A blog about Medicare. What you and your employees need to know
Luck – Emma’s Success Story
Author: Lora Drummond
Medicare Transition Specialist
#11- Solution – Luck -Emma’s Success Story
Emma was turning 65 in March and was going to continue to work.
She called us concerned about all the Medicare penalty discussions that she was warned about by her friends and co-workers. Even her HR team at her employer warned her that she had to sign up for Medicare or incur a penalty.
During our meeting, we laid to rest all the gossip about penalties she had heard. We provided facts about Medicare and confirmed some details about her employer. Her employer plan had more than 20 employees and the medical plan was deemed“creditable coverage” by their group insurance carrier, so Emma could continue to work, keep her health plan at work, and defer Medicare A and B. She was pleased to know she would not have to worry about any penalty when she finally separated from her employer’s health plan years later and would enroll in Medicare then.
Proof in the Math
Having resolved her enrollment concerns, I encouraged her to compare her current benefits to Medicare. “Why?” she asked. I explained that sometimes the comparison math identifies an opportunity to transition to Medicare while still working. Surprised Emma remarked, Really? You mean some people give up their employer plan for Medicare? Oh, but we have a great health plan at work and it only cost me $150 a month”, she replied confidently.” “ Well, we do a bit of comparison math, and If it math makes sense and the benefits Medicare provides meet their needs, people transition while working all the time!” I replied. “Now I am curious! What information do you need to compare plans? I brought my plan documents with me.” Emma asked eagerly.
We reviewed the group plan deductible, co-pays, and the out-of-pocket maximum. The plan she was enrolled in had a $2,000 a year deductible and a $6,500 out-of-pocket maximum. In addition, there was a $25 per doctor visit co-pay and a $75 per specialist doctor co-pay. There was also a 20% co-pay at the hospital until she reached the $6,500 out-of-pocket maximum. So, she had to pay the first $2,000 a year before her employer plan would pay for anything, in addition to the $150 a month premium. 12 x $150 premium = $1,800 + $2,000 deductible = $3,800.
On the Medicare side, if she registered for Medicare A and B and paid the Part B premium at $148.50 a month, she could choose a Medicare Advantage Plan that had a zero monthly premium and no deductible. The out-of-pocket maximum was also only $3,200 for the year, which was half of what her employer plan would cost in the event of a serious medical event or ‘worse case scenario’. Additionally, her doctor and neighborhood hospital were on several plans available to her. Also, there was no co-pay to see her primary doctor and only a $30 co-pay to see any specialist.
But there was still more!
The Medicare Advantage Plan she was considering had less expensive co-pays on her medications too. So the basic plan math= 12 x $135.50 part B premium= $1,626, $0 deductible so plan costs= $1,626.
Erma’s reaction to the results of the comparison was, “Why on earth would I keep my employer plan when this plan has less cost? Do you realize how much money I’m going to save? It’s over $2,000 a year!” Emma decided to let her employer plan go and sign up for Medicare when she turned 65. The comparison math worked for her particular situation.
It’s helpful to have experts to talk to before turning 65. Let our Certified Medicare Planners® give your employees confidence in their Medicare decisions like we did for Emma.
Medicare guidance for your employees in 2021.
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
Subscribe to Medicare@work
Other Posts from Medicare@work
What can folks do when they retire and are on Medicare, and then want to go back to work and enroll in their employer’s health benefits.
Choosing a plan based on a TV ad, a neighbor’s experience (good or bad), a postcard mailer, or a family member’s advice is not based on EXPERT advice. Unless, of course, your neighbor is a Certified Medicare Planner®!
When working past age 65 make sure your employer’s health plan is creditable before you defer your Medicare enrollment when first eligible.
COBRA after age 65 presents many unrealized risks when enrolling in Medicare later. Create a Medicare transition plan to avoid these risks.
Certified Medicare Planners® can be advocates for your employees when situations arise with Medicare and Insurance companies.
Medicare offers retirement benefit choices, and Certified Medicare Planners® provide Medicare transition with true fiduciary support.
Can you use drug manufacturer coupons and patient assistance programs when you are on Medicare to reduce your out-of-pocket expenses?
Medicare has many plan options so you are not stuck with the Medicare plan you chose! You should review your plan annually.
When transitioning to Medicare, employees will need a form called an Employment Verification Form from you to help them enroll under a special enrollment period and avoid penalties.
For retiring veterans, combining TRICARE for Life military benefits with Medicare is a coverage and cost win.