Category Archives: Turning 65

Applying For Medicare Part A and Part B

Under normal circumstances, you may Apply for Medicare Part A and even Part B (only) at a local Social Applying for Medicare Part A and Part B Security Administration office.  Since appointments are limited, consider applying online:

  • You can apply for Part A and Part B at ssa.gov/benefits/medicare and until recently, via telephone appointment:  In some situations, it may still be possible to schedule a telephone appointment:  Phone Social Security at (800) 772-1213‬.
  • Use this link if you already have Part A and intend to Apply for Part B only
  • If you are returning to original Medicare from Medicare Advantage, read this.
  • Link to Social Security’s Video on applying for Medicare through the Social Security website.
  • When should you begin the process of applying to Medicare? Read about important timelines and deadlines in a recent article on this site or phone our office and request a consultation: 408-252-7300.  The ideal age to start understanding and preparing is age 62.
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Did you know, Local, Independent Agents are a free resource and can help you avoid delays and save time applying Medicare Medicare Part A and Part B.  And there is no added cost to your policy!  This saves you valuable time and helps avoid unexpected delays that could cause a missed deadline. Get a free initial consultation today and sign up for our Newsletter to receive periodic “good ideas” on Medicare.

Best Practices: Applying for Medicare Part A and Part B

  • If you are age 61, 62, 63 or 64, here is another must-read article.  It is also helpful for persons working past 65.
  • Find your doctors well before applying for Medicare- See related article.
  • Find a local, experienced Independent Agent, representing lots of insurance companies.

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Leaving Employer Insurance For Medicare

Get Prepared for Part B

It is time to think about leaving your employer insurance for Medicare and to Apply for Medicare Part B.  The purpose of this article is to help you prepare for Medicare, in advance, Losing Sutter Medicare: Returning from Medicare Advantage to Traditional Medicareand to avoid missing important deadlines, which could lead to missed opportunities or even extra costs.  Bookmark this story or share it with a friend.

CHECKLIST: Leaving Employer Insurance and Transitioning to Medicare From Employer Health Insurance

  1. First, if you are currently working and receiving employer-sponsored health insurance, do not sign up for Medicare Part B solely because you turned 65.  Read our related article to Understand what you are getting into.  While there are some exceptions, if you work for a large employer (20 or more employees), you don’t need to do this yet.
  2. Second, those employer plan disclosures e.g. Annual Notice of Creditable Coverage for prescriptions? Don’t throw them away if you are Age 65 or older.  This could cost you extra money.  My advice is to start a Medicare Preparedness File, and save this article as part of your checklist.
  3. Third, have a discussion with your primary care physician:  Ask if they currently accept new patients, especially those on traditional Medicare.  Be bold, and ask if they plan to retire in the near future.  It’s better to find out sooner than later if you need to research a new primary care physician.
  4. Fourth, find an independent agent who focuses on Medicare health plans…and I mean lots
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    of plans e.g FAQs on various Plan Gs.  You are going to need their ongoing, independent advice, as plans (and Medicare) do change over time.  Plus, you need help initially, to discuss a transition plan for leaving employer insurance for Medicare Part A and/or Part B and possibly coordinating temporary COBRA coverage for you and/or a spouse .  Finally, get independent feedback on all the medigap plans and different “flavors of G.”  We put together a good introduction to this topic.  Read:  The Buzz About Plan G and Plan G Extra.

“Our insurance agency is local, and fiercely independent, and contracted with 37 different insurance companies.”

It Is Foolish Not To Use A Local, Independent Agent

Californians do not receive a premium discount when you bypass an agent to go directly to

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the insurer; you only lose your “independence.”  Once you understand this, it is in your best interest to find an experienced, independent agent  to help your transition from employer-sponsored plans to the Medicare world (It’s better than waiting on hold for two hours with Social Security).

A more detailed article on these issues and important timelines and deadlines can be found on our website, derendingerins.com.

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“We do not offer every plan available in your area.  Any information we provide is limited to those plans we do offer in your area.  Please contact Medicare.gov or 1-800-MEDICARE to get information on all your options.”

