• Home
  • /
  • Blog
  • /
  • Nearing Your 65th Birthday? An Introduction to Original Medicare and Medicare Advantage
October 18, 2023

Reaching your 65th birthday is a significant milestone, and understanding your healthcare options, such as Original Medicare and Medicare Advantage, becomes essential. Whether retirement is on the horizon or you continue working, preparing for Medicare eligibility is crucial. Unsure about the initial steps? Let's dive into what you need to know to get ready for Medicare.

1. What is the difference between Medicare and Medicare Advantage?

Medicare, also known as "Original Medicare," is a government program aimed at individuals aged 65 and above. It comprises two parts: Part A and Part B. Part A covers significant expenses like hospitalization, skilled nursing facility care, hospice care, and, in some cases, home health services. Part B provides coverage for routine care such as doctor appointments, outpatient care, preventive services, occupational/physical therapies, and home health services.

Medicare Advantage plans, on the other hand, are private insurance plans that work alongside Original Medicare. Part C represents Medicare Advantage plans. These plans are provided by private insurance companies and encompass the benefits of Part A and Part B, just like Original Medicare. Medicare Advantage plans often come with additional benefits, including prescription drug coverage (Part D), low or no monthly premiums, limits on out-of-pocket expenses, and extra benefits like dental, vision, hearing, and wellness.

Taking the time to understand the differences between Original Medicare and Medicare Advantage will help you determine which option aligns best with your specific needs and preferences.

Remember, as you approach this new phase of healthcare coverage, gathering information from credible sources and seeking personalized advice can further assist you in making informed decisions.

Understanding Medicare Qualifications and Enrollment Guidelines

Determining your eligibility for Medicare health insurance is crucial to ensure access to its benefits. Let's explore the qualifications required to become eligible for Medicare coverage:

Qualifications for those aged 65 or older:

  • Reaching the age of 65 or above
  • Being a legal resident living in the U.S. for at least 5 consecutive years

Qualifications for individuals under 65:

When should you enroll in Medicare?

If you turn 65 this year, there is a seven-month enrollment window for you to join Medicare and Medicare Advantage plans. You can enroll three months before your birthday and up to three months after your birthday. If you are already enrolled in Social Security benefits before turning 65, you will automatically receive Medicare Parts A and B on your birthday, with your card arriving in the mail.

However, if you plan to delay your Social Security benefits, you need to sign up for Original Medicare three months before your birthday. For further clarification on your eligibility and enrollment, contact the Social Security Administration.

It is essential to enroll within the seven-month period to avoid coverage delays or potential late enrollment penalty fees throughout your Medicare coverage. Note that if you or your spouse are still actively working and receiving coverage from an employer, you can delay signing up for Medicare without facing penalties or fees.

Understanding the qualifications and enrollment guidelines of Medicare allows you to make informed decisions about your healthcare coverage. If you have specific questions or concerns, it is advisable to seek personalized advice from healthcare professionals or official Medicare resources.

When you're turning 65, it's important to be well-prepared for enrolling in Medicare.

Explore the Benefits of Medicare Advantage

If you're interested in Medicare Advantage, you can enjoy additional health benefits while potentially saving money. In fact, Medicare Advantage plans often offer the following cost advantages:

  • $0 monthly premiums
  • $0 deductibles
  • $0 copays for generic prescription medications, with annual limits on copays for medical services

Furthermore, many Medicare Advantage plans provide coverage for over-the-counter allowances, gym memberships, routine dental and vision services, as well as benefits for hearing aids and eyewear. This comprehensive coverage ensures that you can receive the necessary care while customizing your plan to meet your specific needs. These benefits are in addition to what regular Medicare provides under Parts A and B.

Please note that this summary is for general information purposes only and should not replace personalized advice from licensed professionals or official Medicare resources.

To determine if a Medicare Advantage plan is suitable for you, please call us at 833-265-9655 (TTY: 711).

Next Steps:

Get Help

Compare Medicare coverage options with the help of one of our agents:

Talk to us: (833) 265-9655 

Top Mistakes People Make When Turning 65 (According to Reddit Users)

TL;DR – Top Medicare Mistakes to Avoid When Turning 65 Choosing a plan based only on the premium: $0 Medicare Advantage plans often come with hidden costs. Missing the Medigap open enrollment window: After 6 months, you could be denied or charged more. Thinking COBRA protects you: It doesn’t delay your need to enroll in

Read More

Plan G Is Not Cheap… But Here’s Why It Might Be the Best Deal in Healthcare

✅ TL;DR: Medigap Plan G offers the most comprehensive Medicare Supplement coverage available in 2025. It’s not the cheapest, but it helps you avoid surprise bills, see any doctor who accepts Medicare, and enjoy predictable healthcare costs. For many turning 65, it’s the safest long-term choice. Plan G costs how much?! Medicare decisions can feel

Read More

Medicare Mayhem: An Honest Look at Turning 65

It Starts the Way It Always Does…You’re turning 65. The mailbox is overflowing. Your phone won’t stop ringing. You can’t even watch Judge Judy without hearing about free flex cards and $0 premiums. Suddenly, you’re the most popular person in the Medicare universe.It’s not just confusing — it’s exhausting. Every flyer screams urgency. Every call promises savings.

Read More

Turning 65 Medicare: Avoid Costly Mistakes Now

Turning 65 Medicare: Choosing between Medicare Advantage and Medigap Plan G is a pivotal decision for individuals approaching 65. This guide aims to clarify both options, helping you make an informed choice tailored to your healthcare needs and financial situation.Medicare Plan Comparison Example: Meet Jane, Age 65If you’re turning 65 and trying to make sense

Read More

Medicare Minute: Plan G vs. Plan N – Which One Is Right for You?

✅ TL;DR: Plan G offers more comprehensive coverage with higher premiums, covering Part B excess charges and eliminating most copays. Plan N has lower premiums but includes copays for doctor and ER visits and doesn’t cover Part B excess charges. Choose based on your healthcare usage and budget preferences. Plan G vs Plan N is

Read More

Medicare brokers such as Lehigh Partners get paid by the insurance companies they represent. And you pay exactly the same rate for your insurance if you use a Medicare consultant (broker). There is no extra fee or cost for enrolling through a broker. You will never pay a fee for our help.


Find a Plan

Shop for coverage online. Safe, Secure, & Confidential

Call us

Call Lehigh Partners at 1-833-265-9655

Licensed insurance agents are available to help you through enrollment and beyond.

Need Help?

Get in touch with a licensed sales agent now by filling out the form - no obligations!

Get Our FREE Medicare Checklist.

Download our complimentary Medicare checklist and conveniently access all the necessary information in one place, ensuring you never miss a crucial number, deadline, or date again.

Tags


Senior Medicare Advisors: Understanding the Role of Senior Healthcare Advisors

As the population ages, there is an increasing need for specialized healthcare services catered towards seniors. Medicare, a federal health insurance program primarily designed for individuals aged 65 and above, plays a crucial role in providing affordable healthcare coverage. However, navigating through the complexities of Medicare can be overwhelming for seniors. This is where Senior

Read More

Does Medicare Cover Wheelchair Ramps?

Medicare, as a federal health insurance program in the United States, provides coverage for various medical expenses. However, when it comes to durable medical equipment, such as wheelchair ramps, the coverage might not always be straightforward. This article will explore the extent to which Medicare covers wheelchair ramps, taking into account the necessary criteria, limitations,

Read More

How to Sign Up for Medicare Part A: Easy Instructions

Sign up for Medicare Part A with this step-by-step guide. Learn about eligibility, enrollment periods, and how to fill out the application. Ensure a seamless process to access essential healthcare benefits. Contact the Social Security Administration for further assistance. Medicare Part A provides coverage for inpatient hospital care, skilled nursing facility care, and some home

Read More

How To Get The Best Medicare Supplement Rate

Find the best Medicare rate for enrolling in a Medicare Supplement Plan any time of the year. Don’t miss out! Unlock the Best Medigap Rate with Expert Guidance from Our Agents! TALK TO AN AGENT During the Medicare Annual Election Period (AEP), which brings Medicare to the forefront of thought for individuals of Medicare age,

Read More

How to switch from Original Medicare to Medicare Advantage

Enrollment in Medicare Advantage has seen a significant increase of over 100% in the past decade.1. One of the driving factors behind this is the availability of plans with premiums as low as $0, that provide coverage for prescription drugs, dental, vision, and hearing care – all of which are not covered by Original Medicare. Making

Read More

What is the Medicare Flex Card for Seniors?

A Medicare flex card helps cover health-related expenses like OTC medicine, dental copays, and more. It’s not related to original Medicare.The prepaid debit card, known as the Medicare flex card, is actually issued by Medicare Advantage plans and not the U.S. government. It is available through select private Medicare Advantage plans as a means to

Read More

Ready to talk to an agent about your Medicare coverage?