Category: Medicare Advantage

Can I Really Get a Medicare Advantage Plan For Free?

Posted on October 24, 2017 by - Medicare, Medicare Advantage, Medicare Annual Enrollment

Can I Really Get a Medicare Advantage Plan For Free?

Yes, for quite a few Medicare Advantage plans, you will not have to pay a dime in premiums. And to sweeten to deal, you can even get extra benefits like gym memberships or a built in drug coverage with some plans. But I’m very stingy with my use of the word “free.”

 

From my experience, an Advantage Plan is free in the same way the newborn puppies of your best friend’s dog are “free.” You may not have to pay for the puppy, but how many know having man’s best friend around the house isn’t exactly a recipe for super savings (especially if you’ve got furniture and footwear that look especially appetizing in black and white)?

 

You see, a Medicare Advantage Plan might not cost anything in premiums, but it may eat up your money in the end. I’m not saying they aren’t right for some people, in fact; I’ve placed people in $0 Advantage Plans to their long-term satisfaction. For the cost-conscious retiree who is romping into retirement, healthy as a horse, it may be the best option. But before you purchase one, make sure you understand the hassles and extra costs that come along with the decision. I’ve outlined a few of the most important ones:

 

Networks

Advantage Plans have networks of health care providers that they have contracted with, usually within a fairly tight geographic area. If you do not receive care at one of their pre-picked providers, it can mean much higher copays and coinsurance amounts. If you are in an HMO plan, they may not even cover you at all while receiving care out of network. This can work just fine for a person who stays local most of the year, but it does put the burden on you to ensure that your health care provider is in-network. Making mistakes could cost you heavily.

 

Inconsistency

With a Medicare Supplement, the benefits are stable, but with an Advantage Plan, this is hardly ever the case.

 

Since the private insurance companies that offer Advantage Plans re-file their contract with Medicare every year, the benefits always change—sometimes dramatically. One of your preferred doctors could go out of network. Copayments, coinsurance, and deductibles can all shoot up. This is why you must review your plan every year so you won’t be caught unaware. If you set your plan to the side and forget about it (see “Don’t Set it and Forget It!) for even one year, it can be quite upsetting financially.

 

Potentially High Out-of-pocket Costs

I always like to remind people that Advantage Plans have more of a “pay as you go” approach. You pay less in premiums, yes.  But you may make up for it in deductibles, copayments, and coinsurance. For example, almost all Advantage Plans still keep you on the hook for the 20% coinsurance on Part B. That’s fine for an x-ray, but not as much for an outpatient surgery that may be $20,000 or more.

So be aware, Advantage plans do limit your annual out-of-pocket spending, but these caps are generally pretty high. If you have a period of extended illness, you could spend anywhere from $3500-6000 per year or more!

 

That doesn’t sound like free to me.

 

Need Expert Help Navigating Medicare? Confused About Your Options?

Click here to sign up for our free Medicare workshop or call our office at 937-492-8800 and get the guidance you need! No high-pressure sales pitches here, just in-depth discussion about the ins and outs of Medicare!

6 Annual Enrollment Dates You (Quite Literally) Can’t Afford to Forget

Posted on October 16, 2017 by - Medicare, Medicare Advantage, Medicare Annual Enrollment, Medicare Drug Plan

6 Annual Enrollment Dates You (Quite Literally) Can’t Afford to Forget

I know you’ve got a lot of dates to juggle: birthdays, anniversaries, holiday get togethers, or departure dates for long awaited travel plans. But you have to leave some empty space—in your memory and on your calendar—to add these 6 dates.

 

Why?

 

Because the Medicare Annual Enrollment Period is upon us, a time when the Medicare marketplace is bustling with transactions. Beneficiaries such as yourself are switching Drug Plans, Advantage Plans, or transitioning from an Advantage Plan to a Medicare Supplement or vice versa. These are strategic moves you can only make during Annual Enrollment!

 

Now, if you are thinking, “I’m perfectly fine with my health insurance. I’ll just let it go this year,” I’d like to offer a word of warning: Not reviewing your Medicare health insurance plans this Annual Enrollment Period could cost you thousands. You see, Benefits and premiums change from year to year, so you have to review your plans with a professional to ensure you are still in the best-valued plan for your needs.