Test Driving Medicare Advantage Plans in Santa Clara Valley

Are recent events tempting you to test drive any of the Medicare Advantage plans in Santa Clara valley? It seems more and more doctors are shying away from traditional Medicare (original Medicare Part A and Part B) in Santa Clara valley.  There is a buzz about reports that Sutter/ PAMF (Palo Alto Medical Foundation- formerly Camino Medical Group, Sunnyvale Medical Clinic etc.) is limiting access to new Medicare patients on traditional Medicare (read story). And in 2024, Stanford Medicine severed its only contract with Medicare Advantage.

According to the Kaiser Family Foundation, in 2021 42% of Medicare beneficiaries nationally have chose a Medicare Advantage plan over traditional Medicare.  This statistic has been growing for years.  So if your current physician is contracted with a Medicare Advantage plan…or if you are willing to try one of these plans, in order to gain access to Sutter/PAMF, should you give it a test drive (note:  the number of plans is expanding in 2023- see related story)?

Palo Alto Medical Foundation participates in popular Medicare Advantage plans in Santa Clara valley, as well as San Mateo and Santa Cruz counties. Some individuals are doing a test drive, in order to gain access to Sutter/ PAMF.  Before you “drive,” first, get independent advice, locally.

Before You Test Drive Medicare Advantage Plans

I would answer you first need a lot of information, including understanding the risks of Medicare Advantage plans. If I were to develop a list of best practices to research the issue, it would begin with finding a competent, local independent agent whom you are comfortable

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with.  Make sure you discuss what, if any, trial rights (i.e. guarantees that you can return to traditional medigap coverage) would apply to your situation.  Another recommendation is… find a doctor, before you apply to Medicare.

Best Practices for individuals approaching Age 65

  • Secure your primary care physician well before applying for Medicare
  • Find a local, experienced Independent Agent, representing lots of insurance companies

Medicare Advantage Trial Period

When you enroll in a Medicare Advantage plan for the first time, you may have Medicare “trial” protections and additional rights under California law, which could allow you to return to traditional Medicare with supplemental (medigap) coverage.  However, these rights do not apply in all circumstances and you should seek a consultation from a competent independent agent before enrolling.  I cannot emphasize this enough.

How do Independent Agents Get Compensated?

Local Independent agents do not charge fees, using them does not add to the cost of your insurance.  In fact, they are only compensated when they help you complete an enrollment application for insurance coverage.  Medicare sets the compensation dollar amount and for Medicare Advantage plans, it is the same from insurer to insurer. So there is really no incentive to favor one plan over another.  However, not every agent is independent and not every independent agent represents a large number of plans. You need to ask questions.

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When you find one, treasure that relationship, because good agents get booked up quickly through referrals.  You are going to need their help over the years because insurance companies have a tendency to bring new plans into the county and close older plans as time goes on.

By local, I mean an agent who is not out of state and not digital (online only).  Chances are good that local agents know your county better:  They hear and know what’s going on with local doctors and medical groups e.g.Sutter/ PAMF, SCIPPA, PMG.  Plus, Medicare Advantage and standalone prescription drug plans are contracted on a county by county basis. New plans are coming and going every year.

Here are my best practice suggestions for choosing a local, independent agent:

  • Represents at least three Medicare Advantage plans
  • Represents at least five Medicare Supplement (medigap) plans
  • Represents at least four standalone Part D prescription drug plans
  • Lots and lots of client references– ask for them or check YELP or both

Finding a Doctor

When I suggest “Find A Doctor” I am alluding to the recent development of some doctors shying away from traditional Medicare.  The Kaiser Family Foundation published an issue brief in 2020 that estimates 1.5% of California doctors have formally opted out of Medicare. While that leaves a healthy 98.5%, the recent Sutter/PAMF reports could be a game-changer.

Even Medicare Advantage (HMO) plans require you to designate a Primary Care Physician on your enrollment application.  Bottomline you need to find a doctor.

