Medicare: You Have Questions, Wheelers Has Answers.

Question: “I’m turning 65 but I am still working. Should I keep the insurance my employer offers or switch to Medicare?”

Question: “My spouse is turning 65 and she is enrolled in my health plan through work. Should she enroll in Medicare or stay on my plan?”

You’ve got choices. To choose between the employer plan and Medicare means comparing the relative costs and benefits of your different options.

Let’s review the basics:

  • Medicare Part A helps pay for hospital costs and Medicare Part B helps pay for physician, diagnostic and other medical costs. Medicare Part D helps pay for prescription drugs.
  • Part A is generally available at no cost, but the monthly premium for Part B is $148 or more and D is $10 or more.
  • Part C Medicare Advantage plan combine A, B & D and many of them have no additional cost (beyond the cost of Part B).
  • Medicare Supplements are paired with Original Medicare and a stand alone Part D plan with a total additional cost of $225 or more. 

The total monthly premium for your Medicare Solution could vary from $148 a month to around $400. On the low cost side, you get a plan in which you pay no more than 20% for claims in network and with an out of pocket maximum of $6000 or $7000. So that’s pretty good coverage for the money. On the high end of the cost scale, you get a plan that nearly eliminates your out of pocket medical costs (but not your pharmacy costs). 

So if you are paying $100 a week or more to have you or your spouse on your plan, switch to Medicare, since with even the most expensive option, you are sure to save premium and have excellent coverage. But if you only pay $40 a week for your coverage or your spouse’s coverage, you might have to dig deeper to see how much coverage that $40 gets you. Maybe it makes sense to switch, maybe not. If you bring the existing plan to us, we can take a look at it to help you make the best choice for you. 

If you do decide to switch, make sure you let the Social Security administration know a couple of months before you want Medicare to start, to give you plenty of time to wait for your Medicare card to arrive and enroll in a Supplement & Part D plan or a Medicare Advantage plan.