 

It doesn’t seem like letting it slide just one year could end up being so costly, but I’ve seen it happen again and again. In fact, I recently had a man come into my office in January, confused about why his approximately $190 per month prescription wasn’t covered anymore. As it turns out, he missed Annual Enrollment. The insurance company dropped his prescription from their formulary (list of covered drugs) for the new year. Unfortunately, I had to tell him, he was stuck in the ill-fitting Drug Plan for the whole year, the consequences of a mistake that would (by the end of the year) cost him $2,280. Ouch.

 

So, if you are a current Medicare beneficiary, get your pen ready and calendar ready. Annual Enrollment (October 15—December 7) is chock full of clear-cut deadlines. Don’t find yourself locked into a financially draining health insurance plan! You (quite literally) can’t afford to miss these 6 dates:

1. October 1st

This is the day we, as an insurance agency, receive all of the new information regarding plan changes.

  • Did your Drug Plan drop your most expensive prescription from its formulary?
  • Was there a premium hike?
  • If you have an Advantage Plan, is your doctor still considered “in-network?”

October 1st is the day we have all these answers and can speak to you about the possibility of switching to save you money and hassle.

 

Note: You can call about your options anytime during Annual Enrollment, but the earlier is truly the better. This time of year is quite busy!

2.October 15

The marketplace is open!  Annual enrollment has officially begun, and you can now enroll in a new plan.

3.December 7

I hope you have made all the necessary changes, because—at this date—you are locked into your plans for another year. Annual enrollment is closed.

4.January 1

It’s a new year, a new resolution, and—quite possibly—new insurance. This is the date any changes you made during the open enrollment period go into effect.

5.January 1

Nope, you didn’t just read the same line twice, and you are not seeing double! I know this is a repeat, but I want to clarify why this date is worth the extra mention: It is also the first day of the Advantage Plan disenrollment period. Just in case you’re second-guessing your decision, Medicare set up a disenrollment period where you can get out of your Advantage Plan with no penalties.

6.February 14

Finally, this is the last day of Medicare’s disenrollment period. If you are in an Advantage Plan and don’t like it, this is your last chance to drop it!

BONUS: February 14th is also Valentine’s Day. You’re welcome.

 

Looking to Review Your Plans With a Medicare Expert?

Even if you are not yet sure if you want to switch, I recommend giving Seniormark a call at 937-492-8800! Our friendly and caring staff is more than willing to be a resource during this bustling Annual Enrollment season. We will help ensure you meet all the deadlines and end up in a great plan for your needs and pocketbook as the New Year rolls around.

The #1 Reason Why You Should Enroll in Medicare Part A

Posted on August 4, 2017 by - Medicare, Medicare Advantage, Medicare Supplement

The #1 Reason Why You Should Enroll in Medicare Part A

(Even If You’re Still Working)

Whether or not you should sign up for Part B while still actively employed is a little more questionable. I mean, why pay that $134 a month premium if you’re employer plan is doing a fine job at a cheaper price. But Part A is not like that. There are basically no downsides to enrolling once you’ve turned 65. Why, you ask?

Because It’s Free!

Of course, that is neglecting the fact that you’ve paid into social security for about 40 years and—therefore—have earned it. But—wherever you stand on the proverbial “free lunch” debate— this does not change the fact that Medicare Part A has no associated premium. If you are approaching 65 and have paid into Social Security for at least 10 years, there is no reason to delay.

There is only one reason why you would want to opt out of Part A…

Health Savings Accounts

If your have an HSA and wish to continue contributing to it, you may want to delay Part A. Of course, you can still have an HSA. And you can still use it to pay medical expenses. But you cannot put any money into it after you enroll in Medicare. There are some people who do, of course—whether unknowingly or purposefully—but this is not a wise choice. If the IRS audits you, you will be subject to a stiff penalty. According to IRS publication 969, the penalty is 6% of your contribution and its interest until you remove the funds from your HSA.

