A blog about Medicare. What you and your employees need to know

Analyze – To Stay or Go?

Author: Lora Drummond

Medicare Transition Specialist

Posted: 08/16/2021

[33-52 Solution Series] -Analyze – To Stay or Go?

A pleasant surprise with a trusted HR Manager

Below is a summary of a success story between Sally, an HR Manager, and Mark, a loyal employee.

Meet Sally, Mark, and Dennis

Mark is an employee that has been with his company for over 25 years and will be turning 65:

  “I don’t want to retire yet, but I think I want my Medicare.”  

Sally is an HR Manager at a local firm. She has seen Mark through several health insurance changes, benefit re-organizations, and even a couple of promotions. Mark comes into her office because his 65th birthday is coming up, and thinks that he has no choice but to give up his employer group health insurance and get Medicare. He informs her though, that he is not ready to retire, does not particularly like change, and would much prefer to stay on the employee group plan until he does decide to stop working.

Sally recently met with The Medicare Architects who explained how they work with companies to consult on Medicare. Her employees have established a long relationship with her and they trust her for guidance regarding their benefit questions, even with Medicare. Sally, wants to continue to help by providing the level of support her employees have come to feel comfortable with.

Sally knows that Mark has options, and has a big choice ahead of him, but she also now knows how to help! Their scheduled appointment day arrives, and Mark walks into Sally’s office. She is ready! Sally has procured the assistance of a Certified Medicare Planner® to virtually assist her with Mark’s Medicare questions and transition process. With Mark’s permission, the CMP™ walks them both through the process. 

Dennis is a Certified Medicare Planner®, and he has linked into a virtual meeting with Mary, ready to help.

A Virtual Meeting 

Dennis introduces himself to Sally and Mark and gets started. “Before we get going, I need to clarify a couple of items that will impact your Medicare options and prices associated with them.”

1) He qualifies with questions related to Mark’s modified adjusted gross income. 

2) He also confirms Mark’s marital status and whether a spouse or dependents would be affected by a decision to transition to Medicare?” 

3)  He obtains 3 important costs related to Mark’s current group plan.

Satisfied with Mark’s replies, Dennis continues and shows Mark and Sally the online tool called the Stay or Go Analysis™ that he is using for their call and continues to explain the process.

“If you have a bad health year, your employer plan costs you a total of $8,800/year maxing out your co-pays and MOOP. If you have a healthy year and just pay your monthly premium and copays for your prescription drugs, you would pay $3,800 for the year. So based on your group plan, here are your worst-case (high $8,800), and best-case (low $3,800) scenarios for the costs on your employer plan.”

“Following so far?” Asks Dennis.

The Analysis

Mark pauses, and replies, “So what you are going to show, is that if we can find a Medicare plan, that allows me to see my current doctor, and keeps my drug costs about the same, but comes with a reduced premium than what I am currently paying, it may be more beneficial to leave our group health plan?”

Dennis replies, “Correct!”, and continues with the analysis showing Mark a new group of figures which represent the average costs for Medicare. After inputting all the data, the tool Dennis is using for the call indicates that it would be advantageous for Mark to “go” to Medicare.

There are some potentially significant savings to which Mark remarks, “Hey! There are plans out there under Medicare where I could actually pay only $300 in premiums?”

Mark seems relieved and is now ready to move forward. “ Whew, that’s great because I want to keep working, so what are my options?”

Dennis has moved to another tool called The Medicare Blueprint Builder ™. This is the tool that will take Mark’s specific interests and compare them to all the Medicare plans in his area. At this point, Dennis researches all available Medigap plans and their respective costs using a carrier-agnostic search tool based on Mark’s age, gender, if he smokes or not, and his current zip code. During this meeting, Dennis is considerate to educate Mark on the various Medicare options and terms. By creating this educational opportunity, Mark and Sally can feel more confident with the final decision to stay on a group plan or go to a Medicare plan.

Fiduciary Support

The Medicare Architects’ compairision tools help Mark see the numbers himself and can compare his actual costs. He decides that a Medicare Advantage Plan will be the most appropriate plan for him. He found his primary care doctor on the network and the local hospital that’s only a few minutes away from his home is also on the network. The plan also has a zero-monthly premium over and above the Medicare Part B Premium and no medical deductible. An appointment with his PCP also has no co-pay and generic prescription drugs are at no cost on his plan. Mark made a great choice but, only after doing his research and feeling confident, he understood his choices!

Also, neither Dennis nor Sally picked a plan for Mark – the most appropriate plan picked Mark.

Sally says to Mark, “If you want to proceed, I can’t enroll you in a Medicare plan, but Dennis, our Certified Medicare Planner® can.”  Dennis chimes in, “Indeed! Now that we have a selection, I would be happy to walk you through the steps allowing you to have a super smooth transition to Medicare. And with the aid of our Medicare Blueprint Builder™, I will be able to provide a timeline for what you need to do to enroll in Medicare, when to enroll to avoid any penalties, and how to enroll in the Medicare Advantage Plan you’ve selected. All without leaving  Sally’s office. It’s my pleasure to help.” 

Mark had no idea that this meeting would turn out to be so educational and productive. 

Sally was delighted. By allowing a Certified Medicare Planner® to assist, she was able to provide Mark with the information necessary to decide for himself whether to stay on the employer group plan or to transition to Medicare. 

Now instead of dreading having to answer employee’s Medicare questions, thanks to confident access to a Certified Medicare Planner®, she can’t wait for the next inquiry to arise to enlist one of the company’s CMPs™.

Education workshops, tools, and advisory services available virtually provide Medicare transition support wherever you or your employees are. 

Create a compliant Medicare benefit support plan. Give your employees personal guidance from a team of experts that will follow them after they retire.

You can receive helpful Medicare resources, and tips and tricks to build your Medicare transition strategy just by signing up to receive a blog article a week delivered to your email. ( We promise only one per week and you can opt-out at any time)

Plus get early notifications of any NEW helpful resources and Medicare news!  SIGN UP BELOW!

Your Medicare Transition Partner
– Lora

Helpful Links

Get the latest reason you need a Medicare transition team right in your inbox!

2021 TMA Medicare Guide image

Subscribe to Medicare@work

Get the latest reason you need a Medicare transition team right in your inbox!

Other Posts from Medicare@work

Stay Tuned! Medicare Help for Business is Here

Stay Tuned! Medicare Help for Business is Here

Don’t adjust your dial! Our Medicare help for businesses is now more accessible than ever. Stay tuned to your favorite social media sites for links to enjoy helpful topics for guiding employees with their options regarding Medicare. When folks turn 65, they have more healthcare choices. We are here to help!

Contact Us

(800) 568-1095

Brought to you from Scottsdale, AZ

Monday-Friday: 9am – 5pm

Get Started

Meet your dedicated Medicare Transition team today!
Share This