It’s more common today than ever before for Americans to continue working past age 65. How do you know if you should keep your health insurance through your employer or make the switch to Medicare?
For free assistance, give us a call at 217-423-8000.
Look At Your Current Employer Health Coverage
When deciding if you should stay on your group plan or switch to Medicare, the best place to start is to lay out your current coverage.
For starters, do you pay a premium or does your employer cover it?
Secondly, what is your plan deductible? Finally, what are your copays and coinsurance? How much did you pay out of pocket for medical expenses last year?
Once you have those numbers figured, compare them to what the costs of Medicare would be.
If you’re paying for some or all of your premium, Medicare will likely save you a lot of money. Additionally, if you use a good portion of your deductible or come close to reaching your out-of-pocket maximum each year, Medicare will likely save you a lot of money.
For individuals who choose Medicare with a Medicare Supplement, their only out-of-pocket costs are going to be the Medicare Part B premium, the Medicare Supplement premium, and potentially some other minor costs depending on which Medigap plan is chosen.
In order to compare the options fairly, we encourage you to call our office and schedule an appointment at 217-423-8000. We can provide you with concrete numbers so that we can truly see the difference between your group costs and the costs of Medicare.
Consider Your Group’s Network
Most employer group health insurance plans have networks. There are going to be doctors, hospitals, and pharmacies in your neck of the woods that aren’t in-network for you.
If this hasn’t been an issue, then you can skip this. However, if you’ve had to choose a doctor you don’t love because that’s what was in your network, you might consider switching to Medicare.
With Medicare, there is no network. Medicare is accepted everywhere as long as the doctor, hospital, or pharmacy accepts Medicare assignment. And that’s 97% of all doctors, by the way.
Consider Your Deductible
The average deductible for a group plan in Illinois is about $1,500. However, some plans blow that out of the water with up to $5,000+ deductibles.
If you were to switch to Medicare, your deductible would only be $183 under Part B. And if you got a Medigap Plan F, that deductible would be covered.
If your deductible has been an issue for you, it’s worthwhile to consider switching to Medicare.
When to Make the Switch
There are a lot of moving parts when it comes to Medicare enrollment rules. Even the gurus here at the office have to double check things sometimes!
That said, there are a few scenarios that are pretty common, so we’ll outline those here. You can also read more about Medicare Enrollment here.
So, when can you make the switch to Medicare from your employer’s group plan?
- Enroll in Medicare Part B when you lose your group plan or when you know that your group coverage is going away. You can do this up to 3 months before you lose your coverage.
- If your group plan has credible drug coverage, you should sign up for Part D the month before you’ll need to replace it. This is called a Special Enrollment Period (SEP) for those of us who are moving from a group plan to Original Medicare.
- Choosing a Medicare Supplement needs to happen 6 months after you enroll in Medicare Part B. During this time, you can select any supplemental plan with no health questions.
- If you already signed up for Part B (over 6 months ago), you have 60 days after you lose your group coverage to sign up for a supplement. This is a Guaranteed Issue (GI) situation, which means there are no health questions. The downside? You’re limited to Plans A, B, C, F, K, and L. If you can pass health questions, you can go through underwriting and choose any plan you like.
We Can Help
This is a big decision to make – we want to help you make the right one.
Call us at 217-423-8000 for expert guidance. We’d love to have you at our office, or we can come to your home if that’s more convenient for you.
Insurance and Medicare can be confusing, but with a Sams/Hockaday expert on your side, it doesn’t have to be.
Get Your Medicare Planner
Using our planner takes the headache out of Medicare… because it’s personalized just for you, showing you what areas you need to focus on right away, or in upcoming years, and what you can ignore.