Joanne:  Whether you are a couple of years away from turning 65 or approaching this infamous birthday in the next few months, there are some overall timelines that you should know to reduce stress during your transition to Medicare. In this episode, we'll break down that by telling you our recommendations for the Medicare enrollment timeline.

Cameron: But before we start, my name is Cameron Giardini. Together with my cohost, Joanne Giardini Russell, I operate Giardini Medicare, an independent insurance agency based in southeast Michigan. Although we are based in Michigan, we work virtually over the phone to help consumers in about 13 states find the right Medicare coverage for them.

If we do not work in your state, we will connect you with another trusted independent agent who will be able to help you find the coverage that you want. You can also have access to our free online course, which you can register for. You can do this by going to gmedcourse.com, or you can also find all of our educational Medicare resources at Doineedmedicare.com

Joanne: Let's do an overview of today's episode. Age 65 is the baseline for this timeline since, for the majority of people, this will be when they are first eligible for Medicare. So we'll discuss that. We'll also talk about whether you're eligible for Medicare before age 65 due to disability and stage renal disease or ALS. Your timeline will be different than the normal timeline for those eligible for Medicare for the very first time at age 65.

We'll discuss varying milestones for your Medicare timeline, ranging from A few years before you turn 65, what you should be doing then and thinking about up until the few months before you turn 65, and maybe things you're going to be doing differently at that point. Then, we're going to end up by discussing some timelines that you should just be aware of going forward in the future after you've enrolled in your Medicare at age 65. Then, we'll recap everything at the end.

Cameron: Okay, so first, we're going to talk about the five- to ten-year timeline before age 65. Ten years before this is when you really have to get serious and learn everything you need to know about Medigap, Medicare Advantage, Original Medicare, and more. And you really should know exactly which plan you want to enroll in this far ahead of time.

Okay. We're just joking. We want to make sure you're paying attention and get that out of the way. So, five years before, you still really shouldn't worry about it. Again, this is way too early to be concerned with your Medicare coverage. And we say this because sometimes we get caught up in things. Our lives revolve around Medicare, but it doesn't mean that yours should as well.

Okay. Two years before you turn 65, you should start thinking about the Medicare landscape and getting ideas for what it will look like. So, at this point, get a general idea of Medicare coverage. We're going to go over some things you can know right now, a couple of years ahead of time.

For example, Part A and Part B are what make up the original Medicare. Beyond that, you really have two choices when it comes to your coverage, which we often talk about. These are Medicare Advantage plans, also known as Part C, or Medicare Supplement plans, also known as Medigap. So, at this point In your journey, you don't really have to stress about the details for each one, but just knowing that these terms and these coverages exist can help you as you see a growing number of Medicare advertisements and hear people talking about it in your life.

At this point, you can also understand Medicare pricing and, most importantly, that Medicare is not free. That's just a big thing to learn ahead of time. You can also understand the cost of part A and part B. You can also understand that something called Irma exists.

That is just basically saying that your Medicare can cost more based on your income. We'll talk about that a little bit more in detail. Also, you should understand some rough estimates for Medicare supplement pricing and Part D pricing, which is drug coverage, as well as Medicare Advantage plans. Again, you don't have to fixate on these specific plans from specific companies, just more of an overview of costs for general budgeting.

So, for Part A, to get an idea of some of the numbers, for 99% of beneficiaries and most of you listening to this, it'll be $0/month for Part A. Then this year in 2024, Part B is $174.70/month. Now, if you are listening to this two years out from starting Medicare, know that the Medicare Trustees Report, which is released by Medicare, does project the base Part B premium in 2026, so two years from now, to be 196.40/month, so that you have an idea.

Now, Medicare Advantage plans, the majority of consumers will pay 0 per month for Medicare Advantage plans. Currently, in 2024, the average monthly premium for a Medicare Advantage plan is 18.50/month. Again, so that you have an idea. Now, Medigap and Part D plans will vary more by state, but to give you A rough estimate, and I would say a good majority of states, you're roughly going to add about $150 or maybe up to $170/month for Medigap and Part D coverage at age 65, and that is in addition to the Part B premium for Medicare. And then last but not least for these rough numbers. Again, we talked about Irma, which is that income-related monthly adjustment amount.

