Whether you’re approaching 65, already on Medicare, or just planning ahead, understanding how Medicare works—and how to make the right choices at the right time—is critical. At Cardinal Advisors, we specialize in helping individuals navigate Medicare as part of their broader retirement planning. And in this post, we’re breaking down a crucial lesson: Four Steps to Medicare and Insurance at Age 65.
Step One: Do You Need or Want Medicare at 65?
The first and most important step is figuring out whether you need Medicare when you turn 65—or if you can delay it.
Most people assume they must sign up at 65 or face penalties. And while that’s true in many cases, there are key exceptions. If you’re still working (or your spouse is) and covered by credible group insurance from a large employer (20+ employees), you may be able to delay without penalty. But here’s the catch—COBRA and ACA plans don’t count as credible coverage for Medicare purposes.
That means if you retire at 65 and stay on COBRA for a while, you could get hit with lifetime penalties when you try to enroll in Medicare later. Don’t assume. Verify your coverage. Better yet—call us and we’ll walk you through it.
Many people skip Step One entirely and jump straight into choosing plans. But skipping this step can cost you dearly. If you’re unsure whether you qualify for a delay, we’ll help you make that decision confidently.
Step Two: Learn How Medicare Works (Before Choosing Insurance)
Once you’ve figured out whether you need Medicare at 65, the next step is learning how the system actually works. Medicare is divided into four parts:
- Part A: Covers hospital stays and skilled nursing. Free for most people who worked long enough.
- Part B: Covers outpatient care and doctor visits. Carries a monthly premium (about $185 in 2025).
- Part C: Also known as Medicare Advantage. It’s a private insurance alternative that bundles A, B, often D, and extra benefits.
- Part D: Prescription drug coverage.
Here’s where it gets confusing. There are also Medicare supplement plans, labeled Plan A, B, C, D, F, G, N, etc. These are different from the “Parts” of Medicare. The government loves its letters, but the overlap can trip people up.
Before choosing a plan or talking to an agent, understand how Medicare functions—both the parts and the plans. Otherwise, you could end up choosing a plan that doesn’t fit your needs or even overlaps improperly.
Step Three: Choose Your Insurance Path—Original Medicare or Medicare Advantage
Now that you understand how Medicare works, it’s time to pick your path. This is where the big “OR” comes in.
Option 1: Original Medicare + Supplement (Medigap)
If you stay with Original Medicare (Parts A and B), you can purchase a Medicare Supplement, also called a Medigap policy. These plans are standardized, which means a Plan G from one company is the same as Plan G from another—only the price differs.
At Cardinal Guide, we offer a free rate comparison tool on our website that lets you search by ZIP code without giving up your personal info. You can see how much Plan G or N would cost in your area—sometimes the same coverage costs double depending on the insurer.
Option 2: Medicare Advantage (Part C)
With Medicare Advantage, you’re transferring your Medicare benefits to a private insurance company like Aetna, Humana, or Blue Cross. You usually get extra perks—like dental, vision, gym memberships—and often a $0 monthly premium.
Sounds great, right? But there’s a trade-off. You’re now in a managed care system. That means you’ll need to stay in-network, get referrals, and may face higher out-of-pocket costs when you use care. Plus, if you want to switch back to Original Medicare later, you may have to answer health questions—and could be denied coverage.
So while Medicare Advantage can be a great fit for some, it’s not always the best option long-term.
Step Four: Understand the True Cost of Medicare
Let’s talk dollars. People often ask us: “What is this all going to cost me?” Here’s a side-by-side comparison of the two main options:
| Expense | Original Medicare + Supplement | Medicare Advantage |
|---|---|---|
| Part B Premium | $185/month | $185/month |
| Part D (Drug Plan) | ~$50/month | Usually included |
| IRMAA (High-income adjustment) | $0 – $700/month | $0 – $700/month |
| Supplement Plan (e.g., Plan G) | $125 – $300/month | Not applicable |
| Dental & Vision | ~$50/month (separate plan) | Often included |
| Out-of-Pocket When Sick | Very low | Higher (copays, limits) |
| Freedom to See Any Doctor | Yes | Limited to network |
Key Insight: The Medicare Advantage route might look cheaper month-to-month, but can cost more when you actually need care. Plus, switching from Advantage to a Supplement later can be tricky if your health changes.
The Bottom Line
Medicare decisions are complex—but they don’t have to be overwhelming. The key is following the four steps in the right order:
- Determine if you need or want Medicare at 65.
- Learn how Medicare works before picking a plan.
- Choose your path: Original Medicare + Supplement OR Medicare Advantage.
- Understand the true cost, including IRMAA, premiums, and care expenses.
At Cardinal Advisors, we specialize in making Medicare understandable, manageable, and connected to your larger retirement plan. We’re CFPs, not just insurance agents. That means our advice is rooted in your long-term financial health—not commissions.
Got questions? Want help comparing plans? Ready to sign up? Call us or visit CardinalGuide.com to get started—no pressure, no spam, just clarity.
