Turning 65? Here’s What You Need to Know Before Signing Up for Medicare

Turning 65 is a milestone in a woman’s life — one that often comes with major health and financial decisions. Medicare is an essential part of that transition, but the system can be confusing. That’s why HealthyWomen and the Society for Women’s Health Research (SWHR) created “Savvy and 65: A Woman’s Guide to Understanding Medicare.” This free, easy-to-understand resource gives women (and caregivers) the tools they need to understand Medicare basics and enrollment, learn about coverage options, and access information about coverage for vital health priorities.

Here are seven common questions many women have about Medicare, and the answers to help you navigate the system. For a lot more helpful information, be sure to download this guide:

1. What can I do to prepare for Medicare?

While people become eligible for Medicare on their 65th birthday, the year leading up to Medicare eligibility is a critical time for preparation. During this period, people can research available plans and healthcare providers (HCPs), assess their current and potential future health needs, learn when enrollment begins and ends, and seek guidance to determine which coverage options best meet their unique needs. It may be helpful to talk to friends, neighbors, and family members about their Medicare experiences, and possibly even meet with a licensed Medicare broker to explore the different pathways. 

2. Who is eligible?

Individuals are typically eligible for Medicare once they turn 65. People younger than 65 with certain disabilities; with amyotrophic lateral sclerosis (ALS), also known as Lou Gehrig’s disease; or with end-stage renal disease (ESRD) qualify for Medicare after being on the Social Security Disability Insurance (SSDI) program for more than two years. 

The Center for Medicare Advocacy has an overview article with more information, which you can read here.

3. What is Medigap?

Medigap is supplemental insurance that helps cover out-of-pocket costs with Original Medicare for those who do not qualify for Medicaid. It covers costs, such as copayments, coinsurance, and deductibles and may cover certain services not covered by Original Medicare, depending on the plan. Individuals must have both Medicare Parts A and B to buy a Medigap policy, and the best time to enroll is generally when you first enroll in Medicare. 

There are 10 different types of Medigap plans named by letters: A-D, F, G, and K-N. Each plan has different benefits. Not every state or company offers every Medigap plan, but the same basic benefits will be offered for plans with the same letter, no matter where you live or which insurance company you buy the policy from. Price is the only difference between plans with the same letter that are sold by different insurance companies. In some states, you may be able to buy another type of Medigap policy called Medicare SELECT. Compare the benefits offered by each plan.

However, some states may have their own enrollment rules, and some plans may not be available to everyone. 

4. Will I be automatically enrolled in Medicare?

Some people are automatically enrolled in Medicare, while others need to actively sign up for Medicare.

People who are already receiving Social Security or Railroad Retirement Board (RRB) benefits at least four months before turning 65 are automatically enrolled in both Medicare Part A and Part B. They’ll receive their Medicare card in the mail about three months before their 65th birthday.

Those who are not yet drawing Social Security benefits must apply for Medicare manually. The application process can be completed online at the Social Security Administration website, by phone, or in person at a local Social Security office. It’s ideal to apply during the Medicare Initial Enrollment Period (IEP). The IEP is the seven-month window around an individual’s 65th birthday when they can sign up for Original Medicare (Parts A and B) and Medicare Part D. This window includes the three months prior, the month of, and the three months after the enrolling person’s birthday. 

Note: This same period is called the “Initial Coverage Election Period (ICEP)” for Medicare Advantage/Medicare Part C.

5. When Can I Enroll in Original Medicare? 

There are a few different scenarios that are important to keep in mind: 

 It is 3 months before, 3 months after or my 65th birthday month. This is your Initial Enrollment Period (IEP). You can choose any Medicare pathway for coverage.

 I missed my Initial Enrollment Period (IEP). From January 1–March 31 (General Enrollment Period), you can enroll in Medicare. From October 15–December 7 (Open Enrollment Period), you can enroll in Medicare.

 I signed up for Original Medicare and need help with out-of-pocket costs. Within the first 6 months of signing up for Original Medicare, you can enroll in Medigap. This is called the Medigap Open Enrollment Period.

 I have a Medicare plan, and I want to change my coverage. From October 15–December 7 (Open Enrollment Period), you can make changes to your plan. You can move from Original Medicare to Medicare Advantage during this time.  

 I have a Medicare Advantage Plan, and I want to change my coverage. You can change your plan if you are in the first 3 months after getting Medicare. From January 1–March 31, you can change your plan during the Medicare Advantage Open Enrollment Period.

 My circumstances have changed. (For example, I changed where I live OR I lost my current health coverage.) You may qualify for a Special Enrollment Period. The types of changes you can make and the timing depend on your life event. Learn more about what events qualify you for a Special Enrollment Period here.

6. What’s the difference between Medicare and Medicaid?

Medicare and Medicaid are both government health programs, but they serve different people and have different rules: 

Medicare is mainly for people 65 and older or those with certain disabilities, regardless of income. 

Medicaid is for people of any age who have limited income and resources. 

Medicare is run by the federal government, while Medicaid is a state and federal partnership, so benefits vary by state.

7. I’ve heard that there are a growing number of Medicare scams. What do I need to know about this?

Those who are enrolling in Medicare should be aware that there are several Medicare scams that will try to trick beneficiaries into providing their Medicare or Social Security number. The scams have become very sophisticated and often sound legitimate. 

The National Council on Aging has put together a guide to help people spot scammers (such as people promising free items or services or applying pressure to switch Medicare plans) and offers tips to avoid being scammed: 

1. Do not share your Medicare number with people who contact you out of the blue 

2. Do not click on suspicious links

3. Do not be afraid of threats about canceling your benefits 

4. Do not speak to anyone who tries to convince you to sign up for a certain Medicare plan 

5. Destroy your old Medicare card immediately if you receive a new one from Medicare 

6. Keep your personal medical information close and do not share it with anyone beyond healthcare providers or trusted caregivers 

7. Do not accept unauthorized genetic testing kits 

Report Medicare scams immediately by calling 1-800-MEDICARE (800-633-4227) or submit a report online to the Federal Trade Commission (FTC).