But other than that, you should definitely enroll in Part A if you are approaching 65. All those years of the government dipping into your earnings have paid off—if only in a small way. There may not be such a thing as a “free lunch”, but there is such a thing as taking advantage of what you’ve so rightfully earned.

We know. Medicare is confusing. Still have questions?  Just contact Seniormark at 937-492-8800 for a free consultation, or sign up for our next workshop!

 

 

A Side-by-Side Comparison of Medicare Advantage and Medicare Supplements

Posted on July 18, 2017 by - Health and wellbeing, Medicare, Medicare Advantage, Medicare Drug Plan, Medicare Supplement, Retirement Planning, Uncategorized

A Side-by-Side Comparison of Medicare Advantage and Medicare Supplements

When it comes to Medicare, you only have two big options. That’s it.

The piles of mail you’ve been receiving from various agents as you approach 65 do not represent hundreds of choices. There are only 2 ways to get your Medicare coverage.

First, I hope you have already signed up for Medicare (If not, hop on over to our blog titled “What Is the Fastest Way to Sign Up For Medicare? to take care of that, then come back and read the rest of this!).

The first way is just to stick with original Medicare—Parts A and B. Then you need what is known as Medicare Supplement Insurance, named as such because it “supplements” Medicare, filling in the gaps of what Medicare doesn’t cover.

The other option, however, is to get a Medicare Advantage Plan. This is an alternative to Original Medicare provided through private insurance companies that have contracted with Medicare. Although you still have to sign up for Parts A and B to be eligible, this replaces Medicare as the primary payer of your claims.

Choosing one or the other comes down to what’s most important to you. You can’t have both! What I am going to do is hold both of these options up to the light, side-by-side, so you can see clearly the strengths and weaknesses of each.

Check it out:

Medicare Supplement

 

PROS  

  1. Minimal Out-of-Pocket Spending

You won’t have much coinsurance or copays with a Supplement. Most of it is covered.

 

  1. Predictability

They are also fairly consistent from year to year. They do creep up in premium (see our blog “Beat the Medicare Supplement Creep”, but they rarely leap! The benefits are guaranteed to stay the same.

 

  1. Out-of-State Coverage

Supplements cover you the same whether you are in your home state or out. Vacation homes? Extensive trips? No big deal. You’re covered.

 

  1. No Networks

You are free to use any doctor or hospital that accepts Medicare without sacrificing your coverage.

 

 

CONS

  1. Higher Premium

An in-the-ballpark average Supplement price is about $110 per month premium. This is higher than most Advantage Plans.

 

  1. No Drug Plan

Drug plans are not built in. You have to get a stand-alone drug plan, which cost an average of $34.10 per month in 2016.

 

Medicare Advantage

 

CONS

  1. High Out-of-Pocket Spending

Advantage plans have more of a pay-as-you-go approach. Higher copays, coinsurance, and unexpected costs are common.

 

  1. Unpredictability

Since Advantage plans are funded by government subsidy, benefits and premium costs tend to vary from year to year as a result.

 

 

 

 

  1. Out-of-State Coverage…Sometimes

Only in the case of emergency will you receive coverage out of your home state. Other than that, you’re on your own.

 

  1. Networks

They have them…networks of preferred hospitals and doctors. If you don’t use those preferred providers, you might have less coverage or—depending on the plan—no coverage at all.

 

PROS

  1. Low to No Premium

The average premium is somewhere around 60 dollars a month. Some are even free!

 

  1. Built-in Drug Plan

The vast majority of Advantage plans include a drug plan. No hassle or extra premium for you!

As you can see, the Medicare Supplement route is more costly, but there are a lot of benefits that give you more peace of mind and—all in all—less hassle.

On the other hand, the Medicare Advantage route is more economic, but it has fewer benefits, leading to unexpected costs and stress.

But both do their jobs. They both limit the potentially high out-of-pocket spending that is left by Medicare alone. Whatever you choose, don’t leave yourself vulnerable. Medicare alone is never a good idea!

Turning 65 soon and not sure what to do? Click here to sign up for our free Medicare workshop. No high-pressure sales pitches here, just in-depth discussion about the ins and outs of Medicare!

