Turning 65 in Santa Barbara County

Find out whether Medicare is coming to you or you are going to it

If you are already drawing Social Security or Railroad Retirement benefits about four months before you turn 65, Part A and Part B are enrolled for you automatically and a card arrives in the post. If you are not drawing benefits yet, which is now the common case because so many people delay claiming, nothing happens automatically. You have to sign up, and no one will chase you.

This is also the moment to answer one question: are you still working, and does your employer have twenty or more employees? If so, the timeline on this page may not apply to you, and the rules on working past 65 do instead.

Make a written list of every doctor, specialist and clinic you intend to keep using. You will need it in month three, and it is easier to write calmly now than under time pressure later.

The Initial Enrollment Period opens

On the first day of the third month before your birth month, you can enroll. Enrolling now, rather than later, is the single most useful thing on this page, because enrolling in any of these three months makes your coverage start on the first day of your birth month with no gap.

One quirk worth knowing. If your birthday falls on the first day of a month, Medicare treats you as turning 65 during the previous month, so the whole seven month window shifts one month earlier than you would expect. We check this for every client rather than assume it.

Decide the shape of the coverage

This is the fork in the road. A Medicare Supplement, also called a Medigap policy, pairs with Original Medicare and a separate Part D prescription drug plan, and lets you use any doctor or hospital in the country that accepts Medicare. A Medicare Advantage plan replaces the way Original Medicare pays and routes your care through a network set for your county.

In Santa Barbara County this decision usually resolves faster than people expect, because of how few Advantage networks exist here. The detail is on Supplement or Advantage on the Central Coast.

If you are going the supplement route, this is where you compare Plan G against Plan N. Plan F is not on the table for you: it is closed to anyone who became eligible for Medicare on or after January 1 2020.

Apply, and get the drug plan right

Applications take time to underwrite, issue and load into the carrier system, so leaving this to the birth month itself creates avoidable stress. Apply in the month before.

Do not treat Part D as an afterthought even if you take no medication today. The Part D late enrollment penalty is triggered by going 63 or more days without creditable prescription drug coverage after your Initial Enrollment Period ends, and it is calculated from the national base beneficiary premium rather than from whatever plan you eventually join. A person who takes nothing at 65 and needs something at 70 pays that penalty for as long as they hold Part D.

Bring us the actual medication list, with doses. Formularies differ enough that the right drug plan for your neighbour is often the wrong one for you.

Coverage begins, and a second clock starts

Part A and Part B are now in force. On the first day of the month in which you are both 65 or older and enrolled in Part B, your Medigap open enrollment period begins and runs six months.

That six month period is worth more than almost anything else in Medicare. During it, any company selling Medigap in California must sell you any plan it offers at its published rate, with no health questions, no underwriting, and no ability to charge you more or decline you because of your medical history. Outside it, most Medigap applications go through underwriting and can be declined.

It is not six months from your birthday. It is six months from the first month you are both 65 or older and enrolled in Part B, which for someone who delayed Part B can be years later.

The window narrows

You can still enroll in Part A and Part B during these three months, but coverage now starts on the first day of the month after you sign up rather than on your birthday, so a gap opens. If a hospital admission lands in that gap it is yours.

Your Medigap open enrollment period is running through this stretch as well, and it does not pause. Every week spent deciding is a week of guaranteed issue spent.

What happens if you miss it

If you had no other qualifying coverage, the next scheduled opening for Part B is the General Enrollment Period, January 1 to March 31, with coverage starting the first of the month after you enroll. A Part B late enrollment penalty is added to your premium for as long as you have Part B.

There are exceptions. Special enrollment periods exist for losing employer coverage, for moving, for a plan leaving your area, and for several other situations, and they can restore rights you thought were gone. If you have already passed a deadline, call before you assume the worst.