Medicare Guidelines For Employees At 65
What to do when your employer drops your Medicare coverage
If you’re 65, retired or retiring and you have employer coverage, your employer pays a portion of your healthcare costs for medical expenses, prescription drugs and other items. You may pay a monthly premium for this coverage. You may also pay a deductible and/or copayment in addition to that premium. Your employer pays the balance of the cost for those services. Your employer also determines the types of plans they make available to you (such as a PPO, HMO, high-deductible HRA, prescription, dental), and they choose the insurers and benefit companies who manage those programs.
However, if your employer is no longer providing retiree health or prescription drug benefits because you’re now Medicare-eligible, consider the many options Medicare offers to help you stay healthy without draining your retirement fund.
Your Medicare Options?
|Medicare Plan||Who Offers It||What’s Covered|
|Part A||Part A is “Original Medicare” and is operated by the government||Hospital care, nursing facilities, nursing home care (not custodial or long-term care), hospice and home health services and inpatient care in a religious nonmedical healthcare institution|
|Part B||Part B is “Original Medicare” and is operated by the government||Medically necessary doctor visits, services and supplies to diagnose and treat a medical or mental health condition, preventative services, ambulance services, and medical equipment (such as canes and blood sugar test strips)|
|Part C||Also known as Medicare Advantage, Part C includes plans offered by private companies that combine Medicare Parts A and B into one plan for greater convenience||Many of these plans also provide prescription drug coverage, and some may also provide coverage for additional services, like hearing, dental and vision|
|Part D Prescription Drug Plan||Offered by insurance companies and private companies approved by Medicare||Prescription medications for beneficiaries eligible for Part A and/or enrolled in Part B|
|Medigap (Medicare Supplement Insurance)||Offered by private companies that help cover some costs not paid by Original Medicare (such as deductibles, coinsurance and copayments)||There are 10 supplemental plans that offer a variety of supplemental options and are labeled A, B, C, D, F, G, K, L, M, and N|
As a Medicare beneficiary, a portion of the cost of your healthcare is paid by Medicare. You will pay monthly premiums, deductibles or copayments/coinsurance, but the amount you pay, and when you pay it, depends on which Medicare plan YOU choose.
Tips for Choosing the Right Route
- Read up on plans: Familiarize yourself with the various parts of Medicare and the options available under them. Your employer or insurance agent/broker may provide an educational kit or refer you to a website that offers videos and other information to help you understand your options. www.medicare.gov is another good resource.
- Make a list: Write down all of the health expenses you’ve had in the past 2 years. This can help determine how much coverage you’ll need next year:
- Prescription medications
- Number of doctor visits (primary care and specialist)
- Number of hospital and emergency room visits
- Lab work
- Medical supplies
- Talk with an agent or broker: Many employers will work with an organization that provides brokers and counselors that help you select the coverage that suits your needs. Talking with a broker will not cost you anything, and it can help you make a decision about which coverage options are best for you. Before you meet with an agent or broker, be sure to read these tips to make the conversation more productive.
- Know your dates: For most people, Medicare Part D (Part D) enrollment takes place during Annual Open Enrollment from October 15 through December 7. You must enroll during this time to have coverage for the following year, and there is no grace period. Mark these dates on your calendar and be sure to start your research early to avoid over-paying or being under-covered. There is a Special Enrollment Period for Medicare members with special circumstances, such as those who move to a different state or lose employer coverage.
You may find that enrolling in Original Medicare combined with a Medicare supplement plan and/or a stand-alone Part D prescription drug plan might be best for you. Enrolling separately allows you to choose a Part D plan with a broader formulary (list of covered medications), a cost-saving pharmacy network with preferred pricing, and/or convenient home delivery.
Or, if you want the convenience of having all your health and possibly your prescription coverage (Medicare Parts A, B and D) bundled into one plan, you can enroll in a Medicare Advantage Plan (Medicare C).