Workshops

10 Medicare Terms To Get You Started

Posted on July 12, 2017 by - Health and wellbeing, Medicare, Medicare Advantage, Medicare Drug Plan, Medicare Supplement, Retirement Planning, Uncategorized

10 Medicare Terms To Get You Started

If you’ve ever done research in your life, you know that knowledgeable people sometimes overdo it. They use words that only other life-long Medicare experts would know.

 

And when you ask them to explain, what do they do? Use even bigger and scarier words to describe the ones you didn’t understand in the first place. Our philosophy: Never use a big word, when a singularly un-loquacious and diminutive linguistic expression will do the trick.

 

Over our 19 years of helping retirees, it has served us well. Now we are here to pass our knowledge onto you in words you understand. To get started, here are 10 commonly used terms:

1. Medicare

At the top of the list, I like to kick-it-off with the basics. Medicare is a government-run health care program for those over 65. It is also for younger people with disabilities or kidney failure, but its primary concern is to serve the older generation.

2. Medicaid

This is often confused with Medicare, but they are completely different programs. Although they both serve the same purpose (to provide health insurance), Medicaid is for people with low income. There is a chance that you might be eligible for both programs at the same time.

3. Medicare Beneficiary

This is you. Or if you haven’t signed up yet, it will be you very soon. A Medicare beneficiary is a person enrolled in Medicare, receiving Medicare benefits.

4. Initial Enrollment Period (IEP)

The IEP is made up of 3 parts: the 3 months before you turn 65, your 65th birthday month, and the 3 months after. This 7-month window is the time that most people should sign up for Medicare. If you miss your IEP, it could lead to costly penalties. So pay attention. Like all time, those 7 months will fly by!

5. Part A

Medicare is divided up into 4 parts (A, B, C, and D). And Part A is your inpatient care. It includes nursing care, hospice, and some home health services. But—for the most part—it is coverage for when you are officially checked-in at a hospital.

6. Part B

Part B is exactly the opposite of Part A. It is your outpatient care, including lab tests, medically necessary supplies, and various screenings. To keep simple, Part B is care received while checked-out of the hospital.

7. Original (Traditional) Medicare

This one is simple. Whenever someone refers to original (or traditional) Medicare, they are referring to Parts A and B together.

8. Part C (Medicare Advantage)

Medicare Advantage is an alternative to original Medicare offered through private insurance companies that have contracted with Medicare. In other words, they replace Medicare as your health insurance provider. About 1 in 4 people choose Medicare Advantage, according to the Reader’s Digest. To find out the advantages and disadvantages of Part C, click here.

NOTE: You still have to sign up for Parts A and B to be eligible for Part C.

9. Part D

Part D is your drug plan. It covers your prescription medications. Also offered through private insurance companies, almost everyone signs up for Part D in addition to original Medicare (Parts A and B).

10. Medicare Supplement Insurance

A supplement is fondly nicknamed a “Medigap plan.” It is referred to this way because it “fills in the gaps” of what Medicare Parts A and B doesn’t cover on its own. Without it, you leave yourself quite vulnerable. There is no limit to what you could spend in uncovered health care costs!

That should be enough to get you started on this often-overwhelming journey of Medicare planning. As you continue to learn more and plan your retirement, we are committed to keeping you up-to date and informed…in words you can understand. How did we do? Leave us a comment below to pose any questions or concerns!

 

Turning 65 soon and confused about Medicare? Click here to sign up for our free Medicare workshop. No high-pressure sales pitches here, just in-depth discussion about the ins and outs of Medicare! We put it into words you can understand.

 

Workshops

Know The Drug Plan Lingo! 5 Terms to Get You Started

Posted on April 26, 2017 by - Employer, Medicare, Medicare Advantage, Medicare Drug Plan, Medicare Supplement

Know The Drug Plan Lingo! 5 Terms to Get You Started

Every field or discipline has its own language. And to the undiscerning ear, it can all run together into nonsensical jargon. Mumbo jumbo. Gibberish. Flim flam. Drivel. You get the idea. But if you want to walk the walk and get ahead, you must first talk the talk. To get you started, you’ve probably come across these 6 terms in your Part D Drug Plan research.