This can cause your part B premiums to be higher, and they can be as high as 594 per month. And this year, That is only going to go up. I'm sure. And it can also increase your part D costs and your part D premiums. We bring this up because when you enroll in Medicare, your Irma amounts or your adjustment amount are based on your income from two years in the past.

However, don't overreact and try to lower your income right now—you know, plan two years ahead of time. Just understand that if you suddenly sign up for Medicare in the future and your income drops due to a qualifying event like retirement or something like that, you can appeal this Irma surcharge.

So I know we've had some people that say, I need to, you know, make less money, or I need to change my lifestyle right now, two years ahead of time because of Irma. But don't worry about that. Just keep doing what you're doing. And then we'll figure it out when the time comes to get that properly lowered, if possible.

So, moving on from two years out, what about one year before you turn 65?

Joanne: All right, so this is the point when advertisements really are going to ramp up. There's going to be a whole lot of things going on, a little different from two years out. So, as you get closer to one year out, we would suggest finding a broker to work with.

There might not be a whole bunch to discuss, but it can help you cut through all the noise as you start to approach age 65. So when you're out, this is really the point when you really want to have that thought in your mind or discuss it with a broker. It's what we call the do I need Medicare conversation.

And that is one of the most important pieces of Medicare: finding out if you really do need that. If you do find out you do, then you're going to want to learn the specific differences between Medicare Advantage and Medigap coverage. As Cameron mentioned at the beginning of this podcast, we have a tool, and it's DoineedMedicare.com

It's a tool that we use. It's designed to give us some information. We can tell you pretty much what you need to do at 65, so you don't want to get caught up with everyone telling you what to do and panic into thinking you have to do Medicare.

It's easy to get overwhelmed and pressured into thinking that you do have to enroll at 65. But for many of you listening to this episode, that really may not be the case. For example, if you're covered by active employer group health insurance due to your working, or maybe your spouse is currently working.

And that employer has 20 or more employees. It's really very possible that you'll at least delay Part B of Medicare beyond age 65. So again, it's that whole panic. You're panicked into doing it, and then you find out you really don't need it. But this is still really a good time to compare your employer coverage.

to your Medicare options since, based on cost, you may still want to enroll in Medicare with a Medicare Advantage plan or a Medigap plan instead of having employer coverage. However, always look further. Look at your dependents. Do you have a spouse on the plan, kids on the plan, or things like that?

Again, that's where working with a broker could really help isolate some of these situations for you. Now, when we discuss Medigap versus Medicare Advantage, we won't dive into many of the details during this episode. Still, we need you to understand that these two coverage options are fundamentally different and will be one of your main decision points when it comes to starting Medicare.

You can listen to our podcast episode comparing those two types of programs in more detail or check out our YouTube channel. At this point, you don't have to choose a specific Medicare Advantage or Medigap plan, but getting specific quotes can help. But understand that these things can all change by the time you're actually going to enroll.

So, use those things that you do collect as more of a guide than being set in stone.

Cameron: Yeah, exactly. That brings us to the six months before age 65 timeline. This is a good time to decide whether to enroll in Medicare Advantage or Medigap coverage and Part D coverage.

Once you have narrowed down which route you likely want to go with your coverage, that is when you should really start narrowing down your search to find specific plans with specific insurance companies, but still understand that specific details may change by the time you go to enroll in them. So, for example, if you decide at this point you want Medigap coverage, next up you can decide, do I want Plan G, do I want Plan N, or maybe you even want a high deductible plan.

You can see our YouTube channel, go to Giardini Medicare on YouTube, and look for our N versus G video. That should give you a good idea of the differences between the two. Then, if you do decide on a specific plan letter, let's say you decide you want plan N, and you can then pick one or two insurance companies you actually want that are offering these plans.

If you want to enroll in a Medicare Advantage plan and don't want the Medigap side of things, you can decide whether you want a PPO plan or an HMO plan. Of course, with the help of a broker, you can find specific insurance companies that will have your medical providers and hospitals in the network.

