Who’s Eligible for Medicare at 65?

Most people become eligible for Medicare when they turn 65—but eligibility hinges on one key requirement: 40 quarters (or 10 years) of work history with contributions to Medicare. If you’ve worked enough, you’ll qualify automatically. But what if you stayed home to raise a family or served as a caregiver?

In those cases, you may be able to qualify using your spouse’s—or even ex-spouse’s—work history. The rules are specific: you must be married to your current spouse for at least one year or to your ex-spouse for at least 10 years. If you’re divorced, you must also remain unmarried before age 60 to qualify under their record. These small details can have a huge impact on your eligibility and what you pay.

What If You Don’t Have 40 Quarters?

Here’s the breakdown:

• If you have 30–39 quarters, Medicare Part A will cost you $285/month in 2025.
• Less than 30 quarters? You’ll pay $518/month.

My advice? If you’re close to the 40-quarter mark, keep working part-time. In 2025, you’ll get credit for one quarter for every $1,810 you earn—so it’s very doable!

When and How to Enroll in Medicare

Your Initial Enrollment Period (IEP) starts three months before your 65th birthday, includes your birthday month, and extends three months after. If you sign up early, your coverage starts on the first day of your birthday month. Enroll later, and your start date could be delayed.

Still working? You may qualify for a Special Enrollment Period (SEP) when you retire or lose employer health insurance. But remember: COBRA doesn’t count as credible coverage, so don’t rely on it to delay Medicare. You’ll need to complete forms L564 (for employer verification) and CMS 40B (to apply for Medicare Part B).

Working Past 65? Know Your Options

If you’re still employed and have coverage through a company with 20+ employees, you might not need to enroll in Medicare right away. But be careful—if you have a Health Savings Account (HSA), enrolling in Medicare Part A will disqualify you from making further HSA contributions. That’s why I often recommend reviewing your employer’s coverage against Medicare. Consider factors like premiums, co-pays, deductibles, and your out-of-pocket maximums. Sometimes, Medicare is the better deal!

Medicare Supplement vs. Medicare Advantage: Which Should You Choose?

Here’s a breakdown of the two main Medicare paths:

Supplement Plans

• Use any doctor that accepts Medicare
• Nationwide coverage—great for travelers
• No referrals needed
• Consistent costs: around $150–$180/month + $257 annual Part B deductible
• Lifetime coverage as long as premiums are paid

Advantage Plans

• Lower or $0 monthly premiums
• Local network restrictions
• May require referrals or prior authorizations
• Plans vary by zip code and can change when you move
• Higher potential costs during major medical events

In short: Supplement plans offer predictability and freedom. Advantage plans may fit a tighter budget but require more careful planning. Think about your travel habits, medical needs, and finances before choosing.

Need Help? You’re Not Alone

Every Medicare journey is unique, and I’m here to guide you through it. At MedicareSchool.com, we provide personalized advice to help you understand when to enroll and which plan works best for you.

Don’t wait until the last minute—Medicare is too important to wing it. Get the facts, plan ahead, and make confident choices for your future.

The post Navigating Medicare at 65: Eligibility, Enrollment, and Choosing the Right Plan appeared first on ROI TV.

Why COBRA Isn’t a Substitute for Medicare at 65
COBRA lets you keep your employer’s group health plan for a limited time after you leave your job—typically 18 months. While that sounds like a helpful safety net, it becomes dangerous when you hit 65. Once you turn 65, Medicare becomes the primary payer, and COBRA automatically becomes the secondary payer. That means if you haven’t enrolled in Medicare yet, COBRA won’t cover most of your medical bills. Imagine being stuck with 80% of a $100,000 hospital bill because you didn’t enroll in Medicare on time. That’s why you must enroll before your 65th birthday if you’re on COBRA.

The Initial Enrollment Period (IEP): Your Best Opportunity
Your IEP is the seven-month window that includes the three months before your 65th birthday, the birthday month, and three months after. If you’re on COBRA, enrolling during the three months before your birthday ensures Medicare coverage begins the first day of your birthday month. Wait too long, and you could have a dangerous coverage gap where you’re financially exposed.

Special Enrollment Period (SEP) for Those Retiring After 65
If you’ve continued working past 65 and had credible coverage through your employer, you get an SEP when you retire. This lets you enroll in Medicare without a late penalty—but only if you file the right forms promptly. You’ll need Form L564 (to prove you had credible coverage since turning 65) and Form CMS 40B (to request your Medicare start date). Timing matters here too—if your employer coverage ends June 30, your Medicare should start July 1 to avoid a lapse.

Don’t Miss the Medigap Open Enrollment Window
Once you enroll in Part B, you get a six-month Medigap Open Enrollment Period (OEP). During this time, you can sign up for supplemental plans like Plan G or Plan N with no medical underwriting. That means no health questions, no exclusions, and guaranteed approval. But once that window closes, it’s a different story. Applying later means answering 20–25 health questions and possibly getting denied based on your medical history.