Here’s my suggestion:  Find your doctors(s) before you apply to Medicare and solidify the relationship by making sure you have been seen within the last year or two.  According to reports, PAMF is defining “existing patient” to mean someone who has been seen by their doctor within the last three years.

I have additional ideas for individuals working past 65 (read story).

Bottomline, find a doctor and find a competent, local independent agent.

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Timelines and Deadlines of Medicare Part B

Applying for Medigap Insurance is easy, but understanding the timelines and deadlines of Medicare Part B is critical, and will be the focus of the remainder of this article.  Insurers will not issue you Medigap (Medicare Supplement) Insurance until you are enrolled in Medicare Parts A and Part B. However, many will accept your application early and pend it, while your Medicare application is being processed.

Timelines and deadlines of Medicare Part B

The official U.S. Government Handbook on Medicare is called Medicare and You. Another valuable government publication is Choosing a Medigap Policy.  These combine for 128 pages of valuable information.  Yes, it’s a lot of pages, and if you want the readers digest version, ask for help:  Connect with an independent agent in west San Jose- it’s FREE and will save you hours of time: (408) 252-7300.  The links to publications are at the bottom of this article, and the following are some important excerpts:

Timelines and Deadlines of Medicare Part B:  Initial Enrollment Period

I encourage everyone to get a local consultation e.g. Silicon Valley/Bay Area by age 62, in order to understand “what you are getting into.”  But once you reach your Initial Enrollment Period or IEP, you can first sign up for Part A and/or Part B during the 7-month period that begins 3 months before the month you turn 65, includes the month you turn 65, and ends 3 months after the month you turn 65. If you sign up for Part A and/or Part B during the first 3 months

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of your Initial Enrollment Period, in most cases, your coverage starts the first day of your birthday month. However, if your birthday is on the first day of the month, your coverage will start the first day of the prior month. If you enroll in Part A (that you have to pay for) and/or Part B the month you turn 65 or during the last 3 months of your Initial Enrollment Period, the start date for your Part B coverage will be delayed. 

“Remember, in most cases, if you don’t sign up for Part A (if you have to buy it) and Part B when you’re first eligible, you may have to pay a late enrollment penalty.”

Still need help?  Then get an independent agent– Did you know there is no extra cost for these services?  They are compensated by your Medigap insurance company and you will pay the same low premium with or without an agent.

Timelines and Deadlines of Medicare Part B:  General Enrollment Period 

If you didn’t sign up for Part A (if you have to buy it) and/or Part B (for which you must pay premiums) during your Initial Enrollment Period, and you don’t qualify for a Special Enrollment Period, you can sign up between January 1–March 31 each year. If you enroll using this SEP, Your coverage won’t start until July 1 of that year, and you may have to pay a higher Part A and/or Part B premium for late enrollment.

What’s the Part B Late Enrollment Penalty? 

If you don’t sign up for Part B when you’re first eligible, you may have to pay a late enrollment penalty for as long as you have Part B. Your monthly premium for Part B may go up 10% for each full 12 months in the period that you could’ve had Part B, but didn’t sign up for it. If you’re allowed to sign up for Part B during a Special Enrollment Period, you usually don’t pay a late enrollment penalty. See page 17

Still need help?  Then get an independent agent– there is no extra cost for these services.

In California, many of us work past Age 65, how does that affect timelines and deadlines?

If you didn’t sign up for Part B when you were first eligible because you’re covered under a group health plan based on current employment, then you can sign up for Part B anytime while you’re still covered by a current employer group medical plan.  You also may sign up for Part B during the 8-month period, immediately after employment or coverage ends (the period begins based on whichever occurs first). This is referred to as a Special Enrollment Period.  

If you are working past 65, and thinking about transitioning off employer health insurance,  we have prepared a checklist to help you, but read this first.

There are other Special Enrollment Periods, in certain situations. Get an independent agent to guide you at no extra cost or phone Medicare directly at 1‑800‑MEDICARE (1‑800‑633‑4227).

Resources and Links

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