 

Formulary

I’ll start with an easy one. The formulary is simply the list of drugs a particular plan covers. There are 24 drug plans at your disposal. Not all of them will cover the same medications. This is why it is important to check a plan’s formulary to find out if it’s right for you.

 

Prior Authorization

If a drug plan requires prior authorization, it means that they will not cover certain drugs unless your doctor or prescriber proves that the medication is medically necessary.

 

Step Therapy

Drug companies do not want you on an expensive drug when a less expensive one will be just as effective. For this reason, they will often make their beneficiaries start on a generic or cheaper drug as a trial to see if it works just as well. If it doesn’t, then the beneficiary can “step” up to the more expensive (often name brand) medication. This is called step therapy.

 

Quantity Limit

Quantity limit is exactly what it sounds like: a limit on the quantity of a specific drug that a plan will cover. Drug companies limit quantity to reduce waste, curb drug costs, and prevent unsafe use. For example, if someone is on a pain medication with a standard dosage of 2 per day, the quantity limit for a month will likely be 60 pills. They don’t want people getting addicted or wasting them through misuse or carelessness.

 

Tiers

Drug plan companies often organize the medications they cover into levels or “tiers”. Drugs on a lower tier (often generic brands) have lower associated costs such as copayments or coinsurance. Drugs on a higher tier (such as name brand or specialty drugs) often have higher costs.

 

The Donut Hole

The donut hole is a gap is prescription drug coverage. After you reach $3,310 in total drug costs, you enter the donut hole (resulting in higher out-of-pocket costs). After you reach 4,850 in out-pocket costs, you leave the donut hole and enter into what is known as “catastrophic” coverage where the plan will cover 95% of your drug costs.

 

All done! If you finished reading this, your Medicare literacy just increased. But if you have run into any more difficult terms, leave a comment. We are more than willing to answer your questions. Or visit Medicare Interactive’s glossary for additional Medicare vocabulary.

 

Have other Medicare questions? Turning 65 soon and not sure what to do? Click here to sign up for our free Medicare workshop. No high-pressure sales pitches here, just in-depth discussion about the ins and outs of Medicare!

Is There an Advantage to Medicare Advantage?

Posted on April 21, 2017 by - Medicare, Medicare Advantage, Medicare Supplement

Is There an Advantage to Medicare Advantage?

According to Reader’s Digest, 1 in 4 retirees receive their health insurance coverage from a Medicare Advantage Plan.  And I can certainly understand the attraction.  Premiums as low as $0 a month.  Prescription drug plans often included.  What’s not to like?

 

But—as it goes for most purchases—you get what you pay for.  And when it comes to Medicare Advantage Plans, they definitely have a dark side.  Allow me to shed some light on the subject.

 

The Medicare (Dis)Advantage Plan

Networks

Medicare Advantage Plans contract with specific hospitals and doctors, usually within a relatively tight-knit geographic area.  If you don’t receive care from the ones with whom they’ve “networked”, you may be subject to higher copays or coinsurance at each visit. Depending on the plan, they may not even cover your expenses at all.

 

This can be a problem for anyone, but especially for those who travel frequently.  So for you snowbirds out there who fly south for the winter and leave us all to freeze, this serves you right (forgive my jealous outburst).  You may find yourself with less (or even no) coverage at your vacation home.  Although they will still cover you in emergencies, that doesn’t mean it won’t be an expensive hassle.

 

Inconsistency

Because Medicare Advantage Plans are funded by government subsidy, the cost and benefits can change drastically from year to year.  If the government decides to spend your tax dollars elsewhere, your plan may let prices creep (or even leap) up, while benefits wane.  This all depends on politics, which—as you already know—is rarely consistent.

 

Potentially High Out-of-Pocket Costs

Medicare Advantage Plans have more of a pay-as-you-go approach.  Although the premium is low, deductibles, coinsurance and copays are often much higher.  This is not a problem if you are healthy, but if you are struck with sudden illness, you might be stuck with astronomically high out-of-pockets: 3,500 to 6000 a year or more!  And if the diagnosis is bad enough, you may not qualify to switch to a Supplement plan.

