My neighbor Sharon is celebrating a milestone in June. She is turning 65 but has no plans of retiring any time soon. She loves her job! She is a longtime caregiver to a senior who is wheelchair-bound and they have become like family. She is fortunate to work for an employer who is offering benefits to employees who want to continue to work past 65 so her milestone won’t involve many changes for her. Just a bigger cake for all those candles this year. 

Sharon mentioned that her senior client HelenAnn remarked on how wonderful it was that Sharon could now enroll in Medicare because it pays for almost ‘everything’. Knowing I work for a company that specializes in Medicare, Sharon asked if she was required to enroll in Medicare as soon as she was eligible since it seemed like a confusing change to navigate, and it was easier to just stay on her employer’s plan.

Medicare or Group Plan?

I was glad she asked because having her group plan is a wonderful option but is it the most appropriate choice for her? Group plans are created for, well…. groups of employees. People can enroll in Medicare based on more options as individuals. Sometimes Medicare can make a better sense with costs too. The best thing to do is to compare what her benefits look like with her employer’s plan versus what Medicare options exist.

I asked her if she consulted with her employer’s benefits team. She said they have a human resources department and a third-party administrator. Both offered to talk to her, but neither had a simple resource to guide her on comparing costs. Both contacts seemed hesitant to offer advice and she was worried about making a change and incurring penalties so staying on the employer plan was just easier.

Common Questions 

I am glad our meeting that day about her birthday created a comfortable opportunity to talk about Medicare. Here are some of her questions and ironically these are some common questions that come up with the employers we work with:

1. Is there a penalty if I stay on my employer’s plan and leave for Medicare later?
2. Can I keep contributing to my HSA if I leave my group and go to Medicare?
3. Should I keep my group plan and add Medicare?
4. How much would Medicare cover and cost compared to my current group plan?
5. Which parts of Medicare will replace my current group plan?

Securing a Medicare Transition Team

Having a transition team creates a confident environment for having Medicare conversations with employees who seek your guidance on whether or not to transition to Medicare.  When questions come up, what you cannot answer can be immediately responded to by a dedicated Medicare expert. 

More details might be necessary to provide answers to questions that come up, but here some general responses to those questions Sharon asked:

1. As long as Sharon’s company employs more than 20 employees and her medical coverage is credible, she is not required to enroll in Medicare when she turns 65. There is no penalty to enroll when she leaves her employer and enrolls later.
2. If Sharon moves to any part of Medicare, she can no longer contribute to an HSA plan.
3. Generally, the Medicare plan can replace a group plan at a lower cost so also keeping the group plan is not necessary.
4. Our Stay or Go Analysis™ takes 3 simple questions and 3 minutes of time to compare group and Medicare plans to tell you mathematically whether to stay on your group plan or go to Medicare.
5. There are many options to consider for coverage under Medicare. Medicare Advantage plans are sometimes called all-in-one plans and can include medical, dental, vision, and some are adding transportation coverage to get you to your medical appointments. The choice depends on the carrier, cost,  your individual lifestyle, health needs, and the options you choose for coverage.

Tools and Education

First, I recommended Sharon attend a Medicare educational workshop. Having more education on what Medicare is and her choices, she could make a more confident decision. I sent her the link for 123Easy Medicare to select a free workshop designed only to teach about Medicare without any sales pitches for any products. 

Sharon and I visited clickTMA.com to use the Stay or Go Analysis™ and she was able to answer 3 questions about her current group plan and saw she could save money by moving to a Medicare plan when turning 65. Her response was, “I can’t believe we got all of this information in just a few minutes. Why does Medicare look so confusing on other sites? This was so easy!”

 A Medicare transition team can provide expert advice and ask appropriate questions to help people with Medicare decisions. What is right for one person is not always right for someone else. Certified Medicare Planners® will have tools and technology to guide people without insurance carrier bias and only if moving to Medicare makes sense. 

Now Sharon knows her options and can make an educated and confident decision when she is ready. For now, she is looking forward to celebrating her birthday milestone!

It’s good to establish a relationship with a Certified Medicare Planner® before you are ready for Medicare so you have the information you need before you need to choose.  

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Your Medicare Transition Partner
– Lora