Question from Sarah: It seems like over the last few years, my husband’s insurance we get through his job has changed. I noticed we have much higher co-pays now. We’re both over 65. How do I know whether staying on the health insurance from my husband’s employer or going on Medicare is the better option? If it turns out Medicare is best, do we need to wait until the next Open Enrollment to make the transition? 

Answer: The simple answer is to allow myself or another of the experienced agents at The Health Insurance Store to analyze your husband’s plan at work and compare it to Medicare which we’ve done for thousands of people over the years. Most just assume that staying on employer coverage is the best option. Often, it’s not. 

You may be paying more and getting less

Due to rising costs for employer sponsored health insurance, the increases are often passed onto employees and spouses in the form of a combination of the following: more money being deducted from paychecks, higher co-pays or deductibles, the addition of coinsurance (percentage of the bill in addition to the deductible), and an increased annual Maximum Out of Pocket. It’s shocking how many people don’t know what they’re actually paying for their health insurance which is what we look at first compared to the expense for Original Medicare plus a Supplement or Advantage Plan. 

Out of pocket liability matters

The next item of importance when making this evaluation is the out-of-pocket costs on employer plans. Again, this is something many people pay no attention to but is extremely important. And increased co-pays should not be the biggest concern. I estimate the average deductible on an employer plan is now $2,000 and many have coinsurance that can add thousands more in bills over and above the deductible. You need to know how much money you would be responsible for if an outpatient surgery was needed, there was hospitalization, or another serious health event were to occur! It’s common for that to be as much as $4,000 to $7,000 or more per person!

HDQHPs are becoming common. How do they work? 

HDQHPs, which stands for High Deductible Qualified Health Plan, are also becoming common as a way for employers to keep their premiums down. With HDQHPs, all services except for those considered preventative, including doctor visits and prescriptions, are subject to a deductible which can be no less $1,700 per person, but usually more than that.   

Other considerations

When helping people evaluate employer coverage versus Medicare, other items need to be carefully considered such as medications being taken, ongoing health conditions, possible upcoming procedures or surgeries, family health history, and more. It’s all extremely nuanced and very difficult for the average person to understand and evaluate.

Lastly, there’s a newer phenomenon taking place where some employers are actually paying their employees a stipend, often a few thousand dollars a year, to opt out of the work plan! When this option exists, going on Medicare is almost always the easy choice. Ask your employer if they offer this incentive!

When can I move to Medicare and how do I do it? 

As far as timing to disenroll from employer coverage and going on Medicare and a Supplement or Advantage Plan, that can be done anytime. There are no time frame restrictions. However, it’s a process that can take a few days to a few weeks, depending on if you already have Medicare Parts A and B or neither. There’s also a form that your employer needs to fill out that must be and submitted to Social Security with the application to enroll in Medicare.

If it does turn out Medicare is a better option, we can provide the form and walk you through the process of applying, compare Medicare Supplements and Advantage Plans, analyze the pros, cons, risks, and rewards of both, narrow down the choices of what company and plans meet your personal health care needs and budget, and finally apply for the policy or policies that is/are the best fit. 

If you have any questions or would like to make an appointment for a no cost consultation, give the office a call, 724-603-3403 or email me personally, Aaron@GetYourBestPlan.com.