 

Let’s take a real life example.

A client of ours came in with an Advantage Plan.  He was diagnosed with cancer in fall of 2012 and started chemotherapy immediately.  Since he was in charge of 20% of the costs due to his plan, he very speedily met his $7,500 annual out-of-pocket limit.  Then it was the New Year, and his out-of-pocket limit reset.  He continued chemo-treatments, which lead to another $7,500 expense.  That is $15,000 of spending in less than 6 months!

 

And since a cancer diagnosis prevented him from switching to a Supplement, he had to stay with his Advantage Plan.  He was stuck, and—needless to say—very unhappy about it.

 

So Here’s the Bottom Line…

Is there an advantage to a Medicare Advantage Plan?

If your doctors are in your plan’s network, you stay on top of changes, and—here’s a big one—you don’t get horribly ill (leading to high out-of-pocket costs), then yes!  The Medicare Advantage dark side has vanished.  The force is with you, and you’ve saved hundreds or even thousands in premium costs.

 

But you need to assess your situation.  You need to take the risk into consideration.  1 in 4 people might be on a Medicare Advantage Plan, but that doesn’t mean it is right for you!

 

Questions?

If you find yourself still searching for answers, one of our workshops might be for you!  Click here to sign up for one of our next workshops!

Looking to switch to or purchase a Medicare supplement, or Advantage plan? Call Seniormark at 937-492-8800 for a free consultation. We are here to help.

What Is the Fastest Way to Sign Up For Medicare?

Posted on April 3, 2017 by - Medicare, Medicare Advantage, Medicare Drug Plan, Medicare Supplement

What Is the Fastest Way to Sign Up For Medicare?

Once you’ve determined that it’s time to apply and have carefully considered all of your options, you are now ready to sign up for Medicare. You’ve got grandkids to get back to, family events to plan, and the world to explore, so you probably want to get this item off your to-do list as quickly as possible.

 

Fortunately, the federal government understands you in this respect. In response, they have designed a user-friendly website and an online enrollment process. It’s quick (taking only about 10 minutes). It’s easy (because you don’t have to leave the comfort of home). And the very fact that you are reading this blog proves you are tech-savvy enough to handle it.

 

To Apply Online, Just Follow These Few Simple Steps:

  1. Go to Social Security’s Website
  2. Click on the “Menu” Tab.
  3. In the “Benefits” section, choose “Medicare”.
  4. Scroll down and click the “Apply for Medicare Only” button.  (you will only be applying for medical coverage — not social security payments)
  5. In the “Apply and Complete” section, choose “Start a New Application”.
  6. The site will guide you from there.

 

Slow Down Partner!

But just wait! Before you start clicking away gung ho, I want you to consider how much thought you’ve put into your Medicare decisions. Not because I want to keep you from your grandkids, but because I know making mistakes in this process can result in unnecessary penalties and unexpected costs. If you haven’t sat down with a retirement expert in consultation, I strongly recommend doing so. It will take extra time, but—as the clichéd saying goes—sometimes slow and steady wins the race.

 

If you need someone to take this weight off your shoulders, give Seniormark a call at 937-492-8800. We make retirement decisions as quick and painless as possible!

 

Tax Penalty Alert: Mixing Medicare and HSAs

Posted on March 23, 2017 by - Employer, Medicare, Medicare Advantage, Medicare Supplement

Tax Penalty Alert: Mixing Medicare and HSAs

Medicare and Health Savings Accounts just don’t mix.

Like oil and water. Like toothpaste and orange juice. Like shopping with grandkids and fixed budgets.

 

This is very important to know. When you start Medicare, either Part A or Part B, you have to stop contributions to your HSA account. Otherwise, you could be on the hook for some tax penalties. According to IRS publication 969, the penalty is 6% of your contribution and its interest until you remove the funds from your HSA.

