What to know when enrolling in Medicare after age 65 with health issues

Dear Toni: I am retiring on Jan. 1 and am beginning to search for the right Medicare option for me and my wife, who is having treatment at a local cancer center. Her cancer treatment drugs are expensive, and I am concerned about the Medicare Part D out-of-pocket costs. I am a diabetic and use a flex pen and take blood pressure medications. Most of my prescriptions are generic, except for the diabetic prescriptions.

Our Medicare Part B will begin Jan. 1 as my company benefits will end Dec. 31. What should I do to prepare for this medical insurance change? I will be 70 and my wife, Sandy, is turning 65 by the time I retire, and I want to be sure I do this correctly. — Scott, San Diego

Dear Scott: With Medicare, there is no cookie cutter, one-size-fits-all solution. Everyone’s finances, health and prescriptions are different, and should be considered in finalizing your Medicare choices.

Scott, it is imperative to search for the most cost-effective Medicare Part D prescription drug plan that covers all the prescriptions that you and Sandy have.

Many people simply don’t practice proper Part D planning. They are more concerned about their doctors and fail to ensure that their prescriptions are covered.

Every Part D plan has a formulary, whether it is a stand-alone plan or a Medicare Advantage plan with a prescription drug plan. If your drugs are not on that formulary, you will pay 100 percent out of pocket.

The 2025 Medicare Part D plans will be released Oct. 1. I recommend that you and Sandy begin researching which Part D plan covers all of your prescriptions and has the best price.

Medicare Part B is like gold because of what it offers, and those receiving Medicare Part B for the first time need to understand the value of the Medigap/Medicare supplement open enrollment period. This six-month period begins the first month that you have Medicare Part B (medical insurance) and you’re 65 or older.

During this window, you can enroll in any Medicare supplement plan without having to answer health questions and you cannot be denied coverage. After the six-month period, medical underwriting takes place, and those with existing health problems may not qualify for a supplement plan.

Many new Medicare beneficiaries explore Medicare Advantage plans, which can be a good option. Given the health conditions that you and your wife have, Scott, be sure to talk with your doctors about which Medicare Advantage HMO or PPO plans they accept.

Toni King is an author and columnist on Medicare and health insurance issues. If you have a Medicare question, email info@tonisays.com or call 832-519-8664.