Medicare at 65: What Virginia Beach Residents Need to Know Before Their Birthday

Your 65th birthday is approaching, and with it comes one of the most important healthcare decisions of your life – choosing your Medicare coverage. Unlike other birthdays, this one comes with homework, deadlines, and decisions that will affect your health and finances for years to come.

After helping Virginia Beach residents prepare for Medicare for over 10 years, I've learned that the better prepared you are before your 65th birthday, the smoother your transition will be. Let me share everything you need to know to approach your Medicare birthday with confidence rather than confusion.

The Medicare Basics: What You're Transitioning Into

Medicare Part A (Hospital Insurance):

• Covers inpatient hospital stays, skilled nursing facilities, hospice care

• Most people pay no premium if they've worked and paid Medicare taxes

• Has deductibles and coinsurance that can add up quickly

• You can go to any Hospital that takes Medicare

  
  

Medicare Part B (Medical Insurance):

• Covers doctor visits, outpatient care, preventive services, medical equipment

• Costs $206.50/month in 2026 

• Has an annual deductible

• Can go to any doctor, provider or specialist who takes Medicare

Medicare Part C (Medicare Advantage):

• Private insurance plans that replace Original Medicare

• Often includes prescription drug coverage and extra benefits

• Has network restrictions and geographic limitations

Medicare Part D (Prescription Drug Coverage):

• Standalone prescription drug coverage to add to Original Medicare

• Required to avoid lifelong penalties unless you have other creditable coverage

• Costs and coverage vary significantly between plans

Your Medicare Rights and Responsibilities at 65

Initial Enrollment Period Rights: You have a 7-month window (3 months before your 65th birthday, your birthday month, and 3 months after) to enroll in Medicare without penalties.

Medicare Supplement Guaranteed Issue Rights: For 6 months after enrolling in Medicare Part B, you can purchase any Medicare Supplement plan available in Virginia Beach without answering health questions or being denied coverage.

Prescription Drug Coverage Requirement: You must have creditable prescription drug coverage to avoid permanent Part D late enrollment penalties.

Annual Review Responsibility: Unlike employer insurance, you're responsible for reviewing and potentially changing your Medicare coverage each year during Open Enrollment.

Key Decisions You Must Make Before Your 65th Birthday

Decision 1: Original Medicare vs Medicare Advantage

Original Medicare + Supplements:

• Freedom to see any Medicare-accepting doctor

• Predictable costs with supplement insurance

• Works nationwide

• Requires separate prescription drug plan

Medicare Advantage:

• Lower monthly premiums, often $0

• Includes prescription drug coverage and extra benefits

• Network restrictions limit doctor choice

• Annual plan changes common

Decision 2: When to Enroll If you're still working with employer coverage, you might be able to delay Medicare Part B without penalties, but this requires meeting specific criteria.

Decision 3: Which Specific Plans Virginia Beach has dozens of Medicare plan options with different costs, coverage, and provider networks.

What to Expect Financially

Monthly Costs You'll Pay:

• Medicare Part B: $206.50/month (automatically deducted from Social Security for most people)

• Medicare Supplement: $120-200+/month OR Medicare Advantage: $0-100+/month

• Part D prescription drugs: $20-80+/month (if not included in Medicare Advantage)

Out-of-Pocket Costs:

• Original Medicare: 20% coinsurance on most services (reduced by supplement insurance)

• Medicare Advantage: Copays for services, annual out-of-pocket maximums

Costs Medicare Doesn't Cover:

• Most dental care

• Routine vision care and glasses

• Hearing aids

• Long-term custodial care

How Medicare Will Change Your Healthcare Experience

Provider Relationships:

• With Original Medicare: Keep any doctor who accepts Medicare

• With Medicare Advantage: Must use plan's network providers

Prescription Drugs:

• Your medications must be on your plan's formulary (covered drug list)

• Costs vary by plan and medication tier

• Some drugs require prior authorization

Claims and Billing:

• Medicare pays providers directly

• You'll receive Medicare Summary Notices showing what was covered

• Supplement insurance or Medicare Advantage plans handle remaining costs

Preventive Care:

• Annual wellness visits covered 100%

• Various screenings covered with no cost-sharing

• Some preventive services better covered than with typical employer plans

Virginia Beach-Specific Considerations

Local Healthcare Systems:

• Sentara Healthcare: Widely accepts Medicare and participates in most Medicare Advantage plans

• Bon Secours: Good Medicare acceptance, verify Medicare Advantage plan participation

• Independent physicians: Acceptance varies, important to verify before choosing plans

  
  

Snowbird Considerations: Many Virginia residents spend time in other states. Original Medicare works nationwide, while Medicare Advantage plans have geographic restrictions.

Military Benefits: Veterans and military retirees in our area need to understand how Medicare coordinates with VA benefits and TRICARE for Life.  Tricare beneficiaries need to sign up for Part A&B, but do not need anything further as Tricare for Life picks up the 20% not paid for by Medicare and also covers prescription drug coverage so there is no need for a drug plan.  

Red Flags: What Should Worry You

High-Pressure Sales Tactics: If someone is pressuring you to enroll immediately without giving you time to research and compare options, understand it is not Best Practices to operate this way.  You should end the conversation. 

Too-Good-To-Be-True Claims: Be skeptical of plans claiming to offer everything for free with no limitations.

Unlicensed Advisors: Only work with licensed insurance agents or certified Medicare counselors.

Limited Options: If someone only shows you one or two plan options, you're not getting the full picture.

Your Pre-65 Checklist

6 Months Before Your Birthday:

• Start learning about Medicare basics

• Inventory your current healthcare needs and costs

• Research local Medicare brokers and resources

3 Months Before Your Birthday:

• Compare specific Medicare plans available in Virginia Beach

• Understand how your current employer coverage coordinates with Medicare

• Schedule consultations with Medicare brokers

1 Month Before Your Birthday:

• Make final decisions on your Medicare coverage

• Complete enrollment applications

• Notify current insurance providers of your transition

Your Birthday Month:

• Confirm your Medicare coverage is active

• Update all healthcare providers with new insurance information

• Keep all documentation organized

What Happens If You're Not Ready

Delayed Enrollment Consequences:

• Part B late enrollment penalties: 10% per year for life

• Part D late enrollment penalties: 1% per month for life

• Loss of Medicare Supplement guaranteed issue rights

Coverage Gaps: Missing enrollment deadlines can leave you without coverage or with inadequate coverage for months.

Getting Help with Your Medicare Transition

Free Resources:

• Medicare.gov for official information

• State Health Insurance Assistance Program (SHIP) for free counseling

Professional Help: Working with a local Medicare broker provides personalized guidance at no cost to you, as brokers are paid by insurance companies.

Why Local Expertise Matters

As your Virginia Beach Medicare broker, I provide guidance specific to our local healthcare market:

• Understanding which local doctors and hospitals work with which Medicare plans

• Knowledge of plan options specifically available in our area

• Ongoing support beyond just enrollment

• Personal relationships with local healthcare providers and insurance companies

Your 65th Birthday Should Be a Celebration, Not a Crisis

With proper preparation, your transition to Medicare can be smooth and successful. The key is starting early, understanding your options, and getting help from local experts who understand both Medicare and the Hampton Roads healthcare landscape.

Call Retha Rish Insurance Agency at 757-692-8388 to prepare for your Medicare transition.

Don't let your 65th birthday sneak up on you unprepared. Start planning now to ensure you have excellent Medicare coverage from day one, allowing you to focus on enjoying this milestone birthday and the years ahead.