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

Medicare @ Work- A True Story

(with a happy ending!)

Author: Lora Drummond

Medicare Transition Specialist

Posted: 03/16/2020

A virtual meeting… a pleasant surprise with a trusted HR Manager


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

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. She learned about how they are a resource for Medicare inquiries that come from her employees, run educational workshops, and provide group plan and Medicare plan comparisons. Her employees have established a long relationship with her and they trust her for guidance regarding their benefit questions, even with Medicare. So she 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™ (CMP™) 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.

Mark sits down and says, “ Hi Sally, thanks for meeting with me today. This looks very high-tech. What is all of this?” 

Sally replies, “With your permission, I am going to try something I learned about recently to help you make the choice to stay on our employee plan, or whether it is more beneficial for you to transition over to Medicare. If we are both lucky, we will even find where you should go to get the coverage you need. What do you say? Want to give this a go?” 

Mark replies with some hesitation, “Sure, why not?” 

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?” 

Satisfied with Mark’s replies, Dennis continues: “Alright. I am going to input three pieces of information into this online tool to create a comparison that will help you with your decision process. These are important characteristics of your employer plan that we will use to compare to your Medicare options. First things first. Sally has told me the maximum out-of-pocket (MOOP) and the deductible under the group plan. Second, do you know about how much you are paying in prescription drug copays annually?” 

Mark replies “About $200.” 

Dennis continues, “Knowing that your prescription drug copays on the employer group plan are $200 a year, we will keep that figure in mind. The last item we will add is the monthly premium you pay out of your paycheck for the employer group plan. When we take those figures into account we can calculate annual medical expenses.” Dennis shows Mark and Sally the total in the online tool called the Stay or Go Analysis™ that he is using for their call and continues to explain the process.

“So, the employer plan costs you a total of $8,800/year on the high side if you have a bad health year by 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 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. 

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?”

As Dennis nods and says, “Yes…,” Mark jumps back in sounding a bit panicked and says, “That would be great … But, I don’t want to start my Social Security until I am 70!” Dennis pauses for a moment, then responds, “That’s not a problem at all and a common misconception. Even though you can go to the Social Security office to apply for your Medicare benefits at age 65, you do not need to turn on your Social Security also. They are separate events.”

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 replies, “This is where it gets a little complicated but let me help simplify Medicare for you first so we are on the same page for understanding. You really have two main Medicare options. Option one is Original Medicare (hospital and doctor visits coverage) which you supplement with a Medigap Plan and a Part D Prescription Drug Plan to complete coverage allowing you to utilize most doctors and hospitals in the United States. Under option two, you can transfer your Medicare benefits to a Medicare Advantage Plan, which runs much like the employer group plan you have now, where you will have a network of providers, and hospitals available to you.” 

Dennis has moved to another online 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. 


Dennis refers back to the tool and types in Mark’s zip code and rolls through the prompts adding any medications Mark would like to add to the research, adds Mark’s preferred pharmacy, and lastly, they search for Mark’s preferred doctors. We are looking to make Mark’s transition to Medicare as seamless as possible matching his needs to the plans available.

Dennis finally arrives in a position to look at all the Medicare Supplements and Medicare Advantage plans in the area. The tool has eliminated the need to go to the website and eliminated Dennis having to search every doctor list on every insurance carrier in his area. The tool has also eliminated Mark having to go to every insurance company’s list of medications to make sure his meds are covered at a cost similar to what he paid on his group plan. Sally turns to Mark and says, “That was amazing; that tool did all the work of shopping for us so easily and quickly! I see this one has your doctors, Mark, and your drug costs are about the same as they are with our group plan, but the premium is quite a bit lower.”  

By using The Medicare Architects’ online tool, Mark can 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 beside herself. 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 are.



 Having a Medicare transition team creates confidence in your ability to compliantly educate and transition eligible employees to Medicare while reducing costs for your employees and boosting your bottom line.

Ready to get started? Check out our blog weekly for new resources, and helpful tips and tricks to build your Medicare transition strategy. Your Medicare Transition Partner – Lora

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