Essential Medicare Tips All Baby Boomers MUST Know
Did you know that approximately 10,000 boomers turn 65 and become eligible for Medicare every single day? Understandably, most are stressed with what their Medicare options are, and I don’t blame them. One wrong move can jeopardize their 401K and life savings that they worked so hard for. If you’re a boomer who’s either just turned 65 or is nearing that milestone birthday, you’re in the right place. I’m going to share a few Medicare tips that ALL boomers must know. Grab a pen and notebook, and make sure to write them down because they’re guaranteed to make your life easier!
Enroll On Time
All right, my friends. Let’s start with the basics. Timing is important, especially when it comes to Medicare. Listen up because there are different rules for enrolling in Medicare!
- The only way Medicare is automatic for those turning 65 is when one is already receiving their Social Security check.
- If you are not receiving your Social Security check and not working full time with true company benefits from either your or your spouse’s employer, then you will want to enroll in Medicare Parts A and B online at socialsecurity.gov.
- Those working full-time with true company benefits or those who are covered under their spouse’s benefits may want to delay enrolling in Medicare Parts A and B until they finally retire or happen to be laid off from their current employment.
Your first chance to sign up for Medicare is 3 months before you turn 65. This is called the Initial Enrollment Period. It lasts for 7 months and ends 3 months after the month you turn 65. You will also have a chance to sign up for Medicare between January 1st and March 31st each year. This is called the General Enrollment Period, and your coverage will start the month after you sign up. However, you might pay a monthly late enrollment penalty if you do not qualify for a Special Enrollment Period.
According to Medicare.gov, here are some Special Enrollment Periods for Parts A & B:
| If you: | Your Special Enrollment Period: | How to Sign Up: |
|---|---|---|
| Lost Medicaid coverage on or after 1/1/2023 | Starts: The day you’re notified that your Medicaid coverage is ending. Ends: 6 months after your Medicaid coverage ends. Coverage begins: The month after you sign up, or the date your Medicaid coverage ends, whichever you choose. | Fill out form CMS-10797 and send the completed form to your local Social Security office by fax or mail. |
| Missed a chance to sign up because of a natural disaster or emergency (on or after 1/1/2023) | Starts: The day the Federal, state, or local government declares the emergency or disaster. Ends: 6 months after whichever happens later: -The end date in the original declaration. -The last day of any extensions to the declaration. -The date the government revokes or announces the end of the declaration. Coverage begins: The month after you sign up. | Fill out form CMS-10797 and send the completed form to your local Social Security office by fax or mail. |
| Missed a chance to sign up because of inaccurate or misleading information from your health plan or employer (on or after 1/1/2023) | Starts: The day you notify the Social Security Administration that your health plan or employer misrepresented or gave you incorrect information. Ends: 6 months later. Coverage begins: The month after you sign up. | Fill out form CMS-10797 and send the completed form to your local Social Security office by fax or mail. |
| Were released from incarceration on or after 1/1/2023 (and missed a chance to sign up while incarcerated) | Starts: The day you’re released from custody. Ends: The last day of the 12th month after the month you’re released. Coverage begins: The month after you sign up, or you can select retroactive coverage back to your release date (but not a date before your release date). You can only request retroactive coverage up to 6 months in the past. | Fill out form CMS-10797 and send the completed form to your local Social Security office by fax or mail. |
| Missed a chance to sign up because of other exceptional conditions | Starts: Once you contact Social Security. Ends: At least 6 months later. Coverage begins: The month after your sign up. | Fill out form CMS-10797 and send the completed form to your local Social Security office by fax or mail. |
| Have or had health insurance through your job, your spouse’s job (or a family member’s job if you’re disabled*) | Starts: The first month after your Initial Enrollment Period ends. Ends: 8 months after the group health plan coverage or the employment ends, whichever happens first. Coverage begins: Generally, the first month after you sign up. You can request to delay your Part B start date up to 3 months if you sign up while you’re still working or within the first full month after losing employer coverage. | If you already have Part A, go to SSA.gov to sign up for Part B. You can also send completed forms to your local Social Security office by fax or mail. |
| Volunteer and serve in a foreign country | Starts: The first day of the month any of these happen: -You’re no longer a volunteer outside the U.S. -The organization you’re volunteering with no longer has tax-exempt status. -You no longer have health insurance that provides coverage outside the U.S. Ends: 6 months later. Coverage begins: The month after you sign up. | Go to SSA.gov to apply for Medicare online. If you already have Part A, fill out form CMS 40B to sign up for Part B. Send the completed form to your local Social Security office by fax or mail. |
| Have TRICARE | Starts: When Social Security notifies you. Ends: 12 months later. Coverage begins: The month after you sign up, or you may decide for coverage to begin after the end of your Initial Enrollment Period. | Get more information about how TRICARE works with Medicare. |
Medicare is NOT Free
Medicare covers a lot, and there is a cost associated with Medicare Parts A and B. The premium for Part A is at no cost if you worked 10 years (or 40 quarters) and paid Medicare taxes. However, if you do not qualify for a premium-free Part A, you will have to pay it yourself. Currently, in 2025, the premium is either $285 or $518 each month, depending on how long you or your spouse worked and paid Medicare taxes (according to Medicare.gov). The Part A deductible is $1,676 for each time you’re admitted to the hospital per benefit period.
