well-intentioned decision creates an unexpected problem, so it is worth a conversation before you file anything.
3. Original Medicare or Medicare Advantage
Nearly every Medicare decision comes down to one fork in the road.
The first path is Original Medicare (Parts A and B), paired with a Medicare Supplement policy to help with costs Original Medicare leaves to you, plus a standalone Part D plan for prescriptions. This path generally offers broader access to providers who accept Medicare and a more predictable cost structure, in exchange for a monthly premium.
The second path is Medicare Advantage (Part C), a private plan that bundles your Part A and Part B benefits and usually includes prescription coverage. These plans often have little or no additional premium beyond your Part B premium and may include extra benefits, but they generally use provider networks, and more of your costs are paid as you use care.
Neither path is automatically better. The right fit depends on your prescriptions, your doctors, how much you travel, and what your household could absorb in a difficult health year.
4. Timing Your Medicare Supplement
If you choose Original Medicare with a supplement, timing matters here too. Your Medigap open enrollment period generally begins the month you are 65 or older and enrolled in Part B, and lasts six months. During that window, you can typically buy any Medigap policy sold in your state without medical underwriting. Applying later may mean answering health questions, which could affect your options.
5. How Your Income Affects Your Premiums
Higher-income households pay an income-related monthly adjustment amount on top of standard Part B and Part D premiums. That adjustment is based on your tax return from two years prior. Retirement decisions such as Roth conversions, selling investments with capital gains, or the timing of retirement account withdrawals can all affect that number.
This is where Medicare becomes a retirement income decision. Premiums, out-of-pocket costs, and prescription expenses are recurring withdrawals from your plan, and they deserve the same attention as any other part of it.
GenWealth Financial Advisors and LPL Financial do not provide tax or legal advice. Please consult a qualified tax professional regarding your specific situation.
Bringing It All Together at GenWealth
At GenWealth Financial Advisors, we help people approaching 65 work through these decisions with their full retirement picture in view. We starts with your medications, your doctors, and your work situation, then explains the options we are able to offer and compare the tradeoffs side by side. If you are married, it is often helpful to review coverage together, since spouses frequently become eligible at different times and may need different coverage.
A good time to start is about three months before your birthday month, or earlier if you are still working and need to coordinate with employer coverage.
Schedule Your Medicare Review
There is no fee for a Medicare review, and meeting with us does not obligate you to enroll in anything.
Request a Medicare review at getreadyforthefuture.com/medicare or call (866) 653-PLAN. Request a Medicare review at getreadyforthefuture.com/medicare or call (866) 653-PLAN.
Securities are offered through LPL Financial, Member FINRA/SIPC. GenWealth Financial Advisors is an other business name of Independent Advisor Alliance, LLC. All investment advice is offered through Independent Advisor Alliance, LLC, a registered investment adviser. Independent Advisor Alliance, LLC is a separate entity from LPL Financial.
