Turning 65 in Philadelphia? Your Medicare Enrollment Checklist

Turning 65 is an important milestone, and for many Philadelphia residents, it also means it’s time to start thinking about Medicare. Understanding when to enroll, what coverage options are available, and what decisions you’ll need to make can help you avoid unnecessary confusion as your 65th birthday approaches.

Medicare has several different parts, enrollment periods, and coverage options. Preparing ahead of time can make the process much easier and give you an opportunity to carefully consider which coverage may fit your healthcare needs and budget.

If you’re turning 65 in Philadelphia, use this Medicare enrollment checklist to help you get started.

1. Know When Your Medicare Enrollment Period Begins

For most people becoming eligible for Medicare at age 65, the first opportunity to enroll is known as the Initial Enrollment Period.

Your Initial Enrollment Period generally lasts seven months. It begins three months before the month you turn 65, includes your birthday month, and continues for three months afterward.

For example, if you turn 65 in November, your Initial Enrollment Period generally begins in August and continues through February.

Enrolling at the appropriate time is important because delaying enrollment in certain parts of Medicare may result in late-enrollment penalties unless you qualify for a Special Enrollment Period.

2. Understand Medicare Part A and Part B

Before comparing private Medicare plans, it’s helpful to understand the foundation of Medicare coverage.

Medicare Part A primarily helps cover inpatient hospital care, skilled nursing facility care, hospice care, and certain home healthcare services.

Medicare Part B generally helps cover services such as doctor visits, outpatient care, preventive services, and certain medical equipment.

Together, Medicare Part A and Part B are commonly referred to as Original Medicare.

3. Decide How You Want to Receive Your Medicare Coverage

Once you understand Original Medicare, one of the biggest decisions you’ll face is how you want to receive your Medicare benefits.

One option is to remain with Original Medicare and potentially add separate prescription drug coverage and supplemental insurance.

Another option is a Medicare Advantage plan, also known as Medicare Part C. Medicare Advantage plans are offered by private insurance companies approved by Medicare and provide your Medicare Part A and Part B benefits. Many plans also include prescription drug coverage and may offer additional benefits.

There isn’t one type of Medicare coverage that’s right for everyone. Your healthcare needs, preferred doctors, prescriptions, budget, and other factors should be considered when reviewing your options.

4. Think About Prescription Drug Coverage

Prescription medications are another important consideration when you’re enrolling in Medicare.

Original Medicare generally doesn’t include coverage for most outpatient prescription drugs. Beneficiaries who choose Original Medicare can consider a standalone Medicare Part D prescription drug plan.

Many Medicare Advantage plans also include prescription drug coverage.

Before choosing coverage, make a list of the medications you currently take, including the dosage and frequency. This information can be useful when reviewing available plans and their drug formularies.

5. Consider Whether Medicare Supplement Coverage Fits Your Needs

If you decide to receive your benefits through Original Medicare, you may also want to learn about Medicare Supplement insurance.

Medicare Supplement plans, commonly called Medigap, are sold by private insurance companies and can help pay certain out-of-pocket costs that Original Medicare doesn’t cover.

Your Medicare Supplement Open Enrollment Period generally begins when you’re 65 or older and enrolled in Medicare Part B and lasts for six months. Understanding this enrollment window is particularly important because your options and underwriting requirements may be different if you apply later.

6. Make a List of Your Doctors and Healthcare Providers

Before selecting Medicare coverage, make a list of the doctors, specialists, hospitals, and other healthcare providers you regularly use.

This is especially important when considering Medicare Advantage because provider networks can vary between plans.

If you have physicians or specialists in the Philadelphia area that you want to continue seeing, check whether they participate in the plan you’re considering before enrolling.

7. Review Your Healthcare Budget

Don’t compare Medicare options based solely on the monthly premium.

Depending on your coverage, healthcare expenses may include premiums, deductibles, copayments, coinsurance, and prescription drug costs.

Think about both your current healthcare usage and the possibility that your healthcare needs could change in the future.

8. Don’t Assume the Same Medicare Plan Is Best for Everyone

Friends and family members may recommend the Medicare coverage they use, but their healthcare needs may be very different from yours.

A plan that works well for one Philadelphia Medicare beneficiary may not be appropriate for another. Doctors, medications, healthcare usage, finances, and personal preferences can all influence which options you may want to consider.

Taking the time to compare coverage based on your own circumstances can help you make a more informed decision.

9. Get Medicare Help in Philadelphia

Understanding Medicare for the first time can feel overwhelming. You don’t have to sort through every option by yourself.

BroadZero is a licensed independent health insurance agency helping Medicare beneficiaries in Philadelphia and throughout Pennsylvania understand their coverage options.

Our licensed agents can help you review the Medicare plans BroadZero offers and discuss options based on factors such as your doctors, prescriptions, healthcare needs, and budget.

BroadZero’s Pennsylvania office is located at 33 Chester Pike, Collingdale, PA 19023.

If you’re approaching your 65th birthday, starting the Medicare process early can give you more time to understand your options and prepare for your enrollment period.

Request a complimentary Medicare benefits review from BroadZero and get help understanding the Medicare options available to you.

BroadZero does not offer every plan available in your area. Any information we provide is limited to the plans we do offer. Please contact Medicare.gov or 1-800-MEDICARE to get information on all of your options.