THE WHO, WHAT & WHEN OF MEDICARE 2025

HANSON INSURANCE | EMILY HANSON

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Medicare is a federal health insurance program designed for eligible U.S. citizens and legal residents. Funded partly by the taxes you pay during your working years, it provides individual coverage that can be complex to navigate on your own. Below are clear answers to some of the most common questions:

Q: DO YOU HAVE TO BE 65 TO GET MEDICARE?

Generally, yes. However, individuals under 65 who have a qualifying disability, end-stage renal disease (ESRD), or amyotrophic lateral sclerosis (ALS) can also qualify for Medicare.

Q: IS MEDICARE ENROLLMENT AUTOMATIC AT 65?

Not always. There are two situations:

1. If you're receiving Social Security Retirement benefits when you turn 65, you'll be automatically enrolled in Medicare Parts A (hospital) and B (medical), and your Medicare card will arrive in the mail 3–4 months before your birthday.

2. If you're not receiving Social Security benefits at 65, you must actively enroll as automatic enrollment does not occur.

Q: I DON’T GET SOCIAL SECURITY RETIREMENT BENEFITS YET. WHEN SHOULD I SIGN UP FOR MEDICARE?

Your initial enrollment period is a 7-month window: starting 3 months before the month you turn 65, the month of your birthday, and extending 3 months after. If you miss this window, you'll have to wait until the next calendar year—typically January through March—for another opportunity, unless you qualify for a Special Enrollment Period.

Q: WHAT ARE THE MEDICARE PENALTIES I’VE HEARD ABOUT?

If you miss your initial enrollment window and lack other creditable coverage (coverage as good as or better than Medicare), penalties will kick in. For Part B, the penalty is an additional 10% per year, and for Part D (prescription coverage), there's a 1% per month penalty. These penalties will remain added to your monthly premiums for life.

Q: I’M STILL WORKING. DO I HAVE TO SIGN UP FOR MEDICARE?

It depends on your employer plan. If your company has 20 or fewer employees, Medicare might be required as your primary coverage, with your employer plan secondary. In larger companies with 21 or more employees, the employer plan usually stays primary, and Medicare acts as secondary if you enroll. It’s best to confirm with your benefits administrator.

Q: DO I HAVE TO STAY ON MY GROUP PLAN WHEN I TURN 65?

No. At 65, you’re free to choose Medicare, combined with an optional Medigap plan and prescription coverage, or a Medicare Advantage plan. Comparing your group coverage with these individual options is wise, and consulting a Medicare broker can help you make the best decision.

Q: HOW MUCH DOES IT COST TO GET HELP FIGURING ALL OF THIS OUT?

Usually nothing but unfortunately that may change. In the past, Medicare brokers have been paid 100% by insurance companies on commission. Their services have been free for you but as of 2025 some insurance companies have stopped paying brokers for their assistance and the industry will have to adapt.

We do not offer every plan available in clients’ area. Currently we represent 13 organizations which offer 92 plans in your area. Please visit Medicare. gov or contact 1-800-MEDICARE or your local State Health Insurance Program (SHIP) to get information on all of your options. We also offer many top rated Medicare Supplement organizations.