Medicare Part B has a premium that is means-tested depending on how much you have earned for that year. In 2025, the Medicare Part B premium costs $185 monthly, though it can run higher depending on your income. The Part B deductible in 2025 is $257 before Original Medicare starts to pay. You must pay for this deductible once a year.
Learn Medicare’s Alphabet Soup
Medicare is made up of multiple parts. Affectionately termed “alphabet soup”, it can seem a bit overwhelming if you don’t know what each letter refers to! However, I’m here today to break it down in “people terms.” Keep reading to find out more about Medicare and what each part covers.
- Part A: Medicare covers hospital insurance and medical expenses, including inpatient hospital care, hospice care, skilled nursing facilities, and some home health care.
- Part B: This covers medically necessary services that Part A does not cover. This may include doctor’s visits and preventative care, like a flu shot or a health screening.
- Part C: Also known as Medicare Advantage, is another way of receiving your Medicare Part A and B benefits.
- Part D: This covers prescription drug plans. It can be enrolled as a stand-alone plan with Original Medicare and a Medicare Supplement or a Medicare Advantage plan with Part D included.
Medicare Covers A LOT
As you can see, Medicare covers a LOT. From in-patient hospital stays to skilled nursing facility care to home health and hospice, Part A runs the gamut of healthcare coverage. Meanwhile, Part B covers everything from outpatient surgery to durable medical equipment to X-rays. However, it’s important to remember that even with this fantastic coverage, you’ll still have to pay some out-of-pocket costs, copayments, and deductibles!
Know What Medicare DOESN’T Cover
Sadly, Medicare doesn’t cover everything. Unless you have other healthcare coverage or a Medigap, you might have to pay for some services yourself. A few of the items that Medicare does NOT cover include:
- Eye exams
- Massage therapy
- Hearing aids
- Cosmetic surgery
- Dental services, such as routine cleanings and dentures
- Long-term care
- Routine physical exams
There’s No Network With Original Medicare and Medicare Supplement/Medigap
Instead, your healthcare provider or facility bills Medicare directly.
Medicare Serves Those Under 65 Also
Yep, you read that right! Those under 65 on Social Security Disability or ESRD (end-stage renal disease) qualify when they meet Medicare’s requirements for enrollment. It’s important to note that there’s a five-month waiting period for beneficiaries determined to meet these requirements!
Medicare Advantage May Be a Good Option
Know that you can choose between Original Medicare (Parts A & B) or Medicare Advantage plans offered by private insurance companies. Medicare Advantage plans often offer lower costs, including a maximum out-of-pocket spending limit per pay period. In 2025, this cap is set at $9,350. Additionally, many Medicare Advantage plans include prescription drug coverage and dental benefits. However, it’s important to note that there are downsides to Medicare Advantage plans, too. For example, you may have flexibility in choosing your healthcare providers, and coverage might not be so straightforward. Make sure you research each option thoroughly before you commit to anything!
Toni Says: Make the most of Medicare! Schedule your important screenings, wellness visits, and preventative care.
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Originally published March 12, 2025
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