You also want to make sure they fit your medications well, and then you'll want to talk about whether or not the plan has out-of-pocket costs and additional benefits that work for your specific needs. So again, this whole point is you're starting to narrow down the plan options to really specific plans, saying I want X plan with X company.

At this point, many insurance companies are also providing Medigap plans. They will also let you apply for coverage at this time, using your Medigap open enrollment period. Your coverage will still not start until age 65 or until your part B is effective, but this will at least help you avoid last-minute, stressful enrollments.

You will still have to wait until later in this timeline, though, as we will discuss applying for Medicare Advantage and/or Part D coverage. Now, just a special note: I mentioned briefly that some things can change, so getting specific quotes can still be a little tricky if you're six months out from turning 65.

This is especially true if you're turning 65 early on in the year. The reason for this is that both Medicare Advantage and Part D coverage change on a calendar year basis, which is from January 1st until December 31st. So right now, we're in 2024, and if we're looking at 2025, those plan details are not going to be released fully until October.

So if you're turning 65 in January or February, be aware that if you're all of a sudden looking six months out, you know, if you're in late summer, looking at plans, a lot of the things you look at will change by the time you actually go to have that coverage effective.

Joanne: So now the next milestone is about three months out before you turn 65.

So, at this point, for those of you who determined that you do need Medicare coverage starting at age 65, you can use your initial enrollment period to enroll in Medicare. This period occurs three months before the month you turn 65, including the month you turn 65 and the three months following that month.

So when you apply three months before you turn 65, that's going to cause your Part A and your Part B coverage to be effective on the first day of the month that you turn 65 years old. Now, if you're collecting Social Security or Railroad Retirement Board benefits for at least four months before you turn 65, you're going to automatically be enrolled into both Part A and Part B of Original Medicare, and you're going to get a Welcome to Medicare package along with your Medicare card, and it roughly arrives three months or so before your Medicare coverage starts.

This is going to come from the Department of Health and Human Services. Now, if you are not collecting Social Security or Railroad Retirement Board benefits, you will not be automatically enrolled in Medicare, and you're going to have to be proactive about applying. You're going to do this before you turn 65, and you can do this by calling the Social Security Administration.

You can go to your local Social Security office in person. You can enroll online for Part A and Part B and do the online application with ssa.gov. And I will tell you that the last method online is our preferred method for you. Now, keep in mind that the timeline for the three months before can shift slightly. If you were born on the first day of any month, when this happens, you're eligible for Medicare on the first day of the month before you turn 65.

For example, if you were born on March 1st, you would be eligible for Medicare effective February 1st. So again, when we're trying to time this as exactly three months before you turn 65, that's going to have to push that forward a month ahead for you.

Cameron:  Yeah, everything we talk about is mostly general timeline guidelines, so don't think of it exactly, except for some of these enrollment periods, which are set time periods.

Okay, so now we're within one to three months before you turn 65. At this point, you will probably have your Medicare card with your Medicare ID number. Once you have that, you can apply for Medicare Advantage coverage if you'd like or Part D coverage if you go with the Medigap route instead.

Again, this is best done with the help of a broker, but it will involve submitting an application to the actual insurance companies that you want to enroll with. These are likely to be different insurance companies. If you're enrolling in Medigap and Part D coverage, Part D will probably be with one company, and then Medigap will probably be with a different insurance company.

This is also a good time to set up your online personal account at Medicare.gov. We won't get into details on how to do that, but you can go to Medicare.gov. You'll see a portion of the website that says login or account, and you can go there and make your accounts with your Medicare number. Applying as soon as you know which plan you want is going to give you plenty of time to spare so you don't have to make last-minute enrollment decisions.

This will give you time to set up your plan premium payments, and it will let you have your ID cards in hand. And it really, overall, will just make sure you're ready to go when you turn 65. This also makes it even easier to hang up on the telemarketers who are going to continue to call you well beyond your 65th birthday.

