Turning 65?
Know your next step.

You must have Parts A and B to join. You can choose Original Medicare instead. Some plans offer dental, vision or hearing benefits and a yearly out-of-pocket limit for covered medical services.

You generally still pay your Part B premium plus any plan premium. A $0 plan premium does not mean free care: copays, deductibles and other costs may apply. Check doctors, hospitals, prescriptions, referrals, prior authorizations and travel coverage. Medigap cannot supplement Medicare Advantage.

Original Medicare: Ask whether each provider takes Medicare, will accept you as a patient, and accepts assignment for your care. Assignment means accepting Medicare’s approved amount; your normal share may still apply.

Medicare Advantage: “We take Medicare” does not establish that the doctor is in your exact plan’s network. Check the exact plan name, hospital, specialists, lab and imaging center with both the plan and each provider. Ask about referrals and out-of-network costs.

Ask: “Are you in this exact plan for the coming year, and will you continue my current treatment?”

Check every drug’s exact name, strength, form and quantity against the new plan’s formulary (covered-drug list). A drug can be covered but placed on a different cost tier, restricted to a specialty pharmacy, or subject to new approval rules. Check whether your pharmacy is preferred or standard and what you would pay there.

Original Medicare by itself generally does not cover most outpatient prescriptions; you may need a separate Part D plan. Many Medicare Advantage plans include drug coverage. Infusions and other clinician-administered drugs can follow Part B rules instead.

Ask: “What will each medication cost at my pharmacy, and are there any approval, step-therapy or quantity rules?”

Prior authorization: The plan must approve certain care or medication before it pays. Step therapy: You may need to try another drug first. Quantity limits: The plan limits how much it covers per fill. A previous insurer’s approval is not a promise of ongoing coverage from the new plan.

Original Medicare usually does not require prior authorization or specialist referrals, but exceptions exist. Medicare Advantage and drug plans may have these requirements. Ask your doctor’s office to check the new rules before scheduling procedures or refilling medication.

Ongoing treatment: Ask about continuity-of-care protection. Coordinated-care Medicare Advantage plans must provide at least a 90-day transition period for a person currently undergoing treatment who switches to a new plan; during it the plan may not require prior authorization for the active course of treatment. Confirm the treatment and provider arrangements with the plan.

Drug transition fill: You may qualify for a temporary fill while your doctor seeks an exception or satisfies plan rules. It is a bridge—not permanent approval. Contact the plan and prescriber before medication runs out.

Ask who pays first after Medicare starts. Employer size and current employment matter. Retiree plans may require Parts A and B. Joining outside Medicare drug coverage can sometimes end employer or retiree benefits for you or your dependents, and dropped benefits may not be recoverable.

Medicare is individual coverage; it does not cover your spouse or children under your policy. If you have Marketplace coverage, update only the people and dates that need changing, and ask how premium tax credits change. Do not assume enrolling in Medicare automatically cancels another policy.

Ask your current insurer: “Can I keep this? What changes when Medicare starts? Will my family lose anything? If I drop it, can I ever get it back?” Get the answer in writing.

You may qualify for both Medicare and Medicaid. Your state decides your Medicaid eligibility; turning 65 or getting Medicare can change the eligibility category or required review. Do not cancel Medicaid simply because Medicare starts.

Medicare generally pays first for Medicare-covered care. Full Medicaid may pay Medicare premiums and other costs and cover services Medicare does not. Most prescription coverage shifts to a Medicare drug plan; check its medications, pharmacy, effective date and Extra Help status. Medicaid may cover some drugs that Medicare does not.

If you are in the Qualified Medicare Beneficiary (QMB) program, Medicare providers cannot bill you for Medicare-covered deductibles, coinsurance or copayments; a small Medicaid copayment may apply. Show your Medicare and Medicaid/QMB cards and ask for help with an improper bill.

Ask your state office: “Will my Medicaid continue? Which program am I in? Who pays my premiums? Are my doctors, home-care services and prescriptions still covered?”

Do not compare the premium alone. Check deductibles, copays, coinsurance, specialist visits, hospital care, medications, and benefits you use such as dental, vision or hearing. Original Medicare has no annual out-of-pocket limit for its covered services unless other coverage helps; Medicare Advantage has a limit for covered Part A/B services, with prescription drug costs handled separately.

Ask about Medigap eligibility and timing if considering Original Medicare. Review HSA contributions before Medicare starts, especially possible retroactive Part A. Check every coupon or assistance program’s eligibility rules again when coverage changes.

Help may exist: Extra Help can lower drug costs. The Medicare Prescription Payment Plan spreads covered out-of-pocket drug costs over the year; it does not reduce the total owed.