Aging Out at 65
Zion HealthShare memberships are available to all individuals under the age of 65. Most individuals above the age of 65 qualify for free or low-cost medical care through Medicare. We recognize the importance of this transition and aim to provide supportive information on navigating the shift to Medicare.
Zion HealthShare Membership and Age Limit
When a primary member or spouse reaches the age of 65, they are no longer eligible to continue membership with Zion HealthShare. Their membership will be withdrawn on the billing cycle in the month in which they turn 65. As you or your spouse approach age 65 you may have questions about how this transition works. Individuals under the age of 65 may remain members of the Zion HealthShare community if they choose. If the individual turning 65 is the primary member, those wishing to remain on the membership will need to become a primary member. Qualifying sharing requests submitted before age 65 will remain eligible for sharing and will be processed as quickly as possible. As per our member guidelines:
*Official Member Guideline
Medical incidents, services, and expenses that occur prior to the members age-out at sixtyfive (65), will have up to thirty (30) days after their membership end date to submit a sharing request. All other time limits will remain in effect including:
- Itemized bills and statements must be submitted within six (6) months of the date of service, and
- The IUA must be paid within six (6) months of the date of service, or they become ineligible for sharing.
Understanding Medicare
Medicare is a government health insurance program primarily for individuals aged 65 and older, though eligibility may also extend to those with disabilities, End-Stage Renal Disease (ESRD), or ALS. Enrollment can be automatic or require active sign up, often tied to Social Security Benefits. Part A and Part B coverage is automatic for those applying for Social Security benefits at least 4 months before turning 65. Those who want to receive Medicare benefits, but do not want retirement benefits right at age 65, will need to actively register. Click here to learn more about enrolling with Medicare.
Parts of Medicare
Medicare comprises several parts, with the most common being:
- Part A: Hospital Insurance
- Inpatient hospital care
- Skilled nursing facility
- Lab tests, surgery
- Home health care
- Hospice
- Part B: Medical insurance
- Doctors and other health care providers’ services and outpatient care
- Durable medical equipment
- Home health care
- Some preventive services
- Part C: An optional addition covering wellness programs, adult day-care services, transportation to doctor visits. Also known as Medicare Advantage
- Part D: Another optional addition for prescription drug coverage
Visit https://www.medicare.gov/health-drug-plans/health-plans for more information on other plans available through Medicare.
Important Considerations Before Transitioning to Medicare
Transitioning to Medicare can raise many questions. Here are some key points to consider:
- Pre-existing Conditions: Medicare cannot deny coverage for pre-existing conditions.
- Choosing a Medicare Plan (Part C & D): Original Medicare (Parts A & B) covers a large portion of medical expenses, but not everything. Consider enrolling in a Medicare Advantage Plan (Part C) for additional coverage, or a Part D plan for prescription drug coverage. Explore your options and choose a plan that best meets your needs and budget.
- Medicare Costs: Medicare has premiums, deductibles, and copays. The Medicare Plan Finder tool can help you estimate costs for different plans.
- Network of Providers: Some Medicare plans have specific networks of doctors and hospitals. Make sure your preferred providers are included in the plan you choose.
- Timeline for Enrollment: There are specific enrollment periods for Medicare. Late enrollment penalties may apply so it is important to understand the Medicare enrollment timelines. Click here to learn more about avoiding Medicare penalties
Zion HealthShare does not receive compensation from or have any affiliation with Medicare. The information provided is merely for your benefit and may not be up-to-date or accurate. It is your responsibility to verify the information provided. This information is not meant to be legal or medical advice.
Member Guideline Notice
Notice
Please note all article sections formatted like this are official member guidelines and will be marked “*Official Member Guideline” when applicable. Anything else is simply helpful information to assist you in understanding the member guidelines and how to use your Zion HealthShare Membership.
Members who call the Zion HealthShare office asking about eligibility of medical expenses will be given an opinion, not a decision. Sharing Requests and medical expenses cannot be authorized over phone. For more information on submitting bills to Zion HealthShare, review the Member Guidelines or login to your Member Portal.
These guidelines are effective as of January 1, 2025.
Note
The Member Guidelines that go into effect January 1, 2025 will only be applicable to sharing requests that are submitted on or after that date. If a sharing request was submitted prior to January 1, 2025 the sharing request will be reviewed for sharing eligibility according to the Member Guidelines in effect at that time.