We recommend that when it comes to setting up payments for plans if they do have a premium, they make sure to set it up using EFT payments or automatic payments for any coverage. So that way, none of them unexpectedly lapse. It's really important because that's one of the few ways you could lose coverage when it comes to Medicare.

So make sure you're paying for everything, and it's all set up and good to go as you approach age 65. Speaking of payments, after you enroll in Medicare, you will also, at some point, receive your actual bill to pay your Medicare Part B premiums. Now, this will happen if you're not collecting Social Security retirement benefits, whether it's SSA or RRB benefits.

The reason for that is that if you are collecting those benefits, your Medicare premiums will be automatically deducted from those benefits. And when I say Medicare premiums, I mean Part B. So if you do get a bill, if you're not collecting benefits, that will come in the form of a quarterly bill right now; as an example, 174.70/month is the monthly premium for part B.

If we multiply that by three for the three quarters, that gives you a bill of $524.10, so understand it as a quarterly bill. We know we get a lot of people who are kind of confused by that because we talk a lot about the monthly premium, and then all of a sudden, you get a bill much larger than you were expecting.

As far as paying these bills, there are a few easy ways to pay your Medicare premiums, but we typically recommend you pay online using your medicare.gov account, or you can enroll in what is called EasyPay. Now, at some point after enrolling in Medicare, if your income, using that two-year lookback we talked about when it comes to IRMAA, is above that threshold. You do have to pay for IRMAA; you will receive an IRMAA initial determination showing the extra amounts you may owe for Medicare Part B and Part D. Now, at this time, if your income is lower like we talked about due to a life-changing event like retirement, you can then file for a redetermination to hopefully have it reduced based on your current income to the lower proper amounts. Last but not least, what about your timeline for after age 65?

Because unfortunately, Medicare does not end right when you turn 65.

Joanne: It only begins. So, we want to end this episode by briefly talking about some of the timelines that you should be aware of after you turn 65. Now, for those of you who did enroll in Medicare at age 65 and have already enrolled in a Medigap plan or a Medicare Advantage plan, plan.

There will be times in the future when you can reevaluate certain coverages and change to new plans if necessary. So, one time that's really important to you going forward is going to be the annual election period. So again, this is a super important time for you since this is the time period from October 15th; this is the time period when it'll allow you to change your Medicare Advantage and your prescription drug coverage.

And there will be years when you will want to make a switch. So, remember that these plans can and will change every year on January 1st. They run a calendar year. And that, again, is the Medicare Advantage plan and your stand-alone plan. Part D plans. Those are the ones that run the calendar year. If you want to change from one Medigap plan to another in the future, know that you can do this at any time of the year if you qualify for a new plan.

When it comes to when and how to make changes to Medicare Advantage, Part D plans, or Medigap coverage. Make sure to listen to our recent podcast episodes about this specific topic. Now, there is a timeline for those who are delayed past age 65. If you're one of the people who did not need to enroll in Medicare at age 65, the timeline for you going forward is going to be based on when your employer coverage through yourself or your spouse is scheduled to end.

So, approximately three to six months before you think that your coverage is going to end is really a good time to think about it. Medicare Advantage versus Medigap and kind of narrow down which plans you might specifically want. You can enroll in Part B using a special enrollment period because you'll be leaving employer coverage, and you can do that up to three months before you want your coverage to be effective.

Overall, we recommend reaching out to an independent broker about six months before you think that your employer coverage will end and again when you're going to be starting your Medicare coverage. They can help you get all those things together.

Cameron: Exactly. Overall, your timeline for handling Medicare will be unique to your specific situation. However, we still have some general guidelines and best practices that we have developed over the years that we discussed in this episode.

Hopefully, this will make your transition to Medicare less stressful than it has to be. As always, please leave us a review on your podcast app and subscribe so you can listen to future episodes. You can also find more Medicare content from us by going to YouTube or TikTok and searching Giardini Medicare.

Last but not least, if you would like to talk with a licensed broker, you can schedule an appointment online at gmedicareteam.com or send us any questions or feedback to info@gmedicareteam.com. Thanks for listening and have a great day.