 

So if you want to continue contributing to your HSA (legally, at least), you will have to delay getting on Medicare. But here’s the catch: Very few people can delay Medicare without receiving—you guessed it—penalties (there seems to be a lot of these nowadays). In fact, the only people who can forgo Medicare benefits without consequences are those who have adequate coverage with their employer through active employment. I’m not talking retiree insurance. I am talking Monday through Friday, on-the-floor or in-the-office work. It’s the only way.

 

And if you started receiving Social Security early and were signed up for Medicare automatically, I’m sorry to say you are stuck. You cannot contribute to your HSA, and it will be very difficult to get around it. This is because you are not allowed to opt out of Part A. Although you can drop Part B, being enrolled in Medicare Part A will still prevent you from contributing to your HSA.

 

However, it is important to note that you can still use the money in your HSA. There is no penalty for that. As a matter of fact, I would strongly encourage you to use your money. You’ve spent a lot of time building up that robust HSA; you might as well take advantage of it! You can use the funds for

  • Your Part B Premium
  • Your Drug Plan Premium
  • Your Advantage Plan Premium
  • Doctor’s Appointments
  • Copays

And this is just the beginning. There are many other qualified medical expenses you can use it for.

 

So don’t get too upset. You’re Health Savings Account is not obsolete. It’s just not going to grow much anymore. But that is just the way it is with a lot of things in retirement. Think of your nest egg. Your 401k. IRAs. It is just that time in your life when you stop working to save and start putting those hard-earned savings to work for you! When you look at it that way, it doesn’t seem too bad.

 

Have more questions about Medicare and your employer insurance?  Click here to receive your free copy of our handout:  “The top 4 questions Medicare-aged employees ask about their employer health insurance.“

 

If you still have questions — give our office a call at 937-492-8800.

 

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Turning 65 and Work For a Small Employer? Sign Up For Medicare Part B!

Posted on March 8, 2017 by - Employer, Medicare, Medicare Advantage, Medicare Supplement, Retirement Planning

Turning 65 and Work For a Small Employer? Sign Up For Medicare Part B!

The general rule of thumb is if you have employer insurance through active employment, you can delay Part B of Medicare without penalty.

 

But that certainly doesn’t mean you should! There are cases, of course, when your employer plan is the better value, and it works out for you to opt out of part B. However, in other situations, it may be very costly.

 

For example, consider the woman who came into our office earlier this year with an $8000 bill for her outpatient surgery. She opted out of Part B, but she had insurance through active employment. Shouldn’t her employer plan cover it?

 

Well, not always. You see, her insurance was provided through a company that employed less than 20 people. This made Medicare the primary payer of her insurance. And when she didn’t have Medicare? Well…it wasn’t good.

 

The costly mistake had to do with how coordination of benefits works between employer insurance and Medicare. Let’s take an employer health insurance plan that covers 80/20 as an example (insurance pays 80%, you pay 20%)

 

When an employer plan covers 20 or more employees, the employer plan is the primary payer of your claims. Therefore, your employer insurance pays 80% of the bill and Medicare (if you have it) pays the remaining 20%. In this case, it is not necessary to have Part B; you can opt out. You’ll have to pay the remaining 20%, but it saves you the $134.00 a month Part B premium.

 

But if your employer plan covers less than 20 employees, Medicare pays first. The whole thing is flipped. So what if you get the previously mentioned expensive surgery and don’t have Medicare? It will not just carry over to your employer plan. They won’t pay the 80% that was supposed to be covered by Medicare. Instead, you will be lucky to get them to pay the 20%, leaving you on the hook…80% or more on the hook, which might just be $8000 in uncovered surgery procedures.

 

This is why it is so important to ensure that you are signing up for Medicare at the right time. Just because your neighbor can opt out of part B doesn’t mean you can. They might work for a Honda or a Copeland, a company with thousands of employees. You might work for a small business of 15 people.

 

So check with your boss or human resources department. Ask and make sure. It could save you from an unexpected, expensive, and potentially crippling bill.

 

Confused about Medicare and not sure what to do next? Download our free E-book here, and let us walk you through it!  Still have questions?  Call our office at 937-492-8800 to schedule a free, no obligation appointment!