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 Question: I am turning 65 in April of 2025 and wondering about Medicare and Social Security Benefits. Should I be signing up now for Medicare and Social Security?

Answer: First, I want to say, “Happy early birthday!”
I know that April sounds warm and sunny to me, and it will come quicker than we think!
This 65^th birthday is an especially exciting year for many people. We often think of retirement and relaxing more. This may or may not be your situation, but you need some information about Medicare and Social Security.

The answer is different for both of these benefits so I will answer this question with two articles. One this week and one next week. This week I will address Medicare. There are over 67 million individuals on Medicare. Medicare coverage eligibility usually begins at age 65 (some individuals get Medicare coverage earlier due to a disability or illness).

Medicare coverage always begins on the first of any given month, and for most individuals that is the month in which you turn 65. For those individuals born on the 1^st of the month your coverage actually begins a month early. If you were born on the 18^th, or the 29^th or the 2^nd of April your coverage begins on the first of April. If you are born on April 1^st, your coverage will begin on March 1^st. So, if you are born on the 1^st you need to start a month earlier with this process.

You are not eligible for Medicare until April of 2025, so you have time to relax, but not as much as you may think. You can certainly begin to look at the Medicare information, and begin to become comfortable with the language of Medicare, but you can’t sign up for any products or make your choice yet.

If you are collecting Social Security in some form (widow’s benefits, early retirement benefits, disability or other types) then Medicare will start automatically in the month you turn 65. About three to four months prior to your 65th birth-month, Medicare will send you a packet of information, including your Medicare ID card. If you want to keep these Medicare benefits, you do not need to do anything to have your benefits begin – you simply watch for the card in the mail and put it in your wallet when it arrives. Your coverage will begin automatically the first of your birth-month, and the Part B premium will be deducted from you Social Security Income. You will receive written notification from SSA about this premium and your adjusted SSI amount. In 2025, the Medicare Part B premium for most enrollees is $185 per month.

If you are NOT collecting Social Security benefits, then you MUST contact the Social Security Administration (SSA) to begin receiving Medicare benefits at age 65, three months before your birthday. This is a step that many miss as they are approaching age 65. Medicare does send you a letter to remind you to sign up, but some individuals miss that notification.

If you do NOT enroll in Medicare A & B when originally eligible, you will have some restrictions as to WHEN you can enroll, and may have premium penalties when you enroll. It’s important to note that even if you do not sign up for Medicare when eligible, if you had insurance through you or your spouse’s employer may not need to pay a premium in many circumstance. Generally, the employer coverage for your or your spouse must be active employment, and the employee group must be 20 or more employees if you are 65 (or 100 or more employees for Medicare enrollment due to Disability).

Most retiree plans offered by employers will require you to join Medicare at age 65 if you want to continue to receive coverage from their plans after leaving active employment. So you may choose to keep that retiree coverage you have, but then you must sign up for Medicare A & B when eligible.

The contact information for SSA is on the web www.SSA.gov or call at 1-800-772-1213. You may also reach out to your local SSA office. Remember that the SSA simply handles the enrollment – they can’t help you make your insurance decision beyond that Medicare enrollment.

Each year our life changes and we never know exactly what will change. For you, there are definitely changes coming in your insurance situation and Medicare will be a part of that. I think you will be pleased with your options under Medicare.

If you have questions or need assistance navigating your options, don’t hesitate to reach out to the Lawley Medicare Solutions Team. You can contact Medicare Service Team Lead Gabrielle Connor at 716.849.8223, or submit an inquiry through our contact form below. We’re here to help you find the right coverage for your needs!

At Lawley Medicare Solutions, our Medicare and Individual Health Consultants are dedicated to helping you make the most informed decisions about your healthcare needs. We offer personalized service and expert advice tailored to your unique situation. Contact us today by phone or email to schedule a consultation and ensure you’re getting the best coverage for your needs.

Read all Inside Medicare articles HERE.

LAWLEY HAS A TEAM DEDICATED TO MEDICARE INSURANCE!

Our licensed Medicare & Individual Health Insurance team can help clients understand the details of Medicare insurance plans, assist with choosing the right benefits and coverage, and provide guidance when life events that affect health coverage occur.

For questions, concerns, or to reach Lawley Medicare Solutions, call 716.849.8223.

 Question: Why are there still commercials about Medicare products on TV? I thought Open Enrollment was over?

Answer: Many of us are aware of Medicare’s Annual Open Enrollment Period, which runs from October 15 to December 7 each year. However, you may not be familiar with the Medicare Advantage Open Enrollment Period (MA-OEP), which takes place from January 1 to March 31. This three-month opportunity is for individuals with a Medicare Advantage Plan, allowing them to switch to any other type of insurance product they choose, with or without drug coverage.

Medicare Advantage Plans (MA) are plans that replace your Original Medicare benefits and usually include prescription drug coverage. There are over 45 MA Plans in the WNY region. While this is fewer than in previous years, it still offers many options. Each plan has different monthly premiums, co-pay structures, and networks of providers, so I will speak broadly about this situation.

Medicare Advantage Plans are health plans that replace traditional Medicare, including options such as HMO (Health Maintenance Organizations), PPO (Preferred Provider Organizations), and PFFS (Private Fee For Service) plans. Each year, insurance companies adjust the coverage of their MA plans, including premiums, co-pays, deductibles, extra benefits, and more. As a result, the plan you let roll over may differ from what you expected.

During the January to March Enrollment Period, you can switch from one MA Plan (with or without drug coverage) to another MA Plan (with or without drug coverage), or from Medicare Advantage to Original Medicare with a Stand-Alone Drug Plan (PDP), or even to Original Medicare with no drug coverage.

It’s also important to remember that if you drop a Medicare Advantage Plan and return to Original Medicare, you should seriously consider adding a Medicare Supplement Plan. Leaving your HMO, PPO, or PFFS plan will default to your Original Medicare coverage, but you will need to actively enroll in both a Drug Plan and a Medicare Supplement Plan. These options do not happen automatically, but the Medicare Consultants at Lawley Insurance can help!

If, for any reason, you chose not to include drug coverage in your current Medicare Advantage Plan, you can now change that choice from January 1 to March 31.

During this period, your new coverage will begin the first of the following month. If you change your insurance in March, your new plan will begin on April 1. This is significant because, after April 1, you may be locked into your plan for the rest of the year without a Special Enrollment Period (SEP) available to you.

The MA-OEP is also helpful for individuals who decide they no longer want to stay in their Medicare Advantage Plan for any reason. One reason could be an increase in premiums or co-pays. Another reason could be that your doctor, hospital, or pharmacy no longer participates in the Medicare Advantage Plan you thought you wanted to keep. People sometimes switch out of MA Plans because of serious medical conditions, such as cancer or renal failure, which may be better covered by Original Medicare.

You may also want to switch your plan if you have gone to the pharmacy recently and found that your medications are more expensive than you expected, or more expensive than last year. Even though you chose not to switch your insurance, the insurance company may have made changes that impact you. Evaluating your insurance choice before it’s too late could help you save money, as you may be locked into your plan for the year after April 1.

If you decide to return to Original Medicare, I always stress the importance of evaluating the option of adding a Medicare Supplement Plan in this situation. In New York State, you can enroll in a Medicare Supplement Plan at any time. There are no pre-existing condition limitations because you are transitioning directly from one product to another, and the “pre-existing condition” clause does not apply to you.

The MA-OEP is certainly one of the ways to switch your insurance right now until March 31! That’s why you’ll continue to see commercials on TV, receive mail from, and possibly get calls from Medicare Advantage Plans.

If you have questions or need assistance navigating your options, don’t hesitate to reach out to the Lawley Medicare Solutions Team. You can contact Medicare Service Team Lead Gabrielle Connor at 716.849.8223, or submit an inquiry through our contact form below. We’re here to help you find the right coverage for your needs!

At Lawley Medicare Solutions, our Medicare and Individual Health Consultants are dedicated to helping you make the most informed decisions about your healthcare needs. We offer personalized service and expert advice tailored to your unique situation. Contact us today by phone or email to schedule a consultation and ensure you’re getting the best coverage for your needs.

Read all Inside Medicare articles HERE.

LAWLEY HAS A TEAM DEDICATED TO MEDICARE INSURANCE!

Our licensed Medicare & Individual Health Insurance team can help clients understand the details of Medicare insurance plans, assist with choosing the right benefits and coverage, and provide guidance when life events that affect health coverage occur.

For questions, concerns, or to reach Lawley Medicare Solutions, call 716.849.8223.