Ask The Medicare Specialist

My husband got early retirement from his job and decided to take Social Security at 62. He will be 65 in the middle of June. It’s my understanding that since he is already receiving Social Security, he will automatically be enrolled in Medicare.  When will he receive his Medicare card/information?  I worry because we are just 4 months away. I am trying to navigate this myself as he is currently not in a healthy position to do so, and I want to ensure I’m on time, so everything is ready in June. My second question is about the remaining parts of Medicare. We both currently have an ACA health insurance plan we got directly from one of our local companies. I’m still several years away from turning 65 so I will have to keep it for myself.  Do we go to where I purchased health insurance to get his Medicare plan(s)? I went to a retail office in the town where I live. Any advice you can provide me with would be greatly appreciated.

I’m going to start off by making sure Sue and all our readers understand that although I write the columns to help educate the public on Medicare and plan options, The Health Insurance Store is a for-profit company. We make our living helping people enroll in Medicare, health, and life insurance plans. It’s how I was able to pay for the costs associated with publishing the columns in the Post Gazette and now digitally on Facebook, our website, and other social media outlets. Please contact us to schedule a no-cost consultation with myself or another of our licensed and experienced agents. We’re brokers appointed to provide plans from every competitive company on the market. Those who use our services will always have both the Supplement and Advantage Plan options presented, be shown plan design and prices from multiple companies, and are ensured to get unbiased advice which often means getting a recommendation for plans we don’t’ get paid a commission for.

Should Sue go directly through an insurance company to get her husband’s Supplement and Part D or Advantage Plan? Absolutely not. No one should. Why? Because the representatives you’re going to speak with are employees and only able to present their own products. Sue stated her husband is not in good health which makes it even more important all his options get laid out on the table. When you go directly through a company, it’s likely only the Advantage Plans get presented, not Supplements. In Sue’s husband’s situation, enrolling in an HMO or PPO at age 65 and staying on it for 12 months or longer would eliminate the possibility he would be able to enroll in a Supplement for at least two or more years, possibly ever, depending on his health conditions. He also could end up with out-of-pocket costs in the $5,000 to $6,500 range this year alone.

Here’s another scenario. You call a company directly, go to their website, or walk into their retail location and want an Advantage Plan. You’re on Ozempic. The agent recommends one of their more popular plans, a good choice for many and one we often recommend to those who prefer Advantage Plans. However, on one of these plans, cost for Ozempic for 2025 would be around $1,600. With a competing company, Ozempic would be $0 for the year. However, that option was never provided for the same reason when you call All State for a quote on auto insurance, they’re not going to explain that State Farm or Liberty Mutual has a similar policy with lower premiums and deductibles.

Here’s one more example where going direct is a mistake. Let’s say Sue’s husband was given the Supplement option, and the differences between them and Advantage Plans were explained correctly. With his medical conditions, he wisely chose Plan N, which we recommend most to clients who prefer Supplements. However, the premium for Plan No with the company she’s referring to is $180/month. Plan N with the companies we would quote and enroll him in are $95 to $100/month. For the exact same coverage with access to the exact same doctors and hospitals! He would get no benefits for the extra $1,000 per year.

As you can see, going directly through a company for Medicare plans can be a very costly, possibly permeant, mistake! It’s also extremely common unfortunately.

Let me now address when Medicare cards arrive. For those like Sue’s husband who are already collecting Social Security prior to turning 65, enrollment in Medicare is automatic. A card should come in the mail about 115 days prior to the month one turns 65, in Sue’s husband’s case, mid-February with June 1^st Part A and B effective dates. I got Sue’s email the morning of February 13^th. I actually told her she might find her husband’s card in the mail that afternoon. For those who aren’t collecting prior to 65, you must apply for Medicare either online, which I highly recommend, or calling Social Security which can slow the process down. Once an application has been submitted, it takes up to 30 days to receive a Medicare card.

Thanks for reading the columns, everyone! I’m going to start the edited for 2025 New to Medicare column, a 10-part series, in the next couple of weeks. Although the title may give the impression that it’s only for people like Sue’s husband who is turning 65 soon, or those who have worked past 65 and going on Part B for the first time, it’s a great way to for those already Medicare to learn more how Original Medicare by itself works as well as the differences, pros, and cons of Supplements versus Advantage Plans.

If you have questions regarding Medicare or to schedule an appointment with an agent, give us a call or email me personally, aaron@getyourbestplan.com.