Supplemental Plans Add Critical Protection
Even with Medicare Parts A and B, you’ll face deductibles and coinsurance. That’s where Plan G or Plan N come in. These supplemental plans pick up where Medicare leaves off and can save you thousands. But again, the key is to enroll during your Medigap OEP. Miss it, and your options could be limited or unavailable entirely, depending on your health.

The Biggest Risk: Gaps in Coverage
The biggest mistake I see? People assuming COBRA will fully protect them after 65. It won’t. As soon as you’re eligible for Medicare, COBRA becomes secondary. And if you haven’t enrolled in Medicare, you’re left holding the bag. You must align your Medicare start date with your COBRA end date or risk a gap in coverage that could cost you tens of thousands of dollars.

My Recommendations Are Simple
Enroll in Medicare before you turn 65 if you’re on COBRA. If you’re working past 65, use the SEP and submit Forms L564 and CMS 40B on time. And once you have Part B, take full advantage of the Medigap Open Enrollment Period. These steps can mean the difference between financial security and a lifetime of regret.

The post COBRA and Medicare: What You Must Know Before Turning 65 appeared first on ROI TV.

Here’s what you need to know about comparing employer insurance with Medicare, making the right decision, and avoiding costly mistakes.

1. Why Creditable Coverage Matters After Age 65

Medicare requires creditable coverage if you delay enrollment past 65.
If your employer coverage doesn’t qualify as creditable, you could face lifelong late enrollment penalties and coverage gaps.
COBRA is NOT creditable coverage—relying on it can lead to major financial risks.

Key takeaway: Always confirm with your HR department or insurer that your coverage is Medicare-creditable. If it isn’t, enroll in Medicare at 65 to avoid penalties!

2. Medicare vs. Employer Coverage: Which Is Better?

Many people assume staying on an employer plan is better, but that’s not always true. Medicare often provides more comprehensive and cost-effective coverage.

How to Compare Employer Coverage & Medicare

Employer Plan Considerations:
Does your employer have 20+ employees? If not, Medicare automatically becomes your primary coverage.
What are your monthly premiums? Many employer plans cost more than Medicare.
What are your deductibles & out-of-pocket costs? Medicare may cover more at a lower cost.

Medicare Benefits to Consider:
Medicare offers nationwide coverage, while employer plans often have network restrictions.
No referrals required for Medicare Supplement (Medigap) plans.
Medicare Part B costs $185/month in 2025, which may be lower than employer premiums.
Medicare Advantage (Part C) plans include low or $0 premiums, with added benefits like dental, vision, and hearing coverage.

Key takeaway: Compare your total costs, coverage networks, and out-of-pocket expenses—Medicare may be the better choice financially and offer better coverage.

3. The Risks of Non-Creditable Coverage & COBRA

What Happens If You Have Non-Creditable Coverage?

If your employer plan isn’t creditable, or if you rely on COBRA after 65, you risk:

Late Enrollment Penalties: 10% lifetime penalty on Medicare Part B for every 12 months you delay enrollment.
Coverage Gaps: COBRA is not primary insurance after 65—major medical bills may not be covered.
Higher Medical Costs: Employer plans may exclude retirees from certain benefits, leading to higher out-of-pocket expenses.

Key takeaway: COBRA is not a safe alternative to Medicare. If you lose employer coverage after turning 65, enroll in Medicare immediately to avoid gaps.

4. Why Enrolling in Medicare at 65 Is a Smart Move

Lower costs: Medicare may cost less than employer coverage.
Better coverage: No pre-authorizations, nationwide access, and lower deductibles with Medigap.
Peace of mind: No worrying about losing employer coverage or being denied due to health issues.

Medicare Enrollment Periods to Know:

Initial Enrollment Period (IEP): The 7-month window around your 65th birthday.
Special Enrollment Period (SEP): If you delay Medicare due to employer coverage, you have 8 months to enroll after losing your job-based insurance.
General Enrollment Period (GEP): January 1 – March 31, but late penalties apply if you missed IEP/SEP.

Key takeaway: If you don’t have creditable coverage, enrolling in Medicare at 65 is the safest and most cost-effective choice.

5. Retirement & Health Coverage Planning: What to Do Next

Step 1: Verify Employer Coverage – Ask your HR department if your plan is Medicare-creditable.

Step 2: Compare Costs – Calculate your monthly premiums, deductibles, and max out-of-pocket expenses.
Step 3: Plan Your Transition – If retiring soon, enroll in Medicare on time to avoid coverage gaps.

Need Help Choosing a Medicare Plan? Consult a Medicare expert or visit Medicare.gov to compare plans and make the best decision for your retirement!

The post Medicare & Creditable Coverage After 65 appeared first on ROI TV.