Turning 65 is a major milestone and a big deal – not just because of the cake and presents, but also because it’s time to start thinking seriously about Medicare. But we all know that sometimes, adulting is necessary, and that is definitely true when it comes to approaching 65 – now is the time to get prepared for proper coverage if you live in Texas.
And no, the process doesn’t have to be overwhelming, especially when you understand the steps involved and what your options look like. We’re here to help you navigate Medicare with clarity and confidence. Let’s walk through what you should do before you turn 65 to make sure you’re ready.
What Is Medicare? (And What It Doesn’t Cover)
Medicare is a federal health insurance program primarily for people aged 65 and older. It comes in several parts:
- Part A: Hospital insurance (usually premium-free if you’ve worked and paid taxes for 10 years).
- Part B: Medical insurance (doctor visits, outpatient care, etc.).
- Part C: Also known as Medicare Advantage, a private insurance alternative to Original Medicare that often includes extra benefits.
- Part D: Prescription drug coverage.
It’s important to know that Medicare doesn’t cover everything. Services like vision, dental, and hearing may not be included in Original Medicare. That’s where supplemental coverage or a Medicare Advantage plan can help.
When Should You Enroll in Medicare?
You have a 7-month window to enroll in Medicare:
- Three months before your 65th birthday
- The month of your birthday
- Three months after
We recommend starting at least three months before your birthday to avoid coverage delays or late penalties, especially if you’re not receiving Social Security yet, since you’ll need to sign up.
Original Medicare vs. Medicare Advantage: What’s Right for You?
One of the biggest decisions you’ll make is whether to stick with Original Medicare (Parts A and B) or choose a Medicare Advantage (Part C) plan.
- Original Medicare allows more flexibility in choosing doctors and hospitals, but it doesn’t cap out-of-pocket costs.
- Medicare Advantage plans are offered by private insurers, often include prescription drug coverage, and may offer dental, vision, and hearing benefits. Many of these plans are available throughout Texas.
Not sure which is best? That’s where our team at Wise Insurance can walk you through your choices based on your health needs and budget.
Why You Shouldn’t Skip Part D Prescription Coverage
Even if you don’t take any medications right now, enrolling in Part D when you’re first eligible is important. If you wait too long, you could face a late enrollment penalty that sticks around for life.
Part D plans are offered by private companies and vary in cost and coverage, so we’ll help you compare what’s available in your part of Texas to find the right fit.
Should You Consider a Medigap Plan?
If you decide to go with Original Medicare, you may want a Medigap plan to help cover out-of-pocket costs like deductibles and copayments. These plans are also sold by private insurers and are standardized across most states, including Texas.
You’ll get the best pricing if you enroll in Medigap during your six-month open enrollment period, which begins when you’re 65 and enrolled in Part B.
What If You Still Have Employer Coverage at 65?
Still working and covered by an employer plan? You may be able to delay enrolling in Part B without penalty, but that depends on your company size and the quality of the coverage.
Talk to your HR department and speak with a Medicare advisor to understand how Medicare will work alongside your current insurance and what steps you need to take.
Your Next Steps to Get Medicare-Ready in Texas
Don’t wait until the last minute. Preparing for Medicare before you turn 65 gives you the best opportunity to avoid penalties, understand your choices, and ensure a smooth transition into retirement or your next stage of life.
Whether you’re still working, planning to retire soon, or just unsure about what steps to take, the good news is: you don’t have to figure it all out on your own. We know that health insurance decisions can feel overwhelming. That’s why our licensed advisors are committed to walking you through the process in a way that’s simple, honest, and focused on your needs.
Let Wise Insurance simplify your Medicare journey—because turning 65 should be a celebration, not a source of stress.
Don’t navigate Medicare alone—let Wise Insurance walk you through it. Call us today or book a free consultation to get expert help tailored to your situation.
Emily Trevino, Senior Managing Partner at Wise Insurance, leverages her extensive background in biology and business finance to master Medicare, health insurance, and retirement planning. With over a decade in the field, Emily has co-authored “Medicare Breakdown – The Alphabet Soup of Medicare,” marking her as a pivotal figure in insurance education. Her commitment extends through active participation in the National Association of Benefits and Insurance Professionals (NABIP) and speaking at major industry events. Emily’s drive for community service and personal resilience shines through her adventurous pursuits and dedication to societal well-being. Connect with Emily on LinkedIn to explore the future of